Jingyi Yang; Xiaoqin Zhang; Bangyu Luo; Hongjun Liu; Zhou Xu; Hongkai Wang; Xin Hu; Jianguo Sun; Liang Qiao; Shaoxiang Zhang; Yi Wu
Volume 24, Issue 10 , 2022
Abstract
Background: With leading morbidity among malignant tumors in otorhinolaryngology, Nasopharyngeal carcinoma (NPC) is one of the most frequent malignant tumors in China.
Objectives: This study aimed to help radiotherapy doctors recognize and segment nasopharyngeal organs at risk of NPC and make a radiotherapy ...
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Background: With leading morbidity among malignant tumors in otorhinolaryngology, Nasopharyngeal carcinoma (NPC) is one of the most frequent malignant tumors in China.
Objectives: This study aimed to help radiotherapy doctors recognize and segment nasopharyngeal organs at risk of NPC and make a radiotherapy plan.
Methods: The authors used B-spline and mutual information to transform, register, and fuse Chinese Visible Human images with the volunteers personalized computed tomography (CT) images, and integrated them into the Treatment Planning System (TPS). Consequently, Three-Dimensional Visualization Treatment Planning System (3DV+TPS) was created. To verify it, 3DV+TPS was deployed to identify and segment the nasopharyngeal organs at risk of NPC, and a questionnaire was filled out by radiotherapy doctors.
Results: Results showed that 3DV+TPS can finish the registration and fusion of four sets of sectional anatomical images and individual CT images of volunteers in approximately 3 min and 50 sec.
Conclusion: The registered and fused images can accurately reflect the position, outline, and adjacent space of the nasopharyngeal structure which is not clear in CT images. Therefore, it is helpful for recognizing and segmenting neural, muscular, and glandular structures. Through automatically registering and fusing color and CT gray images, 3DV+TPS improves the accuracy and efficiency of recognizing nasopharyngeal structures in making radiotherapy plans. It is also useful to improve the teaching quality of tumor radiotherapy for medical students and interns as well.
saba alidadi; mahshid mohammadian; reza zohdiaghdam; kosar esgandari; zhaleh behrouzkia
Volume 24, Issue 2 , 2022
Abstract
Background: Colorectal cancer (CRC) is one of the major leading causes of cancer related death throughout the world. Among various therapeutic strategies for CRC, neoadjuvant radiotherapy, targeted therapy, and chemotherapy are the main techniques to destroy cancerous cells.
Objectives: The main purpose ...
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Background: Colorectal cancer (CRC) is one of the major leading causes of cancer related death throughout the world. Among various therapeutic strategies for CRC, neoadjuvant radiotherapy, targeted therapy, and chemotherapy are the main techniques to destroy cancerous cells.
Objectives: The main purpose of this study was to evaluate the efficacy of radiotherapy in combination with silver graphene quantum dot (SQD) and Resveratrol (Res) on the HCT-116 colorectal cancer (CRC) cells.
Methods: Minimally cytotoxic concentrations of SQD (50µm) with Res (0.5xIC50 and 0.25xIC50) and radiation (2Gy of x-ray radiation) were selected for double and triple treatments. The Acridine Orange/Ethidium Bromide staining was used to detect apoptosis. The Caspase-3 mRNA expression level was measured by the real-time PCR method. In addition, cyclooxygenase 2 (COX-2) protein expression was studied by the western blot technique. Similarly, the superoxide dismutase (SOD), glutathione peroxidase (GPX) enzyme activities, and malondialdehyde (MDA) levels were determined in this study.
Results: In this study, after 24 h, triple combined cases showed decreased cell viability versus double and single treatments (P<0.05). Moreover, cellular viability was decreased in the SQD-radiation and SQD-Res treated cells, compared to the related single treatments (P<0.05). The increased apoptotic cells were observed in the triple combination group, compared to the double and single treated cases. Triple combination treatment exhibited decreased GPX activity versus single treatments (P<0.05). The triple combined case showed reduced SOD activity than the radiation and SQD single treatments. A remarkable increase in the MDA concentration was observed in the triple combination versus single treatments. According to the results, in double and triple treatments, upregulation of Caspase-3 mRNA was presented versus double and single treatments. There was a decreased COX-2 protein expression level in triple combinatorial cases versus double and single treated cells.
Conclusion: These findings proposed that SQD in combination with Res and radiation showed significant anti-cancer effects on CRC in vitro.
Zhiqiang Long; Qinghao Liu; Jian Li
Volume 24, Issue 9 , 2022
Abstract
Background: Esophageal cancer is one of the most prevalent types of cancer and causes of death worldwide. As the mainstream treatment, surgical resection is technically demanding and time-consuming. Therefore, the scope of its application is limited in the clinical setting. A new surgical approach is ...
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Background: Esophageal cancer is one of the most prevalent types of cancer and causes of death worldwide. As the mainstream treatment, surgical resection is technically demanding and time-consuming. Therefore, the scope of its application is limited in the clinical setting. A new surgical approach is thus needed for an improved surgical effect and the prognosis of esophageal cancer.
Objectives: This study aimed to investigate the effect of a modified thoracoscopic en-bloc esophagectomy on the removal of patients esophageal cancers and its outcomes.
Methods: In this study, a modified en-bloc esophagectomy was developed to remove esophageal cancer. Patients who underwent the modified en-bloc esophagectomy by right thoracoscopic approach or thoracoscope-assisted small incisional approach to have their esophageal cancers removed in Peking University First Hospital (Beijing, China) between January 2014 and January 2017, were screened and retrospectively studied. Cancer recurrence, overall survival, mortality, as well as intraoperative and postoperative outcomes, were reported.
Results: A total of 31 patients (22 male and 9 female, mean age: 62.9 years) were included in the study. Out of 30 patients with R0 resection, eight patients had cancer recurrences in the neck, lung, liver, and bone; however, none of the recurrences was identified in the mediastinum. Six patients died during the follow-up period. By the end of December 2020, the five-year survival rate of all patients was 58.3%. The median survival time of N0 patients was 52 months, which was significantly longer than that in N1+2 patients (23 months). Additionally, there was no statistically significant difference between the median survival time of N1 and N2 patients. Moreover, perioperative complications included pneumonia, arrhythmia, hoarseness, and chylous ascites, which were consistent with those reported previously.
Conclusion: The modified en-bloc esophagectomy to remove esophageal cancer by right thoracoscopic approach or thoracoscope-assisted small incisional approach was found safe and reliable due to decreased cancer recurrence, increased overall survival rate, and prolonged survival time.
Abbas Abdollahi; Armin Saeedi; Yeganeh Azadmanesh; Mohammad Etezadpour; Tooraj Zandbaf
Volume 24, Issue 5 , 2022
Abstract
Background: The most common manifestations of metastatic colorectal cancer are found in the liver, lung, bone, and brain. Cutaneous metastasis is rare in rectal cancer, and it indicates a widespread disease and a poor prognosis.
Case presentation: In this report and review we present a 58-year-old man ...
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Background: The most common manifestations of metastatic colorectal cancer are found in the liver, lung, bone, and brain. Cutaneous metastasis is rare in rectal cancer, and it indicates a widespread disease and a poor prognosis.
Case presentation: In this report and review we present a 58-year-old man who diagnosed with rectal cancer (RC) and underwent abdominoperineal resection. The patient developed a skin lesion (indurated erythema) on his scrotum four months later. Histopathological examination revealed adenocarcinoma with lymphovascular invasion.
Discussion: The primary causes of mortality in people with RC have been reported to be disease dissemination and recurrence. Cutaneous metastasis to the scrotum happens seldom, accounting for less than one percent of the total surface area of the body.
Conclusions: Even if an RC patient has been asymptomatic for a long time, skin involvements must be considered by clinicians. So, giving specific attention to all skin nodules, non-healing ulcers, and chronic indurated erythema is essential. Early detection relies heavily on patient engagement.
Emine Fusun Akyuz Cim; Esra Torlak; Gizem Unveren; Gursel Remzi Soybir; Vahit Ozmen; Zeynep ErdoGan Iyigun; Tuba Kayan Tapan; Abdullah Yesilova; Gul Alco; Ebru Yilmaz; Asli Eyrenci; Filiz Elbuken; Ahmet Serkan Ilgun; Tomris Duymaz; Cetin Ordu
Volume 24, Issue 2 , 2022
Abstract
Background: Coronavirus disease 2019 (COVID-19) has spread rapidly across the globe through coughing, sneezing, droplet inhalation, and contact.
Objectives: The current study aimed to assess the impact of the fear of COVID-19 infection on functionality in women with breast cancer.
Methods: The present ...
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Background: Coronavirus disease 2019 (COVID-19) has spread rapidly across the globe through coughing, sneezing, droplet inhalation, and contact.
Objectives: The current study aimed to assess the impact of the fear of COVID-19 infection on functionality in women with breast cancer.
Methods: The present study included women with diagnosed breast cancer (n=75) under treatment in Istanbul Florence Nightingale Hospital and healthy (n=69) women( a total of 144 volunteers). The participants were asked to fill out the Sociodemographic Data Form, Anxiety Sensitivity Index-3 (ASI-3), and Fear of COVID-19 Scale to evaluate the impact of fear of infection and cleaning behavior due to COVID-19 on functionality.
Results: No statistically significant difference was found between the women with and without diagnosed breast cancer regarding the impact of fear of COVID-19 infection on all functionality parameters (all parameters: P>0.05). In the breast cancer group, the effect of Covid-15 anxiety and cleaning behavior on functionality performance was significantly higher in participants with underlying disease (P=0.044, P=0.013) and smoking (P=0.0234, P=0.0147).
Conclusion: As evidenced by the results of this study, smoking and the presence of comorbidity in breast cancer patients may have a negative effect on the functionality effect of fear of Covid-19 infection. In terms of psychiatric intervention, the parameters affected by functionality should be considered.
Payam Khazaeli; Abbas Pardakhty; Amin Mehrabian; Marziyeh Sajadi Bami; Moslem Lari Najafi
Volume 24, Issue 4 , 2022
Abstract
Introduction: Propranolol is a non-specific beta-blocker that is used to treat hypertension, angina, arrhythmia, tremor, and manage thyrotoxicosis. Based on the results of various studies, propranolol can control infantile hemangioma by vasoconstriction, apoptosis induction, and inhibition of cell proliferation ...
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Introduction: Propranolol is a non-specific beta-blocker that is used to treat hypertension, angina, arrhythmia, tremor, and manage thyrotoxicosis. Based on the results of various studies, propranolol can control infantile hemangioma by vasoconstriction, apoptosis induction, and inhibition of cell proliferation signals.
Methods: The conventional film hydration method was used to prepare medium size (2-6 m) multilamellar vesicles (MLVs) containing propranolol. At the lipid phase, sorbitan esters (Spans) and their polyethoxylated derivatives (Tweens) were combined with cholesterol, and deionized water was utilized as a hydration medium. Laser light scattering was used to perform the size analysis, and the Franz diffusion cells were utilized to investigate the release of propranolol from niosomal suspensions and carbomer-based niosomal gels. The vesicles were assessed for their stability within six-month storage at 4°C, and ultraviolet spectrophotometer and centrifuge technique were employed to measure the efficiencies of encapsulation.
Results: Based on the findings, the best niosomes were obtained at 40 and 60 spans in the presence of Tween 40 and 60; however, Span/Tween 20 and 80 were not able to form propranolol niosomes. The selected formulations had an MLV appearance and size distribution of 5 ?m. Encapsulation efficiency and release rate of selected niosomes were optimal. Niosomes had good stability during six months of storage at refrigerator temperature.
Conclusions: Based on the obtained results in this study, the application of a new topical dosage form of propranolol showed promising results for the treatment of infantile hemangioma.
Mahdi Gholian; Mohammad Moghzi; Mohsen Zakerian; Elham Charoghchian Khorasani
Volume 23, Issue 12 , 2021
Abstract
Dear Editor,
Since March 11, 2020, the Coronavirus (COVID-19) has been declared a global pandemic, and the World Health Organization (WHO) has declared it a public health emergency, countries have borne the brunt of the outbreak and attention has been focused on preventing the disease (1, 2). One of ...
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Dear Editor,
Since March 11, 2020, the Coronavirus (COVID-19) has been declared a global pandemic, and the World Health Organization (WHO) has declared it a public health emergency, countries have borne the brunt of the outbreak and attention has been focused on preventing the disease (1, 2). One of the most effective ways to prevent COVID-19 and control the epidemic is general vaccination, which was introduced as a key intervention against this disease (3, 4). A year after the start of the COVID-19 epidemic, a number of companies have developed a safe vaccine against COVID-19, but the lack of production of these vaccines has created problems for various countries (5).
In Iran, national vaccination began on February 9, 2021, with the priority of healthcare personnel, and gradually expanded with the priority of different vaccination groups. However, the success of vaccination depends on the general acceptance of the vaccine (5, 6). Various studies have shown that vaccination is not popular in low- and middle-income countries (4, 7-9).
With the outbreak of the delta type, it should be noted that its infectivity is more than twice that of the original strain, and the morbidity and mortality have increased. In this regard, regional and local healthcare systems have taken new steps (3). One of the cities in Iran that was affected by the COVID-19 delta virus type was Mashhad, which is located 900 km from the capital, the city has a large margin and a population of about 1,200,000 economically disadvantaged people. The mortality rate in these areas is higher than that in other areas of the city, and they are reluctant to be vaccinated.
In order to increase vaccination coverage in these low-income areas of the city, a coalition was formed between the Basij Organization and the University of Medical Sciences. By conducting need assessments, identifying existing barriers, and using facilitators, this coalition was able to create mobile vaccination bases in mosques in low-income areas to increase the vaccination coverage in such areas of Mashhad. From 14 August 2021, when the project started, to 14 September 2021, the total number of injections was 146,186, which shows a 70% increase, compared to the same period last month, when the number of injections was 86,315.
Barriers to vaccination in these areas were: 1) people's fear of vaccine side effects, 2) people's fear that the vaccine would not work, 3) extensive activity of social networks in creating reluctance in people to get vaccinated, 4) linking the corona pandemic in public opinion to divine destiny and consequently the lack of need for vaccination, 5) low level of health literacy in these areas, and 6) difficult access to fixed corona vaccination centers due to working hours of employed people.
In order to eliminate these obstacles, facilitators were used. These facilitators were 1) inter-sectoral activities: an agreement has been reached between Mashhad Medical University and the Basij Organization. The Basij Organization in Iran is a popular and widespread organization that members of the community trust and the involvement of this organization in vaccination increases people's trust; 2) appropriate technology: use of senior students and graduates of the University of Medical Sciences who have passed the specialized course of vaccination as an hourly contract, use of refrigerated cars to deliver vaccines to the injection site while maintaining and controlling the cold chain, the presence of a general practitioner at the vaccine injection site with resuscitation bags and required medications; 3) people's participation: using popular volunteer groups to carry out service activities, propaganda, inviting people and organizing; 4) easy access: vaccination close to where people live from 8 am to 6 pm even on holidays; 5) gaining people's trust: using religious places, such as mosques as a place for vaccination and specialized mobilization forces in carrying out vaccinations; 6) provision of transparent information for the people: through telephone and WhatsApp systems, using a voice machine in the area, house-to-house invitation of people to get vaccinated and encouraging them to get vaccinated; 7) usage of opinion leaders: identify opinion leaders in the region and justify these leaders to receive the vaccine, showing the vaccination of leaders on TV and social channels and their invitation to be vaccinated, asking religious speakers to encourage people to get vaccinated, the presence of experts and vaccinators in the Friday prayers of Shiites and Sunnis and the use of the tribune of these ceremonies to encourage people to get vaccinated; 8) usage of billboards and banners in suburban squares to encourage vaccinations; 9) usage of communication channels: broadcasting documentaries of activities carried out on the outskirts of Mashhad on television, informing through provincial news, forming channels on social media to answer doubts about vaccination, setting up a telephone system and using faculty and expert members of the University to respond online to vaccine suspicions, and face-to-face contact with people about vaccines; 10) usage of health literacy strategies, such as using a simple and understandable language when educating people, rather than using professional jargon; 11) diversification of vaccines and use of vaccines available in the country; 12) creation of an Android application for electronic health records for the online registration of vaccinations; and 13) vaccination of non-Iranian citizens living on low-income areas of the city.
Conclusion
Vaccination is the most effective way to control the COVID-19 epidemic. In order to increase the coverage of COVID-19 vaccination in low-income areas of Mashhad, a coalition was formed between the Basij Organization and the University of Medical Sciences. Barriers to vaccination were people's fear of the side effects of the vaccine, the ineffectiveness of the vaccine, the widespread activity of social networks in creating a reluctance to get vaccinated, and people's misconceptions. Facilitators were used to overcoming these barriers, which are: inter-sectoral activities, usage of appropriate technology, easy access, provision of transparent information and gaining people's trust, support of religious leaders, effective use of communication channels, use of health literacy strategies, and diversity. Finally, by taking these measures, the number of vaccinations in low-income areas of Mashhad will increase by 70% in 1 month, which can be considered as a model for similar areas.
Somayeh Fazaeli; Mehdi Yousefi; Mohadeseh Sabethoseini Dokht
Volume 23, Issue 12 , 2021
Abstract
Background: The ongoing coronavirus disease 2019 (COVID-19) pandemic increased the need for inpatient beds, indicating the need for hospitals to increase the efficiency of beds.
Objectives: This study aimed to increase hospital bed capacity using the implementation of Electronic Patient Discharge (EPD).
Methods: ...
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Background: The ongoing coronavirus disease 2019 (COVID-19) pandemic increased the need for inpatient beds, indicating the need for hospitals to increase the efficiency of beds.
Objectives: This study aimed to increase hospital bed capacity using the implementation of Electronic Patient Discharge (EPD).
Methods: This qualitative-quantitative study was conducted in a tertiary care hospital using the pre-and post-intervention designs, and the main outcome was patient discharge time. By applying the Six Sigma model, including definition, measurement, analysis, improvement, and control, the patient discharge process was assessed and improved by some interventions such as EPD. All hospitalized patients with COVID-19 from 21 March 2020 to 22 July 2021 were examined for the post-intervention. In addition, data were collected from the hospital information system.
Results: By the use of EPD, patient discharge time decreased to 47.70% (from 10.19 h to 5.33 h) (P?<?0.000). According to the Sigma level, the yield and defects per million opportunities of the discharge process also increased to 55%.
Conclusion: Six Sigma methodology can be an effective change management tool to improve discharge time to cover the demand created during pandemics. According to the results of the present study and the obtained saved time, one bed is added to the hospital capacity for every five discharges.
Xiaozhe Zhou; Bao Ren; Xiong Zhang; Jilong An; Ke Zhang; Wenshan Gao
Volume 24, Issue 5 , 2022
Abstract
Background: Soft-tissue sarcomas are cancerous growths of mesenchymal tissues, most commonly arising from fat, muscles, and other connective tissues. Due to the fact that these tumors often lie adjacent to nerves and blood vessels, it is difficult to remove them. Traditional surgery is often carried ...
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Background: Soft-tissue sarcomas are cancerous growths of mesenchymal tissues, most commonly arising from fat, muscles, and other connective tissues. Due to the fact that these tumors often lie adjacent to nerves and blood vessels, it is difficult to remove them. Traditional surgery is often carried out according to the operators discretion and experience of local anatomy; however, the surgery bears the risk of damage to nerves and blood vessels. In cases of postoperative recurrence, the local anatomy is often not clear due to scar formation, and the risk of operation would be greater.
Case presentation: This report describes the application of three-dimensional (3D) modeling prior to surgery, which can clearly reveal the tumor tissue and the surrounding important nerves and blood vessels.
Conclusion: In two operations for recurrent soft-tissue sarcoma of the thigh with complex adjacencies, it was found that 3D models are of great value for preoperative planning and intraoperative navigation. More importantly, these models can improve the success rate of surgery and reduce the operative time.
Mahboobeh Kamali; Maryam sarrafzadeh
Volume 23, Issue 10 , 2021
Abstract
Background: Health literacy refers to the skills and abilities people acquire, analyze, and understand regarding basic health information and services they need so that they can contribute to their health issues and make the right decision.
Objectives: Moreover, given the importance of diabetes in the ...
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Background: Health literacy refers to the skills and abilities people acquire, analyze, and understand regarding basic health information and services they need so that they can contribute to their health issues and make the right decision.
Objectives: Moreover, given the importance of diabetes in the world and in Iran, as well as the impact of health information literacy on the quality of life and control of diabetes, this study aimed to evaluate health information literacy of type 2 diabetic patients and design an information service model for promoting their health information literacy.
Methods: In this study, semi-structured interviews were used to collect the qualitative data needed to present the model. In the qualitative method, semi-structured interviews were conducted with 14 health literacy experts selected through purposive sampling. The Grounded Theory method was then used for analyzing interviews and explaining related dimensions and components.
Results: In total, five categories (nutritional factors, media development, physical activity, inclusive education, as well as racial and age consciousness) and a core category of "type 2 diabetes recognition" were identified in this study.
Conclusion: It was found that diabetes type 2 was heavily influenced by lifestyle and education factors. Finally, according to the interviews, a model was developed to improve the health literacy of diabetic patients.
Zahra Kosarian; Mehrnoosh Zakerkish; Mohammad-Jafar Shaterzadeh-Yazdi; Saeed Hesam; Mohammad Mehravar
Volume 24, Issue 3 , 2022
Abstract
Background: Diabetes mellitus (DM) is one of the most common chronic non-communicable diseases (NCD).
Objectives: The present study aimed to investigate the relationship between demographic and clinical data with balance impairments in people with diabetic peripheral neuropathy (DPN), considering the ...
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Background: Diabetes mellitus (DM) is one of the most common chronic non-communicable diseases (NCD).
Objectives: The present study aimed to investigate the relationship between demographic and clinical data with balance impairments in people with diabetic peripheral neuropathy (DPN), considering the importance of early detection of balance impairments in this population.
Methods: Forty-three patients with DPN were evaluated in this cross-sectional study. Age, disease duration, height, weight, and physical activity, along with blood sugar samples and neuropathy disability scores were collected to explore correlations with the balance evaluation system test (BESTest) in this population.
Results: A significant weak to moderate correlations was found between physical activity (p-value=0.046/ CC= 0.286), severity of neuropathy (p-value=0.025/ CC= -0.317), and gender (p-value=0.032/ CC= -0.311) with BESTest, using multivariate linear regression analysis.
Conclusion: It is recommended that diabetic patients with a sedentary lifestyle, more severe scores on neuropathy screening instruments, and female patients be referred for early screening of balance disorders regardless of age and disease duration. Also, increasing physical activity to prevent balance impairments in the future can be recommended.
Amir Hossein Behnoush; Navid Ahmadi; Mehrdad Mozafar; Seyed Peyman Mirghaderi; Alireza Jafari Azad; Amirmasoud Kazemzadeh Houjaghan; Ghazal Behzad; Negin Abiri Jahromi; Shabnam Zahirian; Elham Bazmi; Zahra Khazaeipour
Volume 24, Issue 2 , 2022
Abstract
Background: The coronavirus disease 2019 (COVID-19) epidemic is a great challenge among healthcare workers, especially nurses, due to their more frequent and closer contact with patients.
Objectives: This study aimed to evaluate anxiety, depression, and their causes among nurses with COVID-19 infection ...
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Background: The coronavirus disease 2019 (COVID-19) epidemic is a great challenge among healthcare workers, especially nurses, due to their more frequent and closer contact with patients.
Objectives: This study aimed to evaluate anxiety, depression, and their causes among nurses with COVID-19 infection in different wards of a hospital.
Methods: This cross-sectional study was carried out between February 1st to October 30th, 2020, among all nurses with COVID-19 infection in different wards of Imam Khomeini Hospital (university hospital), Tehran, Iran. The nurses were contacted by phone, and data were collected using a self-administered, valid, structured questionnaire consisting of sociodemographic characteristics and clinical symptoms. Psychological complications, including anxiety and depression levels, were assessed and their association with other sociodemographic variables was also evaluated.
Results: A total of 158 nurses were entered into the study, out of which 112 (70.2%) cases were females. Among all participants, 72.8% and 42.4% of the subjects reported anxiety and depression, respectively. The frequency of moderate to severe anxiety was significantly greater in women than in men (P<0.001). The infected nurses who worked in low-risk departments experienced a greater proportion of moderate to severe depression (P=0.004). In addition, the most prevalent reason for anxiety and depression was found to be the fear of infecting family members.
Conclusion: Nurses bear a significant psychological burden during the COVID-19 pandemic, markedly when they get infected and experience clinical symptoms. Therefore, the government and other staff should provide some facilities and supportive administrative work for reducing anxiety and depression and improving nurses' psychological health.
Fatemeh Rangraz Jeddi; Mohammadreza Mobayen; Alireza Feizkhah; Razieh Farrahi; Safiyehsadat Heydari; Parissa Bagheri Toolaroud
Volume 24, Issue 5 , 2022
Abstract
Background: One of the most expensive aspects of healthcare is providing treatment for burn victims. However, just a few burn cost analysis studies have been conducted in Iran.
Objectives: This study, thus, aimed to estimate the cost of treating severe burn patients in a burn center.
Methods: This retrospective ...
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Background: One of the most expensive aspects of healthcare is providing treatment for burn victims. However, just a few burn cost analysis studies have been conducted in Iran.
Objectives: This study, thus, aimed to estimate the cost of treating severe burn patients in a burn center.
Methods: This retrospective study was performed on medical records of 143 severe burn patients referred to a specialized burn center between March 2020 and March 2021. The data were collected regarding the treatment costs and were analyzed using the SPSS software (version 16.0).
Results: The mean±SD total per-patient cost was US$ 5445.53±4742.45. Electrical burn patients had a higher average total cost of care and length of stay, compared to other burn patients. Bed charges (21.97%), the surgeons salary (27.17%), as well as equipment and consumables (17.83%), were the main cost drivers.
Conclusion: The results of this study can help hospital authorities and governments understand the direct costs of a burn center and the total budget a country might need to cover the annual costs of treating burn victims. In addition, the cost of burn care in this study differed from that in other studies. The disparity in reported numbers can be attributed to variations in methodologies being used, costing viewpoints, study site, treatment procedures, hospitalization regulations, medications, surgeries, health service providers salaries, nonclinical support, and indirect costs.
Sinan Karacabey; Erkman Sanr?
Volume 24, Issue 10 , 2022
Abstract
Background: Head trauma may cause an increase in intracranial pressure (ICP). The use of ocular ultrasound to measure optic nerve sheath diameter (ONSD) is a method to determine the ICP. The use of the rigid cervical collar in head trauma patients contribute to elevating ICP, and therefore, potentially ...
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Background: Head trauma may cause an increase in intracranial pressure (ICP). The use of ocular ultrasound to measure optic nerve sheath diameter (ONSD) is a method to determine the ICP. The use of the rigid cervical collar in head trauma patients contribute to elevating ICP, and therefore, potentially causing further deterioration in their condition.
Objectives: This study aimed to describe changes in ONSD after the placement of a c-collar and analyze these changes depending on the time in the c-collar.
Methods: This prospective study measured the ONSD of minor head trauma patients before and after the placement of a c-collar. Patients aged ³18 with blunt head trauma and Glasgow Coma Score ³13 were included in the study. Each eye was scanned twice. This was done before c-collar placement, at 5 and 20 min after placement. The mean values of both eyes were calculated and analyzed.
Results: This study investigated 50 patients. The mean baseline ONSD was obtained at 4.71mm±0.22 (4.54-4.77). Furthermore, T5 and T20 measurements were 5.19±0.41 (5.07-5.31) and 5.26±0.45 (5.14-5.39), respectively. The ONSD increased at T5 and T20. The changes from the baseline measurements were statistically significant (P=0.000, P=0.000). The difference between T5 and T20 groups was an increase in ONSD, and these differences were also statistically significant (0.07±0.19; P=0.008).
Conclusion: Our results revealed that minor head trauma patients using a c-collar may increase ONSD by timeline the clinical effects of which have to be determined with further studies. Enlargement in ONSD should be considered when interpreting ICP.
Mandana Rafeey; Amir Hossein Jafari-Rouhi; Suzan Hejrati; Maryam Hosseinpour Sarmadi; Ebrahim Farhadi
Volume 24, Issue 11 , 2022
Abstract
Background: Early diagnosis of cystic fibrosis (CF) and hence the initiation of symptomatic and prophylactic treatment can help improve the outcomes of CF patients. Fecal calprotectin (FC) is a marker of inflammation in the intestinal tract that is elevated in several gastrointestinal inflammatory diseases, ...
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Background: Early diagnosis of cystic fibrosis (CF) and hence the initiation of symptomatic and prophylactic treatment can help improve the outcomes of CF patients. Fecal calprotectin (FC) is a marker of inflammation in the intestinal tract that is elevated in several gastrointestinal inflammatory diseases, but little is known about its value in CF.
Objectives: This study, therefore, aimed to survey the associations of FC among CF patients and its correlation with the clinical manifestations of CF.
Methods: This descriptive cross-sectional study was performed on 52 children with CF visiting the Childrens Hospital of Tabriz, Iran, during 2018-2019, selected through the census sampling method. The calprotectin values of <50 ?g/g were considered normal.
Results: There was no clinically relevant association among FC levels concerning pancreatic insufficiency, diabetes, and airway colonization with Pseudomonas. In a comparison of the number of exacerbations and Forced Expiratory Volume in the first second (FEV1), the levels of electrolytes showed no significant difference between patients with normal calprotectin and elevated FC. The results of the performed analysis indicated no significant difference between the low-fecal elastase and the FC levels in patients with CF (P=0.53).
Conclusion: Demographic and clinical parameters, such as age, gender, FEV1, or Body Mass Index, had no clinically significant relationship with FC. However, serial and longitudinal calprotectin levels should also be checked, which may have clinical relevance during symptomatic episodes.
Abdullah Kahraman; Guler Eraslan Do?anay
Volume 24, Issue 10 , 2022
Abstract
Background: Central venous catheterization (CVC) insertion is a common invasive procedure performed in critical care patients. Although this procedure is considered to providebetter patient comfort and a lower risk of infection compared to other methods, it has a higher risk of complications such as ...
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Background: Central venous catheterization (CVC) insertion is a common invasive procedure performed in critical care patients. Although this procedure is considered to providebetter patient comfort and a lower risk of infection compared to other methods, it has a higher risk of complications such as pneumothorax, arterial puncture, nerve injury, and bleeding. Ultrasonography (USG)-guided subclavian catheterization hasrecently become a popular technique. In this study, we retrospectively analyzed 50 patients who underwent infraclavicular subclavian catheterization with the out-of-plane technique under USG guidance.
Materials and Methods: The retrospective study included50 patients who underwent subclavian CVC insertion via the out-of-plane technique under USG guidance in our intensive care unit (ICU)between March and December 2020.
Results: The 50 patients comprised 27 (54%) men and 23 (46%) women with a mean age of 72.8±11.8 years. In all patients, subclavian CVC insertion was successfully performed under USG guidance via the out-of-plane technique. Mean procedural time was 220.90±60.20 sec. Only one complication (pneumothorax) developed in one patient, who underwent tube thoracostomy. The procedure was completed in a single session in 27 (54%), two sessions in 22 (44%), and three sessions in 1 (2%) patient. No catheter malposition was observed in any patient.
Conclusion: USG-guided subclavian catheterization isa safetechnique to be performed by experienced practitioners.
Hasan Erdem; Abdullah ?i?ik; Selim Sozen
Volume 24, Issue 8 , 2022
Abstract
Background: Demands for fasting occasionally arise in patients undergoing bariatric surgery, depending on their beliefs.
Objectives: In the present study, patients who had undergone laparoscopic sleeve gastrectomy (LSG) and experienced fasting at different postoperative times were examined, and the effects ...
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Background: Demands for fasting occasionally arise in patients undergoing bariatric surgery, depending on their beliefs.
Objectives: In the present study, patients who had undergone laparoscopic sleeve gastrectomy (LSG) and experienced fasting at different postoperative times were examined, and the effects of fasting in Ramadan were evaluated.
Methods: A total of 206 patients who underwent LSG were included in the study. All participants were asked to complete three separate questionnaires. The first questionnaire consisted of 15 items on general eating habits and fasting. The second questionnaire comprised 7 items, scores on a 10-point scale, assessing the feeling of hunger while fasting and the desire to get food. The third questionnaire included a total of 9 items asked to determine the psychological state.
Results: The first fasting was observed 13.6±9.1 months (1-36) after the operation. The mean hunger/food cravings score was 26.1±9.6, and the mean psychological disturbance index score was 6.9±3.8. A total of 42.6% of the patients stated that they lost weight while fasting. There was no significant difference between the genders in terms of food consumption habits. There was no difference between the groups in terms of weight and energy level changes after the initiation of fasting.
Conclusion: One year after LSG, most people begin fasting, and women begin their fasting earlier than men. Fasting becomes more difficult after surgery as time passes.
Mitra Payami Bousari; Parisa Jahangiri; Zeinab Ghahremani
Volume 24, Issue 6 , 2022
Abstract
Background: Effective communication is considered a key factor affecting patients and their family satisfaction. The Therapeutic Communication Helping Model (TCHM) facilitates comprehensive care delivery by focusing on effective communication.
Objectives: Evaluate the effects of nursing care based on ...
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Background: Effective communication is considered a key factor affecting patients and their family satisfaction. The Therapeutic Communication Helping Model (TCHM) facilitates comprehensive care delivery by focusing on effective communication.
Objectives: Evaluate the effects of nursing care based on the Therapeutic Communication Helping Model (TCHM) on patient and family satisfaction in the coronary care unit (CCU).
Methods: This quasi-experimental was conducted based on the posttest-only design between June and October 2017 in the Educational and Treatment Center of Mousavi in Zanjan, Iran. In this study, the time sequence sampling method was used. A total of 58 patients and 58 family members from CCU with inclusion criteria were included through the convenience method in each sequence as the control and intervention groups. One week after the end of the control group sampling, the sampling of the intervention group began. In the meantime, a 4-hour workshop was conducted twice for the ward nurses to get acquainted with TCHM. Trained nurses provided holistic nursing care based on TCHM for patients (n=58) and their family members (n=58). Data were collected using the Patient Satisfaction Instrument, and the Family Members Satisfaction Questionnaire for adult patients. The satisfaction rate of both control and intervention groups were assessed at the time of discharge. Data were analyzed using the Chi-square test, independent t-test, and paired t-test in the SPSS software (version 22) at the significance level of 0.05.
Results: The mean scores of patient and family satisfaction were respectively 3.47±0.84 and 3.91± 0.67 in the intervention group. In the control group, these values accounted for 3.14±0.5 and 3.20±0.78, respectively. The mean scores of patient and family satisfaction and their subscales in the intervention group were significantly greater than those in the control group (P<0.05).
Conclusion: The TCHM significantly improved patient and family satisfaction. It is suggested that by incorporating this model into nursing practice the delivery of care will be enhanced.
Atefeh Jamal; Seyed Morteza Seifati; Mahmoud Dehghani Ashkezari; Alireza Soleimani
Volume 24, Issue 5 , 2022
Abstract
Background: One of the major long-term complications of diabetes mellitus (DM) is diabetic nephropathy (DN) characterized by persistent albuminuria and a progressive renal dysfunction.
Objectives: The aim of this trial was to determine the effects of selenium supplementation on the levels of genes expression ...
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Background: One of the major long-term complications of diabetes mellitus (DM) is diabetic nephropathy (DN) characterized by persistent albuminuria and a progressive renal dysfunction.
Objectives: The aim of this trial was to determine the effects of selenium supplementation on the levels of genes expression associated with insulin, lipid and inflammatory markers in diabetic hemodialysis patients.
Methods: This randomized, double-blind, placebo-controlled clinical trial was done on forty diabetic hemodialysis patients. The study subjects were divided into two groups by random to take either 200 µg/day selenium (n=20) or placebo (n=20) during 24 weeks.
Results: Selenium intake led to upregulation of peroxisome proliferator-activated receptor gamma (PPAR-?) (1.08+0.22 vs. 0.93+0.18 fold change, P=0.049), LDL-receptor (1.06+0.14 vs. 0.90+0.16 fold change, P=0.008) and transforming the growth of factor beta (TGF-?) (1.15+0.18 vs. 0.91+0.20 fold change, P=0.002) in the levels of gene expression. In comparison with placebo, in this intervention also reduction of gene expression of tumor necrosis factor alpha (TNF-?) (0.90+0.19 vs. 1.08+0.19 fold change, P=0.014) and interleukin-1 (IL-1) (1.00+0.11 vs. 1.12+0.15 fold change, P=0.020) were detected. In this study, gene expression of vascular endothelial growth factor (VEGF) (1.02+0.13 vs. 0.96+0.18 fold change, P=0.333) and (IL-8) (0.98+0.20 vs. 1.03+0.17 fold change, P=0.458) were not affected by selenium supplementation.
Conclusion: Selenium supplementation during 24 weeks had positive effects on gene expression associated with metabolic status inflammatory markers in diabetic hemodialysis patients.
Sara Saeidi
Volume 24, Issue 3 , 2022
Abstract
Background: The surgical management of obstructive colon cancers especially those presenting with acute obstruction, is still challenging. Since, the emergent colectomy in cases of unresectable tumors or frozen abdomen, has been reported with high rates of mortality and morbidity. Application of a diverting ...
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Background: The surgical management of obstructive colon cancers especially those presenting with acute obstruction, is still challenging. Since, the emergent colectomy in cases of unresectable tumors or frozen abdomen, has been reported with high rates of mortality and morbidity. Application of a diverting stoma significantly alleviates the symptoms and prevents further intestinal necrosis and perforation.
Case presentation: In this Report a case of unresectable obstructive colon cancer is presented. During the operation, an asymptomatic Meckels Diverticulum (MD) was found which used to be formed as a diverting ileostomy.
Conclusion: We advocate our experience of using incidental MD for constructing a diverting stoma for an obstructive colon cancer
Zeinab Siami; Danial Dehghan; Armin Khavandegar; Mehran Lak; Mahmood Bakhtiyari
Volume 24, Issue 5 , 2022
Abstract
Background: While several antivirals have been considered among the candidate repurposed drugs against SARS-CoV-2 infection, limited evidence exists on Atazanavir/Ritonavir.
Objectives: This trial was designed to assess the efficacy of Atazanavir/Ritonavir compared to Lopinavir/Ritonavir, another antiretroviral ...
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Background: While several antivirals have been considered among the candidate repurposed drugs against SARS-CoV-2 infection, limited evidence exists on Atazanavir/Ritonavir.
Objectives: This trial was designed to assess the efficacy of Atazanavir/Ritonavir compared to Lopinavir/Ritonavir, another antiretroviral drug investigated in the previous studies.
Methods: This randomized, double-blind clinical trial was conducted on hospitalized patients with laboratory or confirmed SARS CoV-2 infection. Patients were randomly assigned (1:1) to receive either Lopinavir/Ritonavir (200mg Lopinavir+50mg Ritonavir, twice a day) or Atazanavir/Ritonavir (300mg Atazanavir+100 mg Ritonavir, once a day) for up to 14 days during their admission along with the standard care. The primary endpoint was total all-cause death in all patients during the hospitalization period. Secondary outcomes included length of hospitalization.
Results: Out of 103 adults included in the analysis 54 and 49 were assigned to Atazanavir/Ritonavir and Lopinavir/Ritonavir groups, respectively. The occurrence of adverse effects, defined as symptoms attributed to the drugs which no longer appear upon the cessation of the drug, was higher for cardiac side effects in Atazanavir/Ritonavir group. No statistically significant difference was observed between the two groups in terms of the length of hospitalization. After adjustment for other covariates in the study, treatment with Atazanavir/ritonavir did not result in a significant reduction in mortality compared to treatment with Lopinavir/Ritonavir.
Conclusion: The efficacy of Atazanavir/Ritonavir in this preliminary study was not superior to Lopinavir/Ritonavir in reducing mortality and length of hospitalization in COVID-19 patients. However, the limited efficacy of both compounds does not support their use in primary care for COVID-19 patients.
Miran Gholami; Paria Ghahremani; Zhaleh Mohsenifar; Mohammad Mahdi Jaafarzadeh; Ali Momeni; Mohammad Reza Parvizi
Volume 24, Issue 1 , 2022
Abstract
Background: Lead, as the most important toxic heavy element, has several devastating effects on human health and influences most biochemical and physiological functions. It is widely accepted that lead can adversely affect the cardiovascular system since it can be quickly absorbed and recycled in the ...
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Background: Lead, as the most important toxic heavy element, has several devastating effects on human health and influences most biochemical and physiological functions. It is widely accepted that lead can adversely affect the cardiovascular system since it can be quickly absorbed and recycled in the blood strain.
Objectives: This survey scrutinized the effects of N-acetylcysteine (NAC) on the oxidative damage, inflammation, and expression of protein kinase C-alpha (PKC-?) and ankyrin repeat domain 1 (ANKRD1) genes in the heart tissue of rats exposed to lead (Pb).
Methods: The rats were incidentally divided into five groups, including four study groups for the investigation of the effects of the single and continuous doses of lead were examined with and without NAC and a control group (G1). The levels of malondialdehyde (MDA), total antioxidant capacity (TAC), interleukin (IL)-10, and tumor necrosis factor alpha (TNF-?) were analyzed. A reverse transcription polymerase chain reaction was applied to investigate the expression of PKC-? and ANKRD1 genes.
Results: Continuous exposure to Pb significantly decreased serum levels of TAC and IL-10; however, it increased MDA and TNF-? contents (P<0.001). The continuous dose of Pb also dramatically increased the expression of PKC-? and ANKRD1 genes in the cardiac tissue by 4.27-fold and 3.07-fold, respectively (P<0.001). N-acetylcysteine treatments not only improved morphological changes, oxidative stress, and inflammatory biomarkers but also compensated antioxidant capacity and the expression of PKC-? and ANKRD1 genes in cardiac tissues.
Conclusion: Lead exposure is remarkably related to cardiotoxicity mainly by inducing oxidative stress, inflammation, and antioxidant discharge. N-acetylcysteine ameliorates Pb-induced cardiotoxicity by improving the antioxidants capacity, mitigating oxidative stress, and down expressing PKC-? and ANKRD1 genes.
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.
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.
Talha Karab?y?k; Durmu? Ayan; Sercan Unal
Volume 24, Issue 3 , 2022
Abstract
Background: Hepsin is known as a cell-surface serine protease expressed predominantly in the liver. Hepsin-deficient mice show resistance to high-fat diet-induced obesity, hyperlipidemia, and hyperglycemia. Up to the present, the physiological function of hepsin has not been fully determined. Hepsin ...
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Background: Hepsin is known as a cell-surface serine protease expressed predominantly in the liver. Hepsin-deficient mice show resistance to high-fat diet-induced obesity, hyperlipidemia, and hyperglycemia. Up to the present, the physiological function of hepsin has not been fully determined. Hepsin may play significant and specific roles in diabetes.
Objectives: This study aimed to evaluate the relationship between hepsin protein concentrations in serum and type 2 diabetes mellitus (T2DM) and elucidate possible associations with disease activity andinflammatory and metabolic parameters. To the best of our knowledge, this is the first study evaluating the relationship between hepsin, lymphocyte-to-C-reactive protein ratio (LCR), and type 2 diabetes in humans in the existingliterature.
Methods: This case-control study included 60 patients (30 males and 30 females) diagnosed with type 2 diabetes, according to American Diabetes Association's criteria, and 30 healthy controls (14 males and 16 females) with similar demographic characteristics. Several laboratory parameters were assessed including fasting glucose, total cholesterol, insulin, hemoglobin A1c, gamma-glutamyl transferase, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, uric acid, C-reactive protein, atherogenic index of plasma, LCR, monocyte-to-neutrophil ratio,neutrophil-to-lymphocyte ratio, and serum hepsin levels.
Results: The type 2 diabetes group had significantly higher LCR than controls (P<0.016). Correlation analysis in the patient group showed a statistically significant relationship between hepsin and LCR (rho=0.296,P=0.02). Hepsin was negatively correlated with CRP in the patient group (rho=-0.333, P=0.01). Correlation analysis in the patient group showed a statistically significant relationship between hepsin and cholesterol (rho= 0.29,P= 0.02). Age was positively correlated with hepsin in the patient group (rho= 0.267, P=0.04). There was no statistically significant difference in serum hepsin levels between the diabetes group and the control group (P=0.157).
Conclusion: To the best of our knowledge, this is the first study assessing the hepsin levels in patients with T2DM. Our results indicated that increased levels of hepsin could be associated with the inflammatory processes. Similar results were not found for diabetes. However, it is recommended that similar studies should be conducted in larger patient populations.
