Research articles
Musa Silahli; Mehmet Tekin
Volume 24, Issue 10 , 2022
Abstract
Background: Although tracheostomy is not performed as frequently as in adults, it is also used in children. There is no clear consensus on timing and risk factors, especially in early infancy and in cases who underwent cardiac surgeries. In the early infancy period, pediatric cardiac surgery patients ...
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Background: Although tracheostomy is not performed as frequently as in adults, it is also used in children. There is no clear consensus on timing and risk factors, especially in early infancy and in cases who underwent cardiac surgeries. In the early infancy period, pediatric cardiac surgery patients have to receive an inotropic agent after the cardiac surgery due to poor general condition or hemodynamic instability. As a result of prolonged intubation, tracheostomy is required to be performed in some of these patients.
Objectives: The present study aimed to investigate the relationship between vasoactive inotropic scores (VIS) and tracheostomy in pediatric cardiac surgery patients.
Methods: A total of 47 patients, 21 with tracheostomy and 26 without tracheostomy, who underwent cardiac surgery were included in this retrospective study. The VIS and inotrope score (IS) values were calculated and recorded hourly for 48 h postoperatively. Scores were calculated by multiplying the inotropes infusion rate of the patients with certain coefficients. It was attempted to determine objective formalized models and cut-off values that may benefit the relationship between VIS values and tracheostomy.
Results: The median weight was 3,630 g (range, 2,040-13,400), and the median age was 69 days (range, 1-1,081) on the surgery day. The majority (93.6%) of the patients were aged < 1 year. Preoperative C-reactive protein measurements were significantly higher by 50% in patients who underwent tracheostomy (P=0.005). The albumin levels in the tracheostomy group (TG) were low, although not significantly (P=0.057). The VIS values of TG had 50% higher values than the non-tracheostomy group (NTG) (P<0.001). In addition, formula 1 predicted with 57% accuracy that a tracheostomy could be performed (VIS =18.170-0.170* HOUR; P < 0.001), and formula 2 predicted with 72% accuracy that a tracheostomy could not be performed (VIS =17.170-0.170* HOUR; P < 0.001). Hospital stay (P<0.001), mechanical ventilation duration (P<0.001), and the number of ongoing intubation on the 7th day post-surgery were significantly higher in TG.
Conclusion: After pediatric cardiac surgery, VIS values can predict tracheostomy status and help intensive care professionals make decisions.
Research articles
Mohsen Zakerian; Fatemeh Roudi; Saeid Eslami; Morteza Mojahedi; Malihe Motavasselian
Volume 24, Issue 10 , 2022
Abstract
Background: Temperament is a critical concept in Persian Medicine (PM) school, and its determinants independently affect human metabolism.
Objectives: The present study investigated the potential relationship between PM-based temperament and metabolic parameters.
Methods: This cross-sectional study was ...
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Background: Temperament is a critical concept in Persian Medicine (PM) school, and its determinants independently affect human metabolism.
Objectives: The present study investigated the potential relationship between PM-based temperament and metabolic parameters.
Methods: This cross-sectional study was carried out at the PERSIAN Organizational Cohort Study at Mashhad University of Medical Sciences Research Center, Imam Reza Hospital, Mashhad, Iran. The participants temperament, physical activity, and dietary intakes were assessed through valid questionnaires. Anthropometric indices were measured by bioelectrical impedance analysis, and energy expenditure components were evaluated using indirect calorimetry.
Results: A total of 334 individuals entered the study. Cold-tempered participants were similar to the warm-tempered in terms of age, sex, general physical activities, and environmental conditions. Warm-tempered participants had lower intakes of spices (P=0.01). Moreover, warm-tempered subjects had more muscle mass (P=0.008) and body water (P=0.007). Finally, the lower metabolic rate in cold-tempered participants was not significant (resting energy expenditure=1468±337 vs. 1519±366 Kcal/day, for cold and warm-tempered subjects, respectively)
Conclusion: Findings of the present study supported the potential relationship between PM-based temperaments and dietary intakes, anthropometric indices, and metabolic parameters. However, further large-population-based studies are required to find the exact mechanisms and interrelations between modern nutrition propositions and PM concepts.
Research articles
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.
Research articles
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.
Research articles
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.
Research articles
Esmeray Mutlu Y?lmaz; ?lknur Esen Y?ld?z; Emine Sehmen
Volume 24, Issue 10 , 2022
Abstract
Background: Stigma and discrimination against patients with HIV and hepatitis C are well defined in the literature. However, hepatitis B is an older and more common infection worldwide than HCV and HIV.Objectives: To determine the rates of stigma and discrimination in people with hepatitis B in our region ...
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Background: Stigma and discrimination against patients with HIV and hepatitis C are well defined in the literature. However, hepatitis B is an older and more common infection worldwide than HCV and HIV.Objectives: To determine the rates of stigma and discrimination in people with hepatitis B in our region and to present data from our country to the international literature.Methods: In this study, a questionnaire prepared for chronic hepatitis B patients was applied using face-to-face interview technique. Data analyzed with SPSS-V23 and AMOS-V24.Results: A total of 505 patients were interviewed. The mean age of the patients was 41 and 56% were male. 47.1% of the patients stated that they hid their illness from their surroundings, 47% feared stigma, 36% feared exclusion. While 20(4%) stated that they broke up with their spouse or lover due to their illness, 47(11.7%) stated that they did not plan to marry because of their illness. It was determined that 73.8% of the participants had fear of transmitting the disease to others. 21.6% of the patients stated that they experienced stigma while receiving health services. The rate of being exposed to any stigma and discrimination in the workplace was 12.3%(n=43). Twenty one(5.8%) of the participants stated that they lost their job due to their illness. The rate of exclusion from the social environment was11%(n=55). There was a significant difference between those who hid their disease and those who did not, in terms of age, education level, marital status, place of residence, worrying about the course of the disease, fear of infecting others, and exposure to any stigma. As the level of education increased gradually, it was observed that the individuals shared that they had hepatitis B with fewer people (p=0.002). It was determined that those who have never been married and those living in towns and villages hid their hepatitis positivity more (p=0.020 and 0.011, respectively). As the participants' anxiety levels about the course of the disease and their fear of infecting others increased, it was observed that the hiding behavior increased (p=0.004 and 0.009).Conclusion: In this article, it is shown that HBV positive people in our country accept this situation as a reason for stigmatization and related discrimination. The participants stated that they avoided disclosing their illness mostly because they were afraid of being stigmatized and excluded.
Research articles
Maryam Yaghoubi; Mohammad Salimi; Mohammad Meskarpour-Amiri; Sayyed Morteza Hosseini_Shokouh
Volume 24, Issue 10 , 2022
Abstract
Background: The increase in the workload of healthcare workers during the coronavirus disease 2019 (COVID-19) pandemic has added further responsibilities for their health.
Objectives: This study was conducted to measure the amount and economic value of COVID-19-related absenteeism and presenteeism and ...
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Background: The increase in the workload of healthcare workers during the coronavirus disease 2019 (COVID-19) pandemic has added further responsibilities for their health.
Objectives: This study was conducted to measure the amount and economic value of COVID-19-related absenteeism and presenteeism and its affecting factors among physicians, nurses, and paramedics working frontline with COVID-19 patients.
Methods: This cross-sectional study was conducted in a COVID-19 tertiary central hospital in Tehran, Iran. Totally, 250 hospital staff who were working frontline with COVID-19 patients between October to December 2020 were entered in the study. The samples included 100 physicians, 96 nurses, and 56 paramedics. The Valuation of Lost Productivity Questionnaire was used to measure job characteristics, absenteeism, and presenteeism. The human capital approach was employed for the valuation of absenteeism and presenteeism. Data were analyzed using ordered logistic regression with backward elimination and the removed value of 0.1 in Stata 14.
Results: Based on the results, the COVID-19 infection rate was 14.4% among healthcare workers, 8% among physicians, 18.6% among paramedics, and 18.7% among nursing staff. A significant association was found between the amount of absenteeism and working in intensive units (odds ratio [OR]: 3.511, P=0.000). A higher amount of absenteeism was related to first-time COVID-19 infection among all participants (OR: 4.918, P=0.000). Current smoker staff, in comparison to quitted smoking staff, was 2.995 times more likely to have a higher amount of presenteeism (OR: 2.995, P=0.030).
Conclusion: COVID-19 had a significant effect on both absenteeism and presenteeism of healthcare workers and its amount and value were unequal among physicians, nurses, and paramedics. Policymakers should do their best to minimize the productivity loss of healthcare workers.
Research articles
Lilly Mary Lazarus; Mei Chan Chong; Vimala Ramoo; Noor Azmi Bin Mat Adenan; Karuthan Chinna; Samira Mohajer
Volume 24, Issue 10 , 2022
Abstract
Background: Pain and wound dehiscence cause physical and emotional traumas, impacting the mothers' quality of life, mental health, and maternal-child bonding.
Objectives: The present study aimed to examine the effect of self-perineal care (SPC) education on episiotomy pain scores and wound healing outcomes.
Methods: ...
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Background: Pain and wound dehiscence cause physical and emotional traumas, impacting the mothers' quality of life, mental health, and maternal-child bonding.
Objectives: The present study aimed to examine the effect of self-perineal care (SPC) education on episiotomy pain scores and wound healing outcomes.
Methods: A quasi-experimental design was used in this study. In the third trimester, 125 primigravida mothers attended the antenatal clinic and were assigned to a SPC education group (n=62) and a control group (n=63). The intervention group received two phases of SPC education apart from the study hospital's routine care, and the mothers in the control group received only routine care. The primigravida mothers in the treatment group were provided SPC education content on their smartphones using the "SPCE" mobile application. Mothers in both groups self-reported their episiotomy pain score and wound healing outcome over 7 days post-childbirth using this mobile application.
Results: The overall pain and REEDA scores (redness, oedema, ecchymosis, discharge, approximation) were significantly lower in the intervention group than in the control group for the first 7-days post-delivery with P < 0.001 except for 4 h of baseline observation. For each activity of daily living, the scores were lower in the intervention group for the 7 days post-delivery.
Conclusion: Self-perineal care education positively reduced episiotomy pain scores and enhanced wound healing outcomes. This study empowered the primigravida mothers to take responsibility for their health by involving in a self-care education program.
Research articles
Ali Mohammad Mosadeghrad; Mahya Abbasi; Sajad Ramandi
Volume 24, Issue 10 , 2022
Abstract
Background: The covid-19 pandemic has affected the health insurance industry in numerous ways.
Objectives: The present study aimed to examine the impacts of the covid-19 on the referral times of insurance policyholders to hospitals and diagnostic centers throughout the country.
Methods: This was a cross-sectional ...
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Background: The covid-19 pandemic has affected the health insurance industry in numerous ways.
Objectives: The present study aimed to examine the impacts of the covid-19 on the referral times of insurance policyholders to hospitals and diagnostic centers throughout the country.
Methods: This was a cross-sectional descriptive study conducted on the data collected from a private insurance company. The statistical population included all insured individuals covered by the insurer in 31 provinces throughout the country who have used the services provided in hospitals and other diagnostic centers from March 21, 2019 to September 21, 2019 (1,699,930 insured people), considered as the pre-covid-19 incidence period, and from March 20, 2020 to September 20, 2020 (1,862,657 insured people), as the post-covid-19 incidence period. Data were analyzed using the SPSS and GIS statistical software.
Results: In the 2019 half-year, 10,416,591 medical expense records have been filed in the country, which decreased by 17.1% in the same period in 2020 to 8,633,613 records. The average referral times in the pre-covid-19 period was 7.02, which decreased by 32.9% during the post-covid-19 period, falling to 4.71.
Conclusion: The overall frequency of referrals to receive all services covered by the insurer, including visits, medicine, hospital services (general surgeries), and laboratory services in the post-covid-19 period decreased significantly, compared to a similar period in the previous year. It seems that in many different provinces, non-emergency patients avoided referring to healthcare centers and unnecessary visits to medical centers. Moreover, the number of general surgeries decreased because of the therapists cautiousness and the changing behaviors of the patients, making diagnostic and medical services more real.
Research articles
Azamsadat Mousavi; Setareh Akhavan; Shahrzad Sheikhhasani; Narges Zamani; Elahe Rezayof; Arezoo Esmailzadeh
Volume 24, Issue 10 , 2022
Abstract
Background: More than 75% of epithelial ovarian cancer (EOC) cases are diagnosed in advanced stages, which is associated with tumor recurrence and chemotherapy resistance. So far, to the best of our knowledge, a similar study has not been conducted in Iran to investigate the clinical characteristics ...
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Background: More than 75% of epithelial ovarian cancer (EOC) cases are diagnosed in advanced stages, which is associated with tumor recurrence and chemotherapy resistance. So far, to the best of our knowledge, a similar study has not been conducted in Iran to investigate the clinical characteristics and survival rate of these patients treated with neoadjuvant chemotherapy (NACT).
Objectives: This study aimed to evaluate the clinical characteristics and survival of patients treated with NACT followed by cytoreductive surgery and the factors affecting survival.
Methods: This retrospective cohort study was conducted on 147 advanced ovarian cancer cases who were treated with NACT referring to the Gynecology Oncology Department of Imam Khomeini Hospital in Tehran, Iran, between 2011 and 2021 and met the inclusion criteria for this study. The survival curve and Cox regression method were used to analyze the data.
Results: The results revealed that 8.9% of advanced EOC (147/1,650) were treated with NACT and the average number of NACT courses was 4.12 periods. The survival rates of 1, 3, 5, and 8 years were 85.31%, 44.05%, 18.35%, and 13.77%, respectively. The mean and median of survival time were 47.7 and 36 months, respectively. Nearly 80% of the patients had stages 3C and 4A before receiving NACT. Based on the results of the adjusted Cox regression model, tumor marker level showed a significant relationship with survival rate (P=0.008), and also peritoneum involvement had a clinically significant impact on survival with a hazard ratio of 2.88.
Conclusion: The results suggested that 8.9% of ovarian cancer cases were treated with NACT. It was also revealed that the average number of NACT courses was 4.12 periods and the 8-year survival rate was 13.77%. CA125 tumor marker level showed a significant relationship with survival rate, and peritoneum involvement had a clinically significant impact on survival.
