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Mohsen Soleimani , ,
Volume 76, Issue 1 (4-2018)
Volume 76, Issue 1 (4-2018)
Abstract
Background: Endotracheal tube cuff pressure must be maintained in safe range. Many factors could be affecting on endotracheal tube cuff pressure in patients on mechanical ventilation. Patients undergoing mechanical ventilation (MV) in critical care settings require changing position for different reasons. The aim of this study was to determine the effect of changes in body position and head of bed on the endotracheal tube cuff pressure in patients with mechanical ventilation.
Methods: This quasi-experimental study (pre-post design) was performed from April to October 2016 on 70 patients with positive pressure mechanical ventilation in critical care settings in two university hospitals in the cities of Semnan and Shahroud, Semnan Province, Iran. At first, the endotracheal tube cuff pressure of patients was regulated on 25 cmH2O in the bed position of 30 degree. Then the patients were randomly positioned on zero degree bed position, 45 degree bed position, lateral position of patients toward mechanical ventilation apparatus and lateral position opposite the MV apparatus. In each position cuff pressure was measured after 5 minutes pause and head and neck of the patients was not flexed or extended. Tube cuff pressure was measured and recorded in the end expiratory with aneroid manometer after each position change. Data analysis was performed with software of SPSS software, version 18 (Armonk, NY, USA) in the significant level of 0.05.
Results: Most of study patients (58.6%) were male and no smokers (81.4%). Age mean of patients were 63.37±20.9 years. Most of patients connected to MV because of respiratory failure. In each change positions and head of bed regulation, the mean of endotracheal tube cuff pressures were significantly increased (P<0.001). Endotracheal tube cuff pressure in the lateral position opposite to the apparatus had maximum increase (29.12±0.41 cmH2O) and in the zero degree bed position tube cuff pressure had minimum increase (27.6±0.38 cmH2O).
Conclusion: Findings of this study showed that changing position of bed and patients undergoing mechanical ventilation, especially in lateral position opposite to the apparatus could increase endotracheal tube cuff pressure. This increase may reach to abnormal range and cause tracheal injury.
Methods: This quasi-experimental study (pre-post design) was performed from April to October 2016 on 70 patients with positive pressure mechanical ventilation in critical care settings in two university hospitals in the cities of Semnan and Shahroud, Semnan Province, Iran. At first, the endotracheal tube cuff pressure of patients was regulated on 25 cmH2O in the bed position of 30 degree. Then the patients were randomly positioned on zero degree bed position, 45 degree bed position, lateral position of patients toward mechanical ventilation apparatus and lateral position opposite the MV apparatus. In each position cuff pressure was measured after 5 minutes pause and head and neck of the patients was not flexed or extended. Tube cuff pressure was measured and recorded in the end expiratory with aneroid manometer after each position change. Data analysis was performed with software of SPSS software, version 18 (Armonk, NY, USA) in the significant level of 0.05.
Results: Most of study patients (58.6%) were male and no smokers (81.4%). Age mean of patients were 63.37±20.9 years. Most of patients connected to MV because of respiratory failure. In each change positions and head of bed regulation, the mean of endotracheal tube cuff pressures were significantly increased (P<0.001). Endotracheal tube cuff pressure in the lateral position opposite to the apparatus had maximum increase (29.12±0.41 cmH2O) and in the zero degree bed position tube cuff pressure had minimum increase (27.6±0.38 cmH2O).
Conclusion: Findings of this study showed that changing position of bed and patients undergoing mechanical ventilation, especially in lateral position opposite to the apparatus could increase endotracheal tube cuff pressure. This increase may reach to abnormal range and cause tracheal injury.
Alireza Mahoori , Nazli Karami , Shabnam Saeifar ,
Volume 77, Issue 12 (3-2020)
Volume 77, Issue 12 (3-2020)
Abstract
Background: Arterial pressure is one of the most important physiological variables and often needs to be monitored repeatedly or continuously in perioperative period. Arterial pressure monitoring is one of the standard monitoring in operating room. During general anesthesia, blood pressure can be measured by using a noninvasive arterial pressure method or continuous invasive arterial pressure by an invasive arterial line. Comparison of invasive measurements in the patient’s candidate to esophagectomy has not been assessed. The aim of this study was to compare invasive and noninvasive blood pressure in these patients.
Methods: In a prospective, cross-sectional, observational study, 42 hemodynamically stable patients candidate for esophagectomy under general anesthesia in supine position were evaluated at Urmia Imam Khomeini Hospital operating room from June 2017 to April 2018. The patients had American Society of Anesthesiologists (ASA) physical status II or III and the patients who had complete heart block and marked arterial blood pressure differences greater than 10 mmHg in the two arms were excluded. After induction of anesthesia and patients monitoring, the radial artery was cannulated for invasive blood pressure monitoring and noninvasive blood pressure was measured via the arm cuff on the other hand at the four-time intervals: after radial artery cannulation (T1), during release of esophagus (T2), during anastomosis (T3) and at the end of operation (T4).
Results: The mean difference between indirect and direct systolic blood pressure was 0.85±2.93, -8.42±2.9, 6.50±3.60 and 2.67±2.6 mmHg and for diastolic blood pressure was 3.53±2.67, 4.57±2.22, 2.10±2.58 and 1.03±1.53 mmHg respectively, at the T1 to T4. At the all-time intervals, there were no statistically differences between systolic and diastolic blood pressure measurement regarding invasive and noninvasive blood pressure (P=0.77)
Conclusion: Noninvasive arterial blood pressure showed acceptable agreement with invasive measurements for systolic, diastolic and mean pressure. According to fhe finding of this study, there were no statistical differences between systolic and diastolic blood pressure measurement regarding invasive and noninvasive blood pressure and these two methods can be used in selected patients.
Methods: In a prospective, cross-sectional, observational study, 42 hemodynamically stable patients candidate for esophagectomy under general anesthesia in supine position were evaluated at Urmia Imam Khomeini Hospital operating room from June 2017 to April 2018. The patients had American Society of Anesthesiologists (ASA) physical status II or III and the patients who had complete heart block and marked arterial blood pressure differences greater than 10 mmHg in the two arms were excluded. After induction of anesthesia and patients monitoring, the radial artery was cannulated for invasive blood pressure monitoring and noninvasive blood pressure was measured via the arm cuff on the other hand at the four-time intervals: after radial artery cannulation (T1), during release of esophagus (T2), during anastomosis (T3) and at the end of operation (T4).
Results: The mean difference between indirect and direct systolic blood pressure was 0.85±2.93, -8.42±2.9, 6.50±3.60 and 2.67±2.6 mmHg and for diastolic blood pressure was 3.53±2.67, 4.57±2.22, 2.10±2.58 and 1.03±1.53 mmHg respectively, at the T1 to T4. At the all-time intervals, there were no statistically differences between systolic and diastolic blood pressure measurement regarding invasive and noninvasive blood pressure (P=0.77)
Conclusion: Noninvasive arterial blood pressure showed acceptable agreement with invasive measurements for systolic, diastolic and mean pressure. According to fhe finding of this study, there were no statistical differences between systolic and diastolic blood pressure measurement regarding invasive and noninvasive blood pressure and these two methods can be used in selected patients.
Fatemeh Nasimi , Hossein Zeraati , Javad Shahinfar , Mohammadreza Safdari , Ali Esmaeili , Maryam Ghorbanzadeh ,
Volume 78, Issue 2 (5-2020)
Volume 78, Issue 2 (5-2020)
Abstract
Background: Premature infants undergo a lot of stressors during treatment procedures in the neonatal intensive care units which causes significant physiological changes in these neonates. Multi-sensory stimulation is a broad category of interventions designed to improve the evolutionary and physiological outcomes of premature infants hospitalized in the neonatal intensive care unit to minimize stress in this environment. So, the study aimed to evaluate the effect of multi-sensory stimulation on physiological parameters in preterm infants.
Methods: This double-blind clinical trial conducted in the neonatal intensive care unit of Shahid Motahari Hospital in Jahrom from April to December 2016. In this study, 80 preterm infants with a gestational age of 34 to 36 weeks were selected by non-probability sampling method and were randomly divided into two groups of multi-sensory stimulation and control. Neonates in the intervention group received a multi-sensory stimulation program for 60 minute. The multi-sensory stimulation program was included a combination of auditory, tactile, motor and visual stimulation. The preterm infants in the control group received only usual care. The data collecting tool was a questionnaire and checklist for physiological parameters of preterm infants.
Results: The results showed that the two groups were homogeneous in terms of fetal age, birth weight, the height of birth, first and fifth minute Apgar score of birth. The results showed that there was no significant difference between the mean of physiological indexes in the two groups before the intervention. Statistical tests showed that there was a decreasing trend in the average of all physiological indices during the intervention (first and second half during the intervention) (P<0.001), However, these changes were not significant in the control group (P<0.05). Also, analysis of variance (ANOVA) with repeated measures showed that there was a significant difference between changes in physiological variables between the two groups at different stages of evaluation (P<0.001).
Conclusion: Multi-sensory stimulation leads to a decrease in heart rate and respiratory rate and the stability of blood pressure in preterm infants.
Methods: This double-blind clinical trial conducted in the neonatal intensive care unit of Shahid Motahari Hospital in Jahrom from April to December 2016. In this study, 80 preterm infants with a gestational age of 34 to 36 weeks were selected by non-probability sampling method and were randomly divided into two groups of multi-sensory stimulation and control. Neonates in the intervention group received a multi-sensory stimulation program for 60 minute. The multi-sensory stimulation program was included a combination of auditory, tactile, motor and visual stimulation. The preterm infants in the control group received only usual care. The data collecting tool was a questionnaire and checklist for physiological parameters of preterm infants.
Results: The results showed that the two groups were homogeneous in terms of fetal age, birth weight, the height of birth, first and fifth minute Apgar score of birth. The results showed that there was no significant difference between the mean of physiological indexes in the two groups before the intervention. Statistical tests showed that there was a decreasing trend in the average of all physiological indices during the intervention (first and second half during the intervention) (P<0.001), However, these changes were not significant in the control group (P<0.05). Also, analysis of variance (ANOVA) with repeated measures showed that there was a significant difference between changes in physiological variables between the two groups at different stages of evaluation (P<0.001).
Conclusion: Multi-sensory stimulation leads to a decrease in heart rate and respiratory rate and the stability of blood pressure in preterm infants.
Mehdi Sanatkar, Mehrdad Goudarzi, Ebrahim Espahbodi,
Volume 78, Issue 6 (9-2020)
Volume 78, Issue 6 (9-2020)
Abstract
Background: Cataract surgery is one of the most common surgeries in the world, especially in elderly patients, and often performed topically with sedative agents. Ketamine is one of the most commonly used agents and the effect of different doses on intraocular pressure is in dispute. The present study investigates the effect of a low dose of ketamine on intraocular pressure in patients undergoing cataract surgery.
Methods: This case-control study was performed in Farabi Hospital, Tehran University of Medical Sciences from January 2020 to February 2020. In this study 92 patients undergoing cataract surgery were randomly divided into two groups of 46 patients. Patients' intraocular pressure and blood pressure were measured at baseline, and then all patients received 1 mg midazolam and 1 μg/kg fentanyl before initiation of the study. In the case group, 0.15 mg/kg ketamine was injected intravenously. Intraocular pressure and blood pressure of all subjects were measured three minutes after injection of sedation. Also, postoperative pain, need for opioids and, postoperative nausea and vomiting were compared between the two groups.
Methods: This case-control study was performed in Farabi Hospital, Tehran University of Medical Sciences from January 2020 to February 2020. In this study 92 patients undergoing cataract surgery were randomly divided into two groups of 46 patients. Patients' intraocular pressure and blood pressure were measured at baseline, and then all patients received 1 mg midazolam and 1 μg/kg fentanyl before initiation of the study. In the case group, 0.15 mg/kg ketamine was injected intravenously. Intraocular pressure and blood pressure of all subjects were measured three minutes after injection of sedation. Also, postoperative pain, need for opioids and, postoperative nausea and vomiting were compared between the two groups.
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Results: There was no significant difference in age, sex and weight between the two groups. Mean intraocular pressure in both groups was not significantly different at baseline. The trend of changes in intraocular pressure was lower in both groups after sedation and there was no statistically significant difference between the two groups. After sedation injection, the mean arterial blood pressure changes in the control group were decreasing while in the case group showed an increasing trend and this difference was statistically significant. Five patients in the control group and one in the case group complained of moderate to severe pain postoperatively. There was no significant difference between the two groups regarding nausea and vomiting and the need for postoperative opioids.
Conclusion: Low-dose ketamine administration had no significant effect on intraocular pressure and did not cause side effects of ketamine such as nausea, vomiting and hallucinations and it may improve the hemodynamic stability of patients if they are injected with sedative medications. |
Salman Daliri, Mohammad Khanbeigi, Reza Heidary Moghadam , Parisa Asadollahi, Khairollah Asadollahi,
Volume 79, Issue 8 (11-2021)
Volume 79, Issue 8 (11-2021)
Abstract
Background: Pulse pressure has recently been considered as a predictor of coronary heart disease. The difference between systolic and diastolic blood pressure is called pulse pressure. Various factors including increased age, vascular stiffness, stenosis, and hypertension are associated with pulse pressure. The present study, therefore, aimed to investigate the relationship between some cardiovascular function indicators such as vascular stenosis, blood pressure and cardiac output with pulse pressure as a predictor of cardiovascular diseases.
Methods: This case-control study was performed on 544 patients who were referred to Imam Ali Hospital in Kermanshah, Iran, from March 2015 to February 2016. In this study, according to the angiographic findings, individuals with artery stenosis were considered as the case group (n=272) and those without artery stenosis were considered as the control group (n=272). Statistical analysis was performed using descriptive statistics, Chi-square and odds ratio estimation by SPSS22 software.
Methods: This case-control study was performed on 544 patients who were referred to Imam Ali Hospital in Kermanshah, Iran, from March 2015 to February 2016. In this study, according to the angiographic findings, individuals with artery stenosis were considered as the case group (n=272) and those without artery stenosis were considered as the control group (n=272). Statistical analysis was performed using descriptive statistics, Chi-square and odds ratio estimation by SPSS22 software.
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Results: According to the findings of this study, ages over 50 (OR: 3.3, 95% CI: 2.1-5.2), high systolic blood pressure (OR: 8, 95% CI: 4.3-15.2), high diastolic blood pressure (OR: 4.9, 95% CI: 2.0-11.7), cardiac output less than 50% (OR: 1.8%, 95% CI: 1.3-2.7) and vascular stenosis (OR: 3.5, 95% CI: 2.4-5.1) were associated with high pulse pressure. The male gender had a preventive role in increasing of pulse pressure (OR: 0.7, 95% CI: 0.5-0.9). A significant relationship was demonstrated between systolic blood pressure and pulse pressure (P<0.0001).
Conclusion: Based on the findings of the present study, the chances of having high pulse pressure are high among individuals over 50 years of age, female gender, those with elevated systolic and diastolic blood pressure, and individuals with high coronary artery stenosis. This chance is associated with decreased cardiac output and coronary stenosis. Increased pulse pressure is a predictive indicator of cardiovascular disease and it is recommended that pulse pressure measurements of all referrals, especially those who are being referred to cardiology clinics, are taken into account by medical professionals to prevent adverse clinical outcomes. |
Monireh Hosseini, Zahra Manouchehri ,
Volume 79, Issue 12 (3-2022)
Volume 79, Issue 12 (3-2022)
Abstract
Background: Fluctuations in blood pressure after induction of general anesthesia have played a significant role in complications of surgery. Therefore, the present study was performed by identifying the causes of blood pressure fluctuations after induction of anesthesia, predicting and preventing them.
Methods: For this study which is a retrospective cohort, data mining methods in the data set including the information related to 3150 patients who underwent anesthesia and surgery from April 2018 to September 2019 in Imam Khomeini Hospital in Kermanshah were used. The data set included patients aged 18 years and older (age range of 18 to 96) who underwent a general anesthesia induction test using Propofol and subsequently endotracheal intubation for non-cardiac surgery. If patients did not have intubation, data were missing, or patients underwent intubation after repeated trials, they got excluded. In total, 2640 patients were included in this analysis. Preoperative patient clinical information was collected from pre-anesthesia evaluation records. Intraoperative data were obtained from computer anesthesia records. This data from the patient monitoring system and the anesthesia machine was automatically stored in the anesthesia files, while drug doses and anesthesia techniques were recorded manually. The data were then pre-processed using SPSS software, version 26 (IBM SPSS, Armonk, NY, USA).
Methods: For this study which is a retrospective cohort, data mining methods in the data set including the information related to 3150 patients who underwent anesthesia and surgery from April 2018 to September 2019 in Imam Khomeini Hospital in Kermanshah were used. The data set included patients aged 18 years and older (age range of 18 to 96) who underwent a general anesthesia induction test using Propofol and subsequently endotracheal intubation for non-cardiac surgery. If patients did not have intubation, data were missing, or patients underwent intubation after repeated trials, they got excluded. In total, 2640 patients were included in this analysis. Preoperative patient clinical information was collected from pre-anesthesia evaluation records. Intraoperative data were obtained from computer anesthesia records. This data from the patient monitoring system and the anesthesia machine was automatically stored in the anesthesia files, while drug doses and anesthesia techniques were recorded manually. The data were then pre-processed using SPSS software, version 26 (IBM SPSS, Armonk, NY, USA).
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Results: In this study, 53 features of patients' records were used (The maximum number of features used in previous studies were 48 features, which compared to them, 5 new features were included in the study) for which a P-value was calculated. Finally, features with a P<0.05 (Indicates the level of significance of the variable) were selected. Then, three data mining algorithms, logistic regression, neural networks and decision tree (the most repetitive data mining algorithms based on previous studies) were used to predict blood pressure. Also, using the criteria of accuracy, precision, sensitivity and F function, the performance of three prediction algorithms in data mining was evaluated.
Conclusion: Six features with P<0.05 were selected that the logistic regression model was more accurate, which was presented as the final model for predicting increased blood pressure fluctuations with path coefficients. |
Alireza Rezaie, Narges Gholami, Leila Bazhdan, Maryam Haghighi Morad , Narjes Jaafari,
Volume 80, Issue 3 (6-2022)
Volume 80, Issue 3 (6-2022)
Abstract
Background: The purpose of this study is a non-invasive diagnosis of increasing the pressure of cerebrospinal fluid in patients involved in idiopathic intracranial hypertension (IIH) that is done with transbulbar sonography.
Methods: In this descriptive cross-sectional study all the non-toxic children under 18 who were referred to the neurology clinic of Loghman Hospital of Tehran from October 2017 to October 2018 with increased intracerebral pressure symptoms were studied. The increased intracerebral pressure symptoms were headache or vomiting or blurred vision or 6th nerve palsy and they had papillary edema. Also, if their diagnostic brain imaging measures were normal such as: Magnetic Resonance Imaging (MRI), Computed Tomography scan (CT scan) and in some cases Magnetic Resonance Venography (MRV), they were suspected to Idiopathic intracranial hypertension and were entered into the study consecutively. Their complete medical history and comorbidities and biographical information were recorded in the file. All patients were candidates for a lumbar puncture to measure cerebrospinal fluid pressure. After full explanation to the parents and obtaining written consent from them before performing a lumbar puncture, patients in coordination with the ultrasound unit without delay in performing a lumbar puncture, first underwent trans orbital ultrasound in supine position and were awakened with closed eyes. Opticians were implanted in both eyes by a skilled sonographer. And then sedated with sedatives (ketamine or midazolam) prescribed by an anesthesiologist. It was placed in a sterile position in a supine semi-flexion position and with lateral decubitus aligned with the body. Cerebrospinal fluid pressure to cm of water was recorded using a serum set in the lumber intervertebral space 4-5. Then a sample was sent for analysis and smear.
Results: Out of 10 patients (age 2.5–14 year, mean 9 years) 10% were girls, 90% were boys, and mean BMI was 22.5 kg/m2. Their symptoms included: 80% Headache, 40% Vomiting, 40% Diplopia, 20% Blurred vision, 10% 6th nerve palsy, and 10% Tinnitus when being reffered. In All patients, CSF pressure was more than 25 cm H2o (mean 40 cm H2o), right and left eyes optic nerve sheath diameter (ONSD) was more than the cutoff point (ONSD≤4.5 mm), the mean right ONSD was 6.31 mm and left eye was 6.64 mm.
Methods: In this descriptive cross-sectional study all the non-toxic children under 18 who were referred to the neurology clinic of Loghman Hospital of Tehran from October 2017 to October 2018 with increased intracerebral pressure symptoms were studied. The increased intracerebral pressure symptoms were headache or vomiting or blurred vision or 6th nerve palsy and they had papillary edema. Also, if their diagnostic brain imaging measures were normal such as: Magnetic Resonance Imaging (MRI), Computed Tomography scan (CT scan) and in some cases Magnetic Resonance Venography (MRV), they were suspected to Idiopathic intracranial hypertension and were entered into the study consecutively. Their complete medical history and comorbidities and biographical information were recorded in the file. All patients were candidates for a lumbar puncture to measure cerebrospinal fluid pressure. After full explanation to the parents and obtaining written consent from them before performing a lumbar puncture, patients in coordination with the ultrasound unit without delay in performing a lumbar puncture, first underwent trans orbital ultrasound in supine position and were awakened with closed eyes. Opticians were implanted in both eyes by a skilled sonographer. And then sedated with sedatives (ketamine or midazolam) prescribed by an anesthesiologist. It was placed in a sterile position in a supine semi-flexion position and with lateral decubitus aligned with the body. Cerebrospinal fluid pressure to cm of water was recorded using a serum set in the lumber intervertebral space 4-5. Then a sample was sent for analysis and smear.
Results: Out of 10 patients (age 2.5–14 year, mean 9 years) 10% were girls, 90% were boys, and mean BMI was 22.5 kg/m2. Their symptoms included: 80% Headache, 40% Vomiting, 40% Diplopia, 20% Blurred vision, 10% 6th nerve palsy, and 10% Tinnitus when being reffered. In All patients, CSF pressure was more than 25 cm H2o (mean 40 cm H2o), right and left eyes optic nerve sheath diameter (ONSD) was more than the cutoff point (ONSD≤4.5 mm), the mean right ONSD was 6.31 mm and left eye was 6.64 mm.
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Conclusion: According to the findings of this study, the measuring of optic nerve sheath diameter in patients suspected of increasing the pressure of idiopathic intracranial hypertension can be helpful as a non–invasive diagnosis method.
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Mehran Kouchek, Niloufar Taherpour, Mirmohammad Miri, Roja Asadpour , Fatemeh Ilbeygi, Seyed Pouzhia Shojaei, Mohammad Sistanizad,
Volume 80, Issue 9 (12-2022)
Volume 80, Issue 9 (12-2022)
Abstract
Background: Hypertension is an important and controllable risk factor for heart diseases, stroke, renal failure and peripheral vascular disease. The aim of this study was to determine the level of awareness of patients with hemorrhagic stroke to control blood pressure and to provide solutions to improve patients’ awareness.
Methods: This study is a descriptive cross-sectional study that was conducted to evaluate the knowledge of patients with hemorrhagic stroke about the use of antihypertensives. The study population consists of all patients with hemorrhagic stroke, who were admitted to the intensive care unit of Imam Hossein Hospital in Tehran from September 2020 to March 2021. Data related to blood pressure awareness and drug history was completed by the researcher through the method of direct contact with the patients or their relatives. In this study, 17 patients diagnosed with hemorrhagic stroke due to hypertension who were admitted to the intensive care unit of Imam Hossein Hospital in Tehran, were included. The extent of the exact treatment adherence was assessed using the Morisky questionnaire.
Methods: This study is a descriptive cross-sectional study that was conducted to evaluate the knowledge of patients with hemorrhagic stroke about the use of antihypertensives. The study population consists of all patients with hemorrhagic stroke, who were admitted to the intensive care unit of Imam Hossein Hospital in Tehran from September 2020 to March 2021. Data related to blood pressure awareness and drug history was completed by the researcher through the method of direct contact with the patients or their relatives. In this study, 17 patients diagnosed with hemorrhagic stroke due to hypertension who were admitted to the intensive care unit of Imam Hossein Hospital in Tehran, were included. The extent of the exact treatment adherence was assessed using the Morisky questionnaire.
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Results: In this study, the median of patients age was 67 and 10 (58.82%) of them were women. The median systolic and diastolic blood pressures were 170 and 95 mmHg on admission. 4(23.53%) subjects were not aware of the disease. Out of 13 people who were aware of their hypertension, 11(64.71%) were under the supervision of a physician. However, 7(63.64%) of the subjects, despite being under the supervision of a physician and acceptable drug adherence, did not have controlled blood pressure and expired.
Conclusion: This study is a warning for patients and health care providers to pay more attention to blood pressure control. Furthermore, educating the community as well as medical staff about the importance of timely diagnosis and accurate treatment of hypertension is highly recommended. |
Negar Heidari , Fatemeh Rajati , Mojgan Rajati, Paria Heidari,
Volume 81, Issue 11 (2-2024)
Volume 81, Issue 11 (2-2024)
Abstract
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Mozaffar Jan Faza, Mohammad Rahman Rahimi ,
Volume 82, Issue 7 (10-2024)
Volume 82, Issue 7 (10-2024)
Abstract
Background: The aim of our study was to evaluate the effect of 8 weeks of aerobic exercise with vitamin D supplementation on indulin-1 and nitric oxide in patients with hypertension aged 30 to 50 years.
Methods: This study was conducted as a semi-experimental pre-test and post-test design, and was conducted from June 1401 at Seyyed Shohada Hospital in Urmia. 40 eligible men and women were randomly divided into four groups (supplement group, placebo + exercise group, a supplement + exercise group, and a control group). The training program of the experimental groups included eight weeks of aerobic exercise running on a treadmill (3 sessions/8 weeks). Blood sampling to evaluate biochemical variables was performed 48 hours before and after the intervention in a fasting state with a volume of 10 cc.
| Results: The results of the study show that after 8 weeks of aerobic exercise, vitamin D, BMI, NO, ET-1 and weight were significantly affected (P < 0.05) and systolic blood pressure in the supplement, supplement + exercise and exercise + placebo groups changed compared to the control group(P < 0.05). Conclusion: Based on the results of the present study, the results showed that taking eight weeks of vitamin D supplements along with aerobic activity reduced blood pressure indices in the subjects. Also, taking vitamin D supplements along with physical activity reduced BMI and increased NO, reduced ET-1 and body weight in the subjects in the study. |
Dorna Yazdan Panah , Mohammad Arish ,
Volume 82, Issue 9 (12-2024)
Volume 82, Issue 9 (12-2024)
Abstract
Background: The thickness of the lamina, especially the lamina cribrosa and prelamina, can be important indicators of optic nerve damage and the severity of glaucoma. Changes in the thickness of these tissues after treatment can indicate improvement or reduction in intraocular pressure (ICP) and nerve protection. ICP produces a different response in the treatment of patients with closed-angle glaucoma (CAG) and open-angle glaucoma (OAG). The aim of this study was to compare the thickness of prelamina and lamina cribrosa tissue before and after treatment in CAG and OAG patients.
Methods: The present study is a descriptive-analytical study conducted on 56 glaucoma patients referred to an Al Zahra Eye Hospital (Zahedan) who had undergone trabeculectomy or laser iridotomy treatment from April to March 2022. Patients were divided into two equal groups, including CAG patients (n=28) and OAG patients (n=28), and at the beginning of the study, in terms of demographic variables, visual acuity, ratio of cup diameter to disc size (C/D), anterior segment depth (ACD), central corneal thickness (CCT), intraocular pressure (IOP) and prelamina and lamina cribrosa tissue thickness were investigated. the thickness of the lamina cribrosa tissue was measured as the distance between the anterior and posterior borders of the highly reflective area in the EDI-OCT horizontal section at the optic nerve head. The measurement of the thickness of the lamina cribrosa tissue was also measured to the extent of safety in the center where there were less vessels. Then CAG patients underwent laser iridotomy and OAG patients underwent trabeculectomy surgery. Before the treatment and after 1 month, 3 months and 6 months after the treatment, the patients underwent FU with the help of ONH OCT and the thickness of the prelamina and lamina cribrosa tissue was checked.
Methods: The present study is a descriptive-analytical study conducted on 56 glaucoma patients referred to an Al Zahra Eye Hospital (Zahedan) who had undergone trabeculectomy or laser iridotomy treatment from April to March 2022. Patients were divided into two equal groups, including CAG patients (n=28) and OAG patients (n=28), and at the beginning of the study, in terms of demographic variables, visual acuity, ratio of cup diameter to disc size (C/D), anterior segment depth (ACD), central corneal thickness (CCT), intraocular pressure (IOP) and prelamina and lamina cribrosa tissue thickness were investigated. the thickness of the lamina cribrosa tissue was measured as the distance between the anterior and posterior borders of the highly reflective area in the EDI-OCT horizontal section at the optic nerve head. The measurement of the thickness of the lamina cribrosa tissue was also measured to the extent of safety in the center where there were less vessels. Then CAG patients underwent laser iridotomy and OAG patients underwent trabeculectomy surgery. Before the treatment and after 1 month, 3 months and 6 months after the treatment, the patients underwent FU with the help of ONH OCT and the thickness of the prelamina and lamina cribrosa tissue was checked.
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Results: After 6 months, the thickness of the lamina cribrosa in patients with CAG increased from 160.21 ± 30.21 µm to 201.73 ± 40.07 µm, and in the OAG group, it increased from 173.71 ± 39 µm to 182.86 ± 46.39 µm. The thickness of the prelamina tissue in patients with CAG increased from 155.46 ± 42.14 µm to 170.03 ± 35.31 µm, and in the OAG group, it increased from 172.57 ± 41.91 µm to 180.07 ± 32.06 µm (P<0.05 for all). Before treatment, the thickness of the prelamina tissue and the lamina cribrosa in patients with CAG was significantly less than in patients with OAG (P<0.05). After 6 months, the lamina cribrosa thickness in patients with CAG (201.73 ± 40.07 µm) was significantly greater than in patients with OAG (182.86 ± 46.39 µm) (P= 0.023).
Conclusion: The increase in the thickness of prelamina tissue and lamina cribrosa tissue after surgery in CAG and OAG patients using OCT imaging is different and the amount of increase in the thickness of lamina cribrosa tissue is more in CAG patients. |
Omolbanin Taziki, Nadia Jamal,
Volume 83, Issue 1 (4-2025)
Volume 83, Issue 1 (4-2025)
Abstract
Background: Asymptomatic hypotension is a common complication in patients undergoing hemodialysis, which can lead to serious consequences. Troponin I, as a biochemical marker for myocardial injury, may play a role in the diagnosis and management of this complication. This study aimed to investigate the relationship between serum troponin I level changes and asymptomatic hypotension in patients with advanced kidney failure undergoing hemodialysis.
Methods: In this cross-sectional study, 120 adult ESRD patients (aged 30–80 years) with an ejection fraction (EF) >50% who attended the hemodialysis unit of Shohada Tajrish Hospital over a 6-month period starting 15 January 2024 were enrolled. Demographic and clinical data were collected using a checklist. Serum troponin I levels were measured before and after dialysis, and patients' blood pressure was recorded throughout dialysis sessions. For quantitative variables, mean and standard deviation were reported; for qualitative variables, absolute and relative frequencies were presented. Statistical analysis was performed using the Paired t-test, Independent t-test, Pearson correlation coefficient, and their non-parametric equivalents as appropriate. A significance level of p < 0.05 was considered statistically significant.
.Results: A total of 120 patients were examined, with a mean age of 57.6 ± 7.1 years. The gender distribution was 67 males (55.8%) and 53 females (44.2%). The mean body mass index was 20.73 ± 0.98. Significant differences were found in mean blood pressure, heart rate, body weight, and changes before and after dialysis (P<0.05). These differences included a decrease in blood pressure, and body weight, an increase in heart rate, and an increase in troponin levels. No significant relationship was found between troponin changes before and after dialysis with age, gender, height, weight, body mass index, heart rate, average duration of dialysis, and other laboratory variables (P>0.05). However, a significant correlation was found between troponin changes and blood pressure changes, indicating that as troponin levels increased, the mean blood pressure of patients decreased.
Conclusion: The findings of this study indicate a significant relationship between increased serum troponin I levels and asymptomatic hypotension in patients with advanced kidney failure undergoing hemodialysis. These results may be useful in identifying at-risk patients and improving therapeutic management. Further research is needed to confirm this relationship and explore its underlying mechanisms.
Methods: In this cross-sectional study, 120 adult ESRD patients (aged 30–80 years) with an ejection fraction (EF) >50% who attended the hemodialysis unit of Shohada Tajrish Hospital over a 6-month period starting 15 January 2024 were enrolled. Demographic and clinical data were collected using a checklist. Serum troponin I levels were measured before and after dialysis, and patients' blood pressure was recorded throughout dialysis sessions. For quantitative variables, mean and standard deviation were reported; for qualitative variables, absolute and relative frequencies were presented. Statistical analysis was performed using the Paired t-test, Independent t-test, Pearson correlation coefficient, and their non-parametric equivalents as appropriate. A significance level of p < 0.05 was considered statistically significant.
.Results: A total of 120 patients were examined, with a mean age of 57.6 ± 7.1 years. The gender distribution was 67 males (55.8%) and 53 females (44.2%). The mean body mass index was 20.73 ± 0.98. Significant differences were found in mean blood pressure, heart rate, body weight, and changes before and after dialysis (P<0.05). These differences included a decrease in blood pressure, and body weight, an increase in heart rate, and an increase in troponin levels. No significant relationship was found between troponin changes before and after dialysis with age, gender, height, weight, body mass index, heart rate, average duration of dialysis, and other laboratory variables (P>0.05). However, a significant correlation was found between troponin changes and blood pressure changes, indicating that as troponin levels increased, the mean blood pressure of patients decreased.
Conclusion: The findings of this study indicate a significant relationship between increased serum troponin I levels and asymptomatic hypotension in patients with advanced kidney failure undergoing hemodialysis. These results may be useful in identifying at-risk patients and improving therapeutic management. Further research is needed to confirm this relationship and explore its underlying mechanisms.
Masoome Pourmokhtari , Shahram Shafa, Nasim Nabizadeh, Reza Sahraei, Hasan Zabetian, Mansour Deylami, Navid Kalani,
Volume 83, Issue 3 (6-2025)
Volume 83, Issue 3 (6-2025)
Abstract
Background: Spinal anesthesia is an effective method for providing analgesia in surgery and a safe alternative to general analgesia; But despite its benefits, in many cases it is not free of side effects, including unwanted cardiovascular events such as hypotension and bradycardia. Ondansetron effectively reduces the incidence of nausea, vomiting, and bradycardia associated with spinal anesthesia Thus, the present study aimed to assess intravenous ondansetron's efficacy in preventing post-spinal hypotension among patients scheduled for lower extremity orthopedic surgery at Peymanieh Hospital in Jahrom, Iran.
Methods: This randomized double-blind clinical trial included 60 patients undergoing lower limb orthopedic surgery at Peymanieh Hospital, Jahrom, Iran, from March 2021 to February 2022. Patients were randomly allocated into two groups: the intervention group (receiving 8 mg intravenous ondansetron) and the control group (receiving distilled water). Systolic and diastolic blood pressure (SBP, DBP) and heart rate (HR) were measured before pre-spinal anesthesia, after spinal anesthesia and then every two minutes for the first ten minutes and at 15, 30, 45, 60 and 90 minutes after surgery. After spinal anesthesia, the patient was asked about pruritus every 10 minutes. Nausea and vomiting during surgery in case of incidence, recording and nausea after spinal anesthesia, the patient was asked every 10 minutes.
Results: The chi-square test indicated no significant differences between the study groups regarding age and sex distribution(P>0.05). Time before anesthesia, immediately after anesthesia, 10 minutes, 15 minutes, 30 minutes, 45 minutes, 60 minutes, 75 minutes, and 90 minutes after anesthesia, significant difference between ondansetron and placebo groups from There was no mean SBP and DBP and HR (P <0.05). No significant difference between ondansetron and placebo groups in the incidence of pruritus and nausea and vomiting at different times (p <0.05).
Conclusion: Dose of 8 mg of ondansetron in lower limb orthopedic surgery has no significant effect on hemodynamic symptoms as well as the prevention of postoperative nausea, vomiting and pruritus in these patients. Therefore, to achieve more results regarding the transient effect of this drug, it can be compared with other drugs in the class of HT3-5 receptor antagonists.
Majid Vatankhah Tarbebar , Saeid Kashani, Milad Mohammadi , Zohreh Nik Eghbali, Mehrdad Malekshoar,
Volume 83, Issue 6 (9-2025)
Volume 83, Issue 6 (9-2025)
Abstract
Background: Laparoscopic cholecystectomy is the gold standard for treating gallbladder diseases; however, it is associated with physiological challenges from pneumoperitoneum and specific patient positioning. Positive end-expiratory pressure (PEEP) may mitigate these effects, but the optimal level remains uncertain. This study compared the impact of three PEEP levels on respiratory performance and hemodynamic stability during laparoscopic cholecystectomy.
Methods: This randomized double-blind clinical trial was conducted at Shahid Mohammadi Hospital, Bandar Abbas, Iran, from August 2023 to February 2024. A total of 75 adult patients aged 18-70 years with ASA class I-II scheduled for elective laparoscopic cholecystectomy were assigned to three groups (n=25 each): PEEP 0 cmH₂O (control), PEEP 5 cmH₂O, and PEEP 7 cmH₂O. Standardized general anesthesia and mechanical ventilation with tidal volumes of 6-8 mL/kg were applied. Hemodynamic variables (mean arterial pressure, heart rate) and respiratory parameters (SpO₂, EtCO₂) were recorded before intubation, during intubation, and at 15, 30, and 60 minutes post-intubation, as well as in the recovery room. Arterial blood gas analysis was performed 30 minutes after intubation. Data were analyzed using ANOVA and chi-square tests with a significance level of 0.05.
Results: The mean age of patients was 41.89±11.39 years, and baseline demographic variables showed no significant differences among groups. Oxygen saturation remained above 94% across all time points without intergroup differences. EtCO₂ values differed significantly at 30 minutes (P=0.04) and 60 minutes (P=0.01), with the highest levels observed in the PEEP 7 group and the lowest in the PEEP 5 group. Although mean arterial pressure and heart rate did not show statistically significant variation among groups, the PEEP 7 group demonstrated the smallest postoperative decline in blood pressure.
Conclusion: A PEEP level of 5 cmH₂O offers the most favorable balance between maintaining oxygenation, supporting effective ventilation, and preserving hemodynamic stability during laparoscopic cholecystectomy. This level can be recommended as a safe and optimal ventilation strategy.
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