Review Article
Dilceu Silveira Tolentino Júnior; Eliseu Miranda de Assis; Roberto Carlos de Oliveira
Articles in Press, Accepted Manuscript, Available Online from 13 February 2021
Abstract
Acute coronary syndrome (ACS) results from acute obstruction of a coronary artery, and is responsible for a high mortality rate worldwide. The consequences depend on the degree and location of the obstruction and vary from unstable angina to non-ST segment elevation myocardial infarction, ST segment ...
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Acute coronary syndrome (ACS) results from acute obstruction of a coronary artery, and is responsible for a high mortality rate worldwide. The consequences depend on the degree and location of the obstruction and vary from unstable angina to non-ST segment elevation myocardial infarction, ST segment elevation myocardial infarction and sudden cardiac death. The symptoms are similar in each of these syndromes (except for sudden death), involving chest discomfort with or without dyspnea, nausea and diaphoresis. The diagnosis is possible thanks to the electrocardiogram that is essential and the existence or absence of serological markers. In addition to these initial resources, other diagnostic methods are important, such as stress electrocardiogram, echocardiography, nuclear cardiology, computed tomography angiography, exercise test. Other necessary measures are the stratification of the identified cases according to the degree of risk, availability of a coronary intensive care unit and the establishment of the opportune treatment that consists of oxygen therapy, analgesia, sedation and antiplatelet, anticoagulants, nitrates, beta-blockers drugs, reperfusion of emergency with fibrinolytic drugs, percutaneous intervention or, occasionally, myocardial revascularization surgery to provide the recovery and consequently a better quality of life for the patient. This brief review aims to discuss the diagnostic and therapeutic resources available and the appropriate risk stratification for adequate care for victims of acute coronary heart disease in a timely manner in a hospital setting.
Original Article
Bineeta Kashyap; Rajat Jhamb; NP Singh; Krishna Sarkar; Rajnish Avasthi; Ashwani Khanna
Articles in Press, Accepted Manuscript, Available Online from 08 January 2021
Abstract
Background: In December 2019, in the city of Wuhan, China; a new coronavirus emerged, that had not been previously identified in humans.
Objectives: Since infected health care workers (HCWs) may be responsible for secondary transmission to patients, their contacts and finally community, it becomes crucial ...
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Background: In December 2019, in the city of Wuhan, China; a new coronavirus emerged, that had not been previously identified in humans.
Objectives: Since infected health care workers (HCWs) may be responsible for secondary transmission to patients, their contacts and finally community, it becomes crucial to characterize the infection risk among them.
Methods: The participants were HCWs having suspicion of COVID-19 infection and reporting to the Fever Clinic preferring diagnosis of possible COVID-19 by Truenat. The participants were enrolled through a self-reporting COVID-19 Risk Assessment form. Oropharyngeal swab specimen was collected and subjected to Truenat testing that works on the principle of Real Time Reverse Transcription Polymerase Chain Reaction (RT PCR) based on Taqman chemistry.
Results: 60% of our HCWs comprised of doctors. 83% reported either the presence of BCG scar or gave history of BCG immunization at birth. Maximum number of HCWs (29.16%) took Hydroxychloroquine prophylaxis for 4 weeks. 74% of the HCWs affirmed the use of personal protective equipment at the time of exposure. The commonest mode of infection reported was exposure from COVID-19 patients. Fever was the most common reported symptom. Truenat was positive in 9 of 100 HCWs who got tested, giving an infection rate of 9%. Being asymptomatic or symptomatic at the time of testing was found to be significantly associated with the positivity by Truenat.
Conclusion: The study provide further insights into the burden of COVID-19 infection among HCWs, the epidemiology and guides us to evaluate and further plan our preventive measures and management strategies.
Original Article
Emmanuel O. Taiwo; Lateef OA. Thanni
Articles in Press, Accepted Manuscript, Available Online from 13 February 2021
Abstract
Background: Serum lipid levels are known to be affected by the level of smoking of individuals in an environment. The prevalence of current smokers in Nigeria was 10.4%. Objectives: This study was designed to assess the blood lipid levels of selected people of Sagamu. Methods: This study involved 100 ...
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Background: Serum lipid levels are known to be affected by the level of smoking of individuals in an environment. The prevalence of current smokers in Nigeria was 10.4%. Objectives: This study was designed to assess the blood lipid levels of selected people of Sagamu. Methods: This study involved 100 subjects selected using random sampling method in Sagamu, aged 25 to 54years. Hypertensives and Diabetic subjects were exempted. The weight in kg and height in meters of each subjects were measured. The body mass index (kg/m2) (B.M.I) was calculated. LP was determined by analytical method.Data were analyzed using descriptive statistic. Results: There were 80 males and 20 females in the study population. 40(80.0%) males and 10 (20.0%) females were smokers in the study group. There were 24(48.0%) smokers and 27(54.0%) non-smokers in the age group 25 and 34 years. Two (4.0%) smokers of the study group were obese while 4(8.0%) were obese non-smokers. Eighteen (36.0%) smokers were overweight and 14(28.0%) non-smokers were overweight. The average total cholesterol of 198.71mg/dl± 2.30 in smokers was significantly greater than 174.62mg/dl±1.51 in non-smokers (p <0.05). The mean HDL of 56.74mg/dl±1.15 in non-smokers was significantly higher than 40.87mg/dl±1.32 in smokers (p <0.05). The average TC of 195.38mg/dl± 2.22 in male smokers was significantly greater than 166.04mg/dl±1.51 in male non-smokers (p <0.05). Conclusion: The HDL levels in smokers are lower than non-smokers. LDL, TG and TC in smokers are however higher. The lipid levels of smokers gotten from this study can be used as baseline for future study.
Original Article
Farshid Rahimibashar; Amir Vahedian azimi; Mahmood Salesi; Masoum Khosh Fetrat
Articles in Press, Accepted Manuscript, Available Online from 08 January 2021
Abstract
Background: Endotracheal intubation (EI) associated with mechanical ventilation (MV) is frequently performed in critical ill patients admitted in ICU with sepsis.
Methods: Adult patients admitted in the mixed medical–surgical ICUs with sepsis at the ICU admission who needs prolonged mechanical ...
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Background: Endotracheal intubation (EI) associated with mechanical ventilation (MV) is frequently performed in critical ill patients admitted in ICU with sepsis.
Methods: Adult patients admitted in the mixed medical–surgical ICUs with sepsis at the ICU admission who needs prolonged mechanical ventilation (PMV) (≥ 21 days) were included in this retrospective secondary analysis study. The primary outcome was the ICU mortality. Baseline demographic and clinical characteristics of all patients were assessed as risk factors associated with duration of MV by univariate and multivariate Binary Logistic regression.
Results: Among patients with sepsis at ICU admission, 85 patients requiring more than 21 days of MV. Out of the 85 patients, 52 (61.2%) patients were intubated within 30 to 34.50 days and 33 (38.8%) patients had intubation within 34.51 to 65 days, and categorized as PMV and very prolonged MV groups, respectively. According to the adjusted model, two parameters were significantly associated with very prolonged MV which as follows by older age 1.229 (95% CI: 1.002-1.507, P=0.048) and long hospital LOS 2.996 (95% CI: 1.676-5.356, p <0.001). In addition, no significant survival difference was observed between two groups of study. (33.3% vs. 25%, P=0.406).
Conclusion: Our observations showed that the older age and long hospital LOS as pre-ICU stay in patients with positive sepsis at the ICU admission can prolong the duration of intubation. In addition, no significant survival difference was observed between patients with PMV and very prolonged MV.
Original Article
Vahid KHodadadi; Asghar Bakrani; Mohammadhosein Vafaei
Articles in Press, Accepted Manuscript, Available Online from 13 February 2021
Abstract
Introduction: Considering the importance of the role of medical equipment in critical situations such as the current situation and the coronary heart disease pandemic, therefore, this study was conducted to determine and identify the factors affecting the management of medical equipment in crisis situations. ...
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Introduction: Considering the importance of the role of medical equipment in critical situations such as the current situation and the coronary heart disease pandemic, therefore, this study was conducted to determine and identify the factors affecting the management of medical equipment in crisis situations. Methods: The present study was conducted as a mixed qualitative and quantitative study in 2020 in Tehran province. The target population of the quality department consisted of all university professors and experts in the field of accident management and medical equipment engineering, and the target population of the quantitative sector consisted of managers and experts active in public and private medical equipment companies. Results: 60% of the participants were men, 46.6% of the participants were in the age range of 31 to 40 years and 47.5% of the participants had a master's degree. Structural validity assessment was performed using heuristic factor analysis. KMO index was 0.971 and Bartlett test was significant (p <0.05). All six components approved in the content validity section explain and determine more than 77% of the variance related to the purpose of the study, ie the management of medical equipment in the event of a corona crisis, based on the mathematical model. Conclusion: In this regard, appropriate instructions should be provided first and localized uniform protocols should be communicated to the whole unit, from the same reference and at a certain time.
Original Article
Iraj Abdi; Ali Komeili; Leila Riahi; Seyed Jamaledin Tabibi
Articles in Press, Accepted Manuscript, Available Online from 19 October 2020
Abstract
Background: Due to the expansion of addiction treatment clinics and the costs that these clinics incur on the government and the families of addicts, it is necessary to monitor the performance of these clinics and the need to pay attention to the principles of management, efficiency and effectiveness. ...
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Background: Due to the expansion of addiction treatment clinics and the costs that these clinics incur on the government and the families of addicts, it is necessary to monitor the performance of these clinics and the need to pay attention to the principles of management, efficiency and effectiveness. Objectives: The present study was conducted to identify the factors affecting the management of addiction treatment clinics. Methods: The present study is a descriptive-applied and cross-sectional study that was conducted in 2019. Experts and academic experts have been considered as the research community, and 18 people were selected as the research sample by the purposeful snowball method. Data collection tools were review of relevant national and international documents as well as semi-structured exploratory interviews. Finally, after collecting information from the interview sections and reviewing the sources, the data foundation and coding methods (open, axial and selective) were used to classify the data. Results: The findings of the study showed that the effective factors in the management of addiction treatment clinics are dimensions such as organization, planning, control, guidance and leadership and treatment management. Conclusion: According to the findings of this study, it can be concluded that the effective factors in the management of addiction treatment clinics can be a good basis for evaluating managers so that the policies and programs of the organization can be upgraded, modified and reviewed.
Original Article
Ali Gilani; Pezhman Farshidmehr; Hossein Zabihi Mahmoudabadi; Mohammad Sadra Nazari
Articles in Press, Accepted Manuscript, Available Online from 08 January 2021
Abstract
Background: The primary patency rate (PPR) is still controversial in angioplasty and heart bypass surgery for blood vessel repair and reconstruction in patients with femoropopliteal disease.
Objectives: This study aimed to investigate the prolonged PPR rate in patients with stenosis/occlusion of the ...
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Background: The primary patency rate (PPR) is still controversial in angioplasty and heart bypass surgery for blood vessel repair and reconstruction in patients with femoropopliteal disease.
Objectives: This study aimed to investigate the prolonged PPR rate in patients with stenosis/occlusion of the femoropopliteal artery undergoing superficial femoral artery (SFA) and popliteal angioplasty.
Methods: A case series study population consisted of patients demonstrating femoropopliteal artery occlusion referred to Sina Hospital for angiography during 2016-2018. After angiography, patients underwent either stent placement or balloon angioplasty in the case of stenosis/occlusion of femoropopliteal arteries. After angioplasty, patients were followed up in the 3rd, 12th, and 24th months for re-examination, and color Doppler Ultrasonography of femoropopliteal arteries was also performed to measure the patency rate. The SPSS Statistics V21.0 was used to analyze the data. The Kaplan–Meier method and a log-rank test were used to evaluate this rate.
Results: 60 patients were included in the study, out of them, 44 were women (73.3%) and 16 were men (26.6%) with a mean age of 69.9 years. 52, 41, 29 patients were examined at intervals of 3, 12, 24 months, with PPRs of 86%, 79%, and 68%, respectively. There was a significant relationship between claudication degree and procedure success (p =0.02(.
Conclusion: The prolonged PPR rate of patients after femoropopliteal artery angioplasty was acceptable and it`s a safe and effective treatment. It is suggested that an increase in the number of study variables, a more comprehensive classification, and PPR-related variables in future research studies.
Original Article
Arash Malakian; Mehdi Sayyah; Kowsar Motamed
Abstract
Introduction: Poor teaching and lack of proper relations between teacher and student and various other causes affect students' academic burnout. Therefore, the present study was conducted to determine the relationship between educational justice and academic burnout in medical interns of Ahvaz Jundishapur ...
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Introduction: Poor teaching and lack of proper relations between teacher and student and various other causes affect students' academic burnout. Therefore, the present study was conducted to determine the relationship between educational justice and academic burnout in medical interns of Ahvaz Jundishapur University of Medical Sciences. Methods: This study was a descriptive and analytical study. The number of samples was equal to 300 medical interns who were identified and entered by census sampling method. Data were completed by two questionnaires (researcher-made educational justice and burnout standard) whose reliability and validity were confirmed. Data were analyzed by SPSS Version 22. Results: There was no significant relationship between educational justice and academic burnout (P> 0.05). Also, educational justice was below average and academic burnout was above average. There was a significant relationship between educational justice score and gender (P <0.05) and there was no significant relationship with other demographic variables (P>0.05). There was no significant relationship between academic burnout score and all demographic variables (P>0.05). Conclusion: It can be concluded that causes other than educational justice have been effective on students' academic burnout, so it is suggested that studies be conducted on the cause of high academic burnout and identify effective variables. On the other hand, although the relationship between the two variables was not significant, but due to the low level of educational justice, the need for fair educational opportunities by the university, especially professors, should be considered.
Case Report
Ensieh Vahedi; Seyed Jalal Madani; Hamideh Molaee; Esmat Davoudi Monfared
Articles in Press, Accepted Manuscript, Available Online from 21 December 2020
Abstract
Introduction: pneumomediastinum and pneumothorax is usually a rarer condition after pnomonia. This study examines the progress of pneumonia of the COVID-19 to spontaneous pneumothorax and pneumomediastinum in a patient
Case Presentation: The patient was a 40-year-old man who complained of nonproductive ...
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Introduction: pneumomediastinum and pneumothorax is usually a rarer condition after pnomonia. This study examines the progress of pneumonia of the COVID-19 to spontaneous pneumothorax and pneumomediastinum in a patient
Case Presentation: The patient was a 40-year-old man who complained of nonproductive cough and dyspnea. He also complained of fever, sore throat, back and chest pain. The patient had previously smoked and had now quit .His O2 saturation was 89% at the time of admission. He was assessed with suspicion of COVID-19. CT scans of the chest showed brief changes of emphysema and grand glass view was also seen in the lungs. In the patient's tests,RT‐PCR testing of SARS‐CoV‐2 was performed and it was positive. Treatment was initiated and because of progression of symptoms, the serial CT scanning of the patient’s lungs was performed daily and cavitary changes, air fluid appearance and destructive changes of lungs were reported. After eight days, the patient's cough worsened. CT scans of the patient’s lungs showed some bullaes, pneumothorax and pneumomediastenum, so chest tube was inserted and oxygen therapy was started to the patient with 3-6 lit/minute. After five day in CT, the patient was relieved of pneumothorax and pneumomediastenum and after a week, chest tube came out.
Conclusion: Pulmonary lesions of COVID 19 can progress to bullae, pneumomediastenum and pneumothorax. Deterioration of dyspnea and respiratory symptoms can be a warning of pneumomediastenum and pneumothorax that can be confirmed by graphics and timely treatment of the patient can be life-saving.
Original Article
Farshid Rahimibashar; Mahmood Salesi; Amir Vahedian-Azimi; Masoum Khosh Fetrat
Articles in Press, Accepted Manuscript, Available Online from 13 February 2021
Abstract
Background: The study of neuromuscular blocking agents (NMBAs) in the management of acute respiratory distress syndrome (ARDS) has provided conflicting results in terms of their effect on mortality.
Objectives: The main purpose of this study was to evaluate mortality in ARDS patients who underwent NMBA.
Methods: ...
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Background: The study of neuromuscular blocking agents (NMBAs) in the management of acute respiratory distress syndrome (ARDS) has provided conflicting results in terms of their effect on mortality.
Objectives: The main purpose of this study was to evaluate mortality in ARDS patients who underwent NMBA.
Methods: A retrospective secondary analysis of 4,200 patients with ARDS was collected from two academic medical centers, Tehran, Iran. This study was performed to assess the impact of NMBAs use in ARDS patients with different subgroups including mild and moderate-to-severe ARDS, age more and less than 65 years, having medical turnover vs. not-having, and high acute nursing care vs. moderate to low nursing care. The primary outcome was the ICU mortality
Results: In the subjects without medical turnover, the moderate dose of NMBAs significantly reduces the mortality of patients (P=0.044). In patients who need high acute nursing care, increasing the NMBAs dose significantly reduces patients' mortality (P=0.010). In addition, increasing the NMBAs doses significantly reduces ICU LOS (p <0.001). Logistic regression analysis revealed that the high dose vs. low dose of NMBAs was increased the risk of mortality among patients between 80 to 84 years old (OR: 3.142, 95% CI: 1.461-6.756, P=0.003). However, higher doses of NMBA than low doses reduce the risk of death in patients between 50 and 54 years of age (OR: 0.432, 95% CI: 0.267-0.798, P=0.006).
Conclusion: this study provides evidence that the administration of different doses of NMBAs had no effect on patients’ mortality with mild or moderate-to-severe ARDS.
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