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Mous0avi A.s, Behtash N, Karimi Zarchi M, Modarres Gilani M, Ghaemmaghami F,
Volume 65, Issue 2 (3-2008)
Volume 65, Issue 2 (3-2008)
Abstract
Background: Although endometrial cancer is primarily a disease of the postmenopausal female, 25% of patients are premenopausal, with 3-5% in women 40 years old or younger. The younger group of women with endometrial carcinoma are frequently nulligravid with a history of infertility, and a strong desire to preserve fertility. This may pose a therapeutic dilemma for both patients and treating physician.
Case report: We reported 3 young patients with atypical complex hyperplasia or early stage endometrial cancer that treated with conservative hormonal therapy.
Conclusion: Medical treatment of young patients with endometrial carcinoma and complex atypical hyperplasia who wish to preserve fertility is a reasonable and appealing option. A comprehensive evaluation prior to counseling the patient should include A complete history and physical examination. A formal D&C with review of history with an experienced gyn-onc pathologist. Evaluation of the pelvic and abdomen preferably with contrast-enhanced MRI or transvaginal ultrasound. In patients found to have a clinical stage I grade I tumor and who want to preserve fertility , thorough counseling include risks and benefits, and explanation that the data is partial and incomplete due to the lack of appropriate controlled studies is mandatory. In patients considered for medical treatment, a high dose progestin regimen should be started with endometrial sampling every 3 months until complete regression of the tumor is documented. Although most responses are long standing, there is a small risk of progression during or after cessation of progestin therapy.
Behnamfar F, Yazdani Sh, Sakhaee M,
Volume 65, Issue 8 (11-2007)
Volume 65, Issue 8 (11-2007)
Abstract
Background: The use of serial quantitative beta-human chorionic gonadotropin (β-HCG) with transvaginal ultrasound to enhance early diagnosis of ectopic pregnancy (EP) improves options for conservative treatment with methotrexate (MTX). The aim of this study was to evaluate the outcome of unruptured EP treated with a single dose of intramuscular MTX injection.
Methods: This clinical trial included 41 EP patients with specific inclusion criteria for medical treatment. For each patient, MTX (50 mg/ml) was administered intramuscularly and a repeat dose was given if the weekly decrease in the level of β-HCG was less than 15%. The therapy was considered successful if the level of β-HCG fell below 10 mIU/cc without surgical intervention.
Results: Overall, 78% of the patients were successfully treated, among whom 18.7% received second doses of MTX. Of the patients who were successfully treated, 60% presented with vaginal bleeding without pelvic pain however, of those patients in whom the treatment failed, 88% presented with pelvic pain together with vaginal bleeding. Furthermore, the presence of free peritoneal fluid on vaginal ultrasound was a significant predictor of treatment failure (p<0.005). There was no relation between the women's age, gravidity or parity, the size of the conceptus, gestational age, pretreatment serum β-HCG titer, endometrial thickness on vaginal ultrasound and the efficacy of treatment.
Conclusions: With a reasonably high success rate, we found systemic single-dose MTX treatment to be a safe, conservative therapy for EP. However, when free peritoneal fluid is noted upon transvaginal ultrasound or when the patient presents with pain, the threshold for surgical intervention may be lower.
Eslamian L, Shahsavari H,
Volume 65, Issue 12 (3-2008)
Volume 65, Issue 12 (3-2008)
Abstract
Background: There is dearth of reports from Iran regarding the prevalence of postterm pregnancy and its complications. The present study was conducted to evaluate the prevalence, management and outcome of prolonged pregnancies.
Methods: This cross-sectional study included data from the hospital records of all women referred to Shariati Hospital, Tehran, from 2001 to 2002 with pregnancies of more than 40 weeks in duration. Pregnancies ≥40-42 weeks were considered postdate and those more than 42 weeks postterm pregnancy. The data compiled from the hospital records were subjected to t, χ2 and Mann-Whitney U tests.
Results: Of the 1500 deliveries in this hospital, 98 patients were included in this study, 66.3% of whom were nullipara and 33.7% multipara. The prevalence of postterm pregnancy was estimated to be 3.3%. Cervix dilation of 2 cm or less on admission occurred in 65 women (73.3%). The mean Bishop score was 4.31. Of the 62 fetuses that underwent assessment tests, 54 (87.1%) were normal. The median time between the last test and induction of labor was 2.1 days, and 2.6 days for cesarean deliveries, which was not a significant difference (P=0.6). Cervical ripening with misoprostrol was performed in 36 cases (36.7%) and was successful in 18 cases. In this group, the median time for cervical ripening in multiparas was significantly less than nulliparas (4 vs. 7 hrs, P=0.004). Women not subjected to cervical ripening had a higher cesarean rate than those who did undergo cervical ripening (74.7% vs. 66.1%), although this difference was not significant (P=0.9). Vaginal and cesarean delivery rates showed no significant difference between cases that underwent induction with oxytocin and those subjected to cervical ripening with misoprostol (P=0.9). The mean Apgar score was 9.5, with all scores above 6. There were no cases of neonatal hypoglycemia, hypocalcemia, NICU admission or prenatal death. The mean nursery stay was 1.84 days with a range of 1-8 days.
Conclusions: The prevalence of postterm pregnancies was 3.3% in this study, due in part to erroneous estimation of gestational age. Sonography exam in the first half of pregnancy can provide a better estimation of gestational age and thereby reduce the rate of postterm pregnancy. Cervical ripening and induction of labor shorten the duration of pregnancy however, whether it has any beneficial effect on neonatal outcome remains controversial.
Sadr Momtaz N, Tabebi S J, Mahmode M,
Volume 65, Issue 13 (3-2008)
Volume 65, Issue 13 (3-2008)
Abstract
Background: Assessment of different strategic in disaster planning in selected countries. According to the international report indicating that IRAN is among the seven countries most susceptible to disaster, experiencing 31 known disasters out of 40 in the world, occurrence of 1536 moderate to severe earthquake, during 1370-80 and 712 other disasters at the same period it seems necessary to design a disaster plan.
Methods: This research is a comparative-descriptive and case based study in which the researcher used random sampling process in selecting the statistical society from both developed and developing countries. In this goal oriented research the necessary information are extracted from valid global reports, articles and many questionnaires which were subjected to scientific analysis.
Results: Studying different countries (which includes: Canada, Japan, India, USA, Turkey, Pakistan and Iran) shows that there is a direct relationship between the level of countries development and their success in disaster planning and management (including preventive measures and confrontation). In most of the studied countries, decentralized planning caused many professional planners participate in different levels of disaster management which ultimately led to development of efficient and realistic plans which in turn decreased the catastrophic effects of disasters dramatically. The results of the aforementioned countries showed that a balanced approach to disaster plan with investment in prophylactic area is very important.
Conclusion: As our country uses a centralized strategy for disaster management which has proven its ineffectiveness, the researcher suggests that we should change our approach in disaster management and let our planners participate from all levels include: provincial, rural and etc. This will led to a reality based planning and using all potential capacities in disaster management. According to this study it will be possible to use prophylactic delusions and to mitigate the outcome of threatening disasters.
I Lotfinia, M Shakere, M Shimia, B Mahbobee, O Mashrabi,
Volume 66, Issue 5 (8-2008)
Volume 66, Issue 5 (8-2008)
Abstract
Background: Chronic Subdural Hematoma (CSDH) is one of the most common challenges of neurosurgeons. Most predominant among the elderly, the incidence increases incrementally with age and might lead to permanent severe complications. The aim of this study is to outline the symptoms and signs and to compare the outcomes and complications among two groups of patients who underwent two different surgical procedures.
Methods: In a cross-sectional and descriptive-analytical study performed on 125 patients with CSDH from 2000 to 2005. Computed tomography scan was used for diagnostic imaging in all cases and magnetic resonance imaging was also obtained for six patients. In one center, group 1, which included 82 patients, underwent surgery with a single burr hole and closed drainage, and, at another center, group 2, which included 43 patients, was treated with a method using two burr holes and close drainage.
Results: Of the 125 patients, 102 were male and 23 were female. The mean age of patients was 65.79±16.41 years. The most common symptoms were weakness in extremities (78.4%), headache (72.8%) and decreased level of consciousness (24%), respectively. At presentation, 88 (70.4%) of the patients had several symptoms and 37 (29.6%) had only one symptom. A history of mild head trauma, such as falling, was observed in 83 (68%) of the patients. The interval between head trauma and the onset of symptoms ranged from 10 to 120 days (mean: 46 days). Hematoma recurred in five cases from group 1, whereas two cases from group 2 had recurrence of hematoma. Postoperative epidural hematoma developed in one case from group 2 and tension pneumocephalus also occurred in one group 2 patients.
| Conclusion: As a treatment for CSDH, the single burr hole method was significantly better than the two burr hole method. |
Sarmast Shoushtary Mh, Askarpour Sh, Asgari M, Talaiezadeh A, Sabet M,
Volume 66, Issue 11 (2-2009)
Volume 66, Issue 11 (2-2009)
Abstract
Background: Although nonoperative management is as an alternative method for surgery in the management of blunt splenic trauma, there are many contraversies in criteria for appropriate selection of the best method of management in patients. This study was conducted to find clinical and diagnostic criteria for selection of patients for surgery.
Methods: One hundred and one patients with blunt splenic injury entered in our prospective observational and cross sectional study. Patients with unstable hemodyna-mics and obvious abdominal symptoms underwent emergency splenectomy was performed. In stable patients, abdominal and pelvic CT scan with IV contrast was performed. Patients with stable hemodynamics who lack obvious abdominal symptoms, admitted in ICU ward. Patients' demographics, blood pressure changes, hemoglobin concertration, severity of trauma with injury severity score (ISS) scoring system, CT scan findings, amount of blood transfusion Hospitalization time and mechanism of injury were recorded.
Results: From 101 patients, 61(60.3%) underwent early laparotomy. 40 patients were planned for conservative management. In 30 patients (29.7%) nonoperative management was successful. In 10 patients (9.9%) This management failed and they underwent surgery. Hypotension, hemoglobin concentration dropping more than one episode and blood transfusion requirement more than one time, increased the risk of operation. Higher ISS number and ISS≥16 had a direct relation with operative management. In patients who underwent early laparotomy CT grade of injury was higher. CT findings correlated well with laparotomy findings.
Conclusion: Nonoperative management was successful in 75% of selected patients. With correct selection of patients and concerning to homodynamic status, hemoglobin concentration changes and injury severity score in conjunction with CT findings, we can use this management in greater number of patients.
Mohammad Banazadeh , Mohsen Eshraghi , Mohammad Ali Noyan Ashraf,
Volume 68, Issue 8 (11-2010)
Volume 68, Issue 8 (11-2010)
Abstract
Background: Acute Necrotizing Mediastinitis (ANM) is a lethal disease that without antibiotic therapy and surgical Intervention has a mortality rate about 40% in best medical centers. With development of imaging technology (spiral CT- Scan) and shortening in time of diagnosis and surgery, the outcome and prognosis of the patients are improved. The surgical modalities are trans- cervical and trans- thoracic approaches.
Case series: We present a series of four patients with acute necrotizing mediastinitis that admitted to thoracic surgery ward in vali-e-asr Hospital in Tehran, Iran, during years 2009 and 2010. A 31years old woman and three male patients with ages 21, 25 and 63 years. Odontogenic infection was the cause in two cases while pharyngeal perforation and cervical esophageal perforation were the causes of acute necrotizing mediastinitis the others.
Results: Mean±SD of hospitalization time was 24±6 days. Infection of cervical space (periviceral spaces) and the superior mediastinum were found in all patients while extension of infection below the carina was found in two of them. All patients were operated by trans- cervical approach. One patient was operated by trans- thoracic approach. All patients were discharged with good general condition.
Conclusion: Early usage of spiral CT- scan for diagnosis of acute necrotizing mediastinitis and early drainage with trans- cervical approach could be life saving in acute necrotizing mediastinitis patients with good results.
Hamid Reza Hemmati , Mehdi Sadat-Hashemi , Raheb Ghorbani , Toraj Jafari ,
Volume 72, Issue 12 (3-2015)
Volume 72, Issue 12 (3-2015)
Abstract
Background: Inguinal hernia is a common surgical problem which increases with aging especially in men. A common method for treatment is surgical repair using prosthesis, Lichtenstein technique. One frequent complication after inguinal herniorrhaphy is soft tissues seroma. There are several methods to prevent or to drain seroma. Some surgeons suggest the insertion of closed suction drainage system but others disagree. Methods: In this clinical trial study, 42 patients who are candidate for hernia repairing (Lichtenstein technique), referred to Amir Al-Momenin Hospital in Semnan, Iran, from 2011 to 2012, were randomly divided into two groups. So that, the list of eligible patients in the study, were numbered, and then using the patients' code, patients, who assigned an odd number in the registration list, were allocated to group 1, the remainder were placed in group two. The two first numbers in registration list (1 or 2), were randomly assigned to groups. Group 1 underwent hernia surgery without closed suction drainage and the second group underwent hernia surgery with closed suction drainage. The patients were evaluated for seroma, hematoma or wound infection after 24 hours, during days 4 to 7 and days 10 to 15 following surgery. Results: No adverse event including hematoma, seroma or wound infection occurred in either group with or without closed suction drainage in the first 10 days after surgery. Only one patient carried wound infection during days 10 to 15 following operation who was in the group with closed drainage (P=1.00). Conclusion: In this study, Seroma and hematoma was not observed in patients with and without closed suction drainage. To avoid drains' complications, indiscriminate use of antibiotics, prolonged hospital stay, we do not recommend the use of drains in this type of surgery.
Ali Mohammad Mosadeghrad , Fatemeh Khalaj ,
Volume 74, Issue 5 (8-2016)
Volume 74, Issue 5 (8-2016)
Abstract
Background: Operation theatre in a hospital requires considerable human and physical resources to deliver surgery services on an agreed schedule. However, operation theatres are sometimes underutilized due to avoidable last minute cancellations of operations. Cancellation of operations on the day of intended surgery results in operation theatre planning difficulties, hospital inefficiency and resource wastage. In addition, it causes stress for patients and their relatives and results in unnecessary hospital staying. Cancellation of planned operations could be avoided by applying appropriate management strategies and techniques. Quality management as an organizational strategy helps enhance hospital departments’ productivity.
Methods: This study aimed to reduce cancelled surgeries in Shahid Rajaei Hospital in Tehran using a quality management model. A participatory action research was used for the intervention between April 2013 and March 2014. Information on operations cancelled on the day of surgery obtained each day from the operating theatre list. Using a checklist, the reasons for operations cancellation were identified, investigated and an action plan was developed for its reduction. The plan was implemented using the action research cycle.
Results: The number of surgeries increased by 4.06 percent and operations cancellation was reduced by 32.4 percent using the quality management strategy. Surgeon and anesthetist related factors, over-running of previous surgery, changes in patient clinical status and lack of intensive care unit beds were the main reasons for cancelling surgeries. Standardization of processes, proper planning and using anesthetics clinic helped reduce the operations cancellation.
Conclusion: Last minute surgeries cancellation is potentially avoidable. Implementing an appropriate quality management model helps enhance hospital departments’ productivity and reduce surgical cancellation.
Mahboobeh Shirazi , Fatemah Azadi , Mamak Shariat , Shirin Niromanesh , Mahmoud Shirazi,
Volume 74, Issue 7 (10-2016)
Volume 74, Issue 7 (10-2016)
Abstract
Background: There are evidences that suggest the impact of stress on pregnancy outcome. Prolong antenatal depression and anxiety may cause lots of adverse pregnancy outcomes such as abortion, still birth, low birth weight and preterm labor. The aim of this pre-posttest randomized control trial study was to determine the role of stress management training in the first trimester on stress reduction in pregnant women referring to General Yas Women Hospital related to Tehran University of Medical Sciences in Tehran, Iran, from May 2014 to January 2016.
Methods: Anxiety status of 75 pregnant women in the first trimester was assessed by standard anxiety questioner using Hamilton anxiety rating score. Scores 18-25, 25-35 and >35 were considered for mild, moderate and severe anxiety, respectively. According to the level of anxiety, women with moderate and severe anxiety as the interventional group were arranged for participation in stress management workshops, applying mindfulness technique including: body scan, setting meditation and passing thought technique in 5 an hour sessions. For this experimental group were made available CD training for practicing lessons during the week. All groups didn’t need to medical treatment according to the psychiatrist interview. In the ending of therapy, clinical groups were assessed by anxiety scale again. Women with mild anxiety as the control group received only regular prenatal care without any psychological interventions. The validity and reliability of questioner were approved by experts in this field. This research was supported by Tehran University of Medical Sciences and Health Services grant and also the study approved by ethics committee of Tehran University of Medical Sciences. Data were analyzed using the statistical software SPSS version 18, and Student’s t-test analyses were performed.
Results: The level of anxiety and stress was decreased significantly between women in clinical groups, 27.5 to 14.1 for moderated level stress (P= 0.001) and 40.1 to 16.6 for high level of stress (P= 0.0001) respectively.
Conclusion: First trimester of pregnancy is a crucial stage of fetal growth and development. Based on our findings, stress management training in this period has beneficial effects on stress reduction and enhances maternal health status.
Ali Mohammad Mosadeghrad , Ensieh Ashrafi ,
Volume 75, Issue 3 (6-2017)
Volume 75, Issue 3 (6-2017)
Abstract
Background: Patient satisfaction is an important indicator of healthcare quality and effectiveness. Quality management as an organizational strategy enhances the quality of hospital services through continuously improving hospital structures and processes. This study aimed to examine the impact of quality management on patient satisfaction.
Methods: A participatory action research was conducted in respiratory intensive care unit, at Labafinejad hospital, Tehran, Iran, in 2013. A quality improvement team was established. Operational processes were improved using a quality management model. The quality improvement team standardized processes, identified quality goals for the processes and improved them until achieved quality goals. Patients’ satisfaction data was collected before and after the intervention using a valid and reliable questionnaire.
Results: Patients’ satisfaction was 75 percent at the beginning of the study. Patients were mostly dissatisfied with the nutrition services, amenities, lack of attention to their personal needs and lack of involving them in their treatment processes. An action plan was developed for improving patient satisfaction. After the quality management intervention, patient satisfaction reached to 81 percent at the end of this study. The quality management model improved the quality of services by 54.5 percent and consequently increased patient satisfaction by 7.2 percent. Almost half of the patients at the beginning of this study were definitely willing to recommend the hospital to their friends and relatives. This figure increased to 76 percent. The rest of patients stated that they may recommend the hospital to others.
|
Conclusion: Implementing an appropriate quality management model appropriately in a supportive environment helps improve the quality of services and enhance patient satisfaction and loyalty. |
Ali Mohammad Mosadeghrad , Mahnaz Afshari ,
Volume 75, Issue 10 (1-2018)
Volume 75, Issue 10 (1-2018)
Abstract
Background: Hospitals are dealing with unlimited demands and limited resources. Hospital managers should use appropriate strategies to improve quality of services, enhance patients’ satisfaction and increase financial resources. This study aimed to examine the impact of quality management.
Methods: A participatory action research was used for the intervention on income of operating theatre in Vali-e-Asr Hospital in Tehran University of Medical Sciences, between March and September 2014. A quality improvement team was established and improved operational processes of the operating theatre department of the hospital using Mosadeghrad’s ten-step quality management model. The quality improvement team standardized processes, identified goals for the processes and improved them until achieved the goals. Accordingly, an action plan was developed and implemented for increasing the income of the operating theatre department. Income data of the operating theatre department were obtained for a 6-month period in 2014, and were compared with a control 6-month period in 2013.
Results: Implementing quality management increased the number of surgeries by 14.96 percent, decreased cancelled surgeries by 14.6 percent and reduced bill deductions imposed by health insurance companies by 44.9 percent. As a result, the operation theatre department income has increased by 68.8 percent (P=0.028). Some of solutions used for increasing the income were as standardizing and improving working processes, removing unnecessary activities, empowering staff; increasing department’s working hours, on time visit of patients by doctors and surgeons, reducing surgery cancellations, increasing number of patients, reducing deductions applied by the health insurance companies and training staff and patients.
Conclusion: Implementing an appropriate quality management model appropriately helps improve quality of services and enhance hospital departments’ income.
Methods: A participatory action research was used for the intervention on income of operating theatre in Vali-e-Asr Hospital in Tehran University of Medical Sciences, between March and September 2014. A quality improvement team was established and improved operational processes of the operating theatre department of the hospital using Mosadeghrad’s ten-step quality management model. The quality improvement team standardized processes, identified goals for the processes and improved them until achieved the goals. Accordingly, an action plan was developed and implemented for increasing the income of the operating theatre department. Income data of the operating theatre department were obtained for a 6-month period in 2014, and were compared with a control 6-month period in 2013.
Results: Implementing quality management increased the number of surgeries by 14.96 percent, decreased cancelled surgeries by 14.6 percent and reduced bill deductions imposed by health insurance companies by 44.9 percent. As a result, the operation theatre department income has increased by 68.8 percent (P=0.028). Some of solutions used for increasing the income were as standardizing and improving working processes, removing unnecessary activities, empowering staff; increasing department’s working hours, on time visit of patients by doctors and surgeons, reducing surgery cancellations, increasing number of patients, reducing deductions applied by the health insurance companies and training staff and patients.
Conclusion: Implementing an appropriate quality management model appropriately helps improve quality of services and enhance hospital departments’ income.
Alireza Mahoori, Nazli Karami , Seyedeh Zahra Karimi Sarabi ,
Volume 77, Issue 9 (12-2019)
Volume 77, Issue 9 (12-2019)
Abstract
Background: Emergence from general anesthesia and removing of tracheal tube can be associated with coughing, agitation, and hemodynamic disturbances. Dexmedetomidine is an alpha two adrenoceptor agonist that has effective sedation with less cardiovascular unstability and respiratory depression and may be useful for extubation and prevention of hemodynamic response during tracheal tube removing. The aim of this study was to evaluate the effect of dexmedetomidine on hemodynamic responses during endotracheal extubation and sedation level in recovery room.
Methods: In an analytical study, fifty women aged 20-50 years old candidate to cholecystectomy under general anesthesia and tracheal intubation were entered randomly to this study in two groups (no. 25) at Imam Khomeini Hospital, Urmia, Iran, and under support of Urmia University of Medical Sciences Urmia, Iran, from May 2017 to May 2018. Ten minutes before end of surgery, 0.8 µg/kg dexmedetomidine in the study group and for the other patients in control group normal saline as placebo were infused over ten minutes. During the emergence phase, blood pressure, heart rate and oxygen saturation were recorded at 0,1,2,3 and 5 minutes after extubation. Also, sedation index was evaluated via the Ramsay sedation score and recorded at recovery room.
Results: Heart rate, systolic blood pressure and diastolic blood pressure in patient with infusion of dexmedetomidine were lower significantly at 1,2,3 and 5 minutes after extubation than control group. Data for heart rate, systolic and diastolic pressure, at min 1 after extubation were 81±6 vs. 88±9, 120.64±13.21 vs. 137.52±11.06, 72.84±8.32 vs. 81.36±9.26 in dexmedetomidine and control groups respectively. Data for heart rate, systolic and diastolic pressure, at min 5 after extubation were 73±6 vs. 80±8, 110.64±10.68 vs. 119.88±10.01, 69.84±8.32 vs. 73.48±5.13 in study and control groups, respectively. As well as 80% of the patients in dexmedetomidine group had satisfactory sedation and cooperation in compare to the 28% in control group (P=0.001).
Conclusion: Intravenous infusion of 0.8 µg/kg dexmedetomidine 10 minutes before extubation of endotracheal tube and during emergence, facilitate extubation and lead to hemodynamic stability and satisfactory sedation.
Methods: In an analytical study, fifty women aged 20-50 years old candidate to cholecystectomy under general anesthesia and tracheal intubation were entered randomly to this study in two groups (no. 25) at Imam Khomeini Hospital, Urmia, Iran, and under support of Urmia University of Medical Sciences Urmia, Iran, from May 2017 to May 2018. Ten minutes before end of surgery, 0.8 µg/kg dexmedetomidine in the study group and for the other patients in control group normal saline as placebo were infused over ten minutes. During the emergence phase, blood pressure, heart rate and oxygen saturation were recorded at 0,1,2,3 and 5 minutes after extubation. Also, sedation index was evaluated via the Ramsay sedation score and recorded at recovery room.
Results: Heart rate, systolic blood pressure and diastolic blood pressure in patient with infusion of dexmedetomidine were lower significantly at 1,2,3 and 5 minutes after extubation than control group. Data for heart rate, systolic and diastolic pressure, at min 1 after extubation were 81±6 vs. 88±9, 120.64±13.21 vs. 137.52±11.06, 72.84±8.32 vs. 81.36±9.26 in dexmedetomidine and control groups respectively. Data for heart rate, systolic and diastolic pressure, at min 5 after extubation were 73±6 vs. 80±8, 110.64±10.68 vs. 119.88±10.01, 69.84±8.32 vs. 73.48±5.13 in study and control groups, respectively. As well as 80% of the patients in dexmedetomidine group had satisfactory sedation and cooperation in compare to the 28% in control group (P=0.001).
Conclusion: Intravenous infusion of 0.8 µg/kg dexmedetomidine 10 minutes before extubation of endotracheal tube and during emergence, facilitate extubation and lead to hemodynamic stability and satisfactory sedation.
Mohammad Taghi Najafi , Mohammad Hossein Shojamoradi , Farzanehsadat Minoo ,
Volume 78, Issue 2 (5-2020)
Volume 78, Issue 2 (5-2020)
Abstract
Background: Resistant hypertension is defined when the blood pressure remains elevated above the therapeutic target levels despite the use of three antihypertensive agents including calcium channel blocker (CCB), renin-angiotensin system (RAS) blocker and a diuretic. These drugs should be used at maximally tolerated doses and white coat effect and non-adherence should also be excluded. In this article, by describing a case of resistant hypertension, we discuss a diagnostic and therapeutic approach to resistant hypertension.
Case Presentation: A 59 years old man, known case of diabetic nephropathy with a serum creatinine level of 1.2 mg/dL and proteinuria of about 3300 mg in 24 hours referred to Hypertension Clinic of Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, for evaluation of resistant hypertension. The patient was under treatment by losar-H, diltiazem, and furosemide, which are not appropriate combinations of antihypertensive agents. The ambulatory blood pressure monitoring (ABPM) of the patient revealed daytime and nighttime hypertension and also the non-dipping status of blood pressure. Dihydropyridine CCB was prescribed in combination with RAS blocker (Exforge 50 mg/ 160 mg) and the diuretic was changed to thiazide-like agents. In the next step, spironolactone and carvedilol were added for better control of blood pressure. The patient referred to the sleep clinic for polysomnography and evaluation of obstructive sleep apnea. Following three months prescription of these medications, ABPM revealed relatively appropriate control of blood pressure, so the average 24-hour blood pressure decreased from 157/91 mm Hg to 136/83 mm Hg.
Conclusion: The complications and mortality of hypertension would be increased dramatically in patients with resistant hypertension. So, an appropriate diagnostic and therapeutic approaches should be considered for these patients. Choosing appropriate diuretic agents would be important in the management of resistant hypertension.
Case Presentation: A 59 years old man, known case of diabetic nephropathy with a serum creatinine level of 1.2 mg/dL and proteinuria of about 3300 mg in 24 hours referred to Hypertension Clinic of Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, for evaluation of resistant hypertension. The patient was under treatment by losar-H, diltiazem, and furosemide, which are not appropriate combinations of antihypertensive agents. The ambulatory blood pressure monitoring (ABPM) of the patient revealed daytime and nighttime hypertension and also the non-dipping status of blood pressure. Dihydropyridine CCB was prescribed in combination with RAS blocker (Exforge 50 mg/ 160 mg) and the diuretic was changed to thiazide-like agents. In the next step, spironolactone and carvedilol were added for better control of blood pressure. The patient referred to the sleep clinic for polysomnography and evaluation of obstructive sleep apnea. Following three months prescription of these medications, ABPM revealed relatively appropriate control of blood pressure, so the average 24-hour blood pressure decreased from 157/91 mm Hg to 136/83 mm Hg.
Conclusion: The complications and mortality of hypertension would be increased dramatically in patients with resistant hypertension. So, an appropriate diagnostic and therapeutic approaches should be considered for these patients. Choosing appropriate diuretic agents would be important in the management of resistant hypertension.
Hossein Shakeri , Aliasghar Arabi Mianroodi , Mohammadali Haghbin , Narges Khanjani ,
Volume 78, Issue 3 (6-2020)
Volume 78, Issue 3 (6-2020)
Abstract
Background: A major problem in surgical procedures is postoperative pain. The effectiveness of prescribing preoperative tizanidine in reducing postoperative pain is not clear. The aim of this study was to determine the efficacy of tizanidine as a premedication in reducing pain after septoplasty.
Methods: This double blind clinical trial study was performed in 71 patients aged from 18 to 50 years, undergoing septoplastic surgery for the first time, who were classified in ASA (American Society of Anesthesiologists) classes 1 and 2 in the Ear, Nose, and Throat (ENT) Department of Shafa Hospital, in Kerman, Iran from April 2014 to March 2015. Patients were randomly assigned into two groups using numbers from a randomization table. A dosage of 4 mg of tizanidine was administered orally to the patients two hours before the surgery (septoplasty) in the intervention group. In the control group, placebo pills which were 100 mg vitamin B1 were prescribed. The severity of pain was measured and recorded after 4 and 8 hours, and the morning after the surgery.
Results: 62 patients (87.32%) were male and 9 (12.68%) were female. The mean age of the subjects was 24.6±7.5 years. The two groups were similar in regard to age (P=0.54), but the duration of surgery was different in the two groups (P=0.038) and was longer in the group that received tizanidine. The mean of pain was different between the two groups, after 4 hours and was significantly higher in the group that received tizanidine (P=0.043). The mean of pain was not significantly different between the two groups after 8 hours (P=0.95) or one day after surgery (P=0.79).
Conclusion: Although some researchers have reported that taking tizanidine before some surgeries may reduce postoperative pain, in this study the administration of tizanidine before surgery was not effective in reducing pain after septoplasty.
Methods: This double blind clinical trial study was performed in 71 patients aged from 18 to 50 years, undergoing septoplastic surgery for the first time, who were classified in ASA (American Society of Anesthesiologists) classes 1 and 2 in the Ear, Nose, and Throat (ENT) Department of Shafa Hospital, in Kerman, Iran from April 2014 to March 2015. Patients were randomly assigned into two groups using numbers from a randomization table. A dosage of 4 mg of tizanidine was administered orally to the patients two hours before the surgery (septoplasty) in the intervention group. In the control group, placebo pills which were 100 mg vitamin B1 were prescribed. The severity of pain was measured and recorded after 4 and 8 hours, and the morning after the surgery.
Results: 62 patients (87.32%) were male and 9 (12.68%) were female. The mean age of the subjects was 24.6±7.5 years. The two groups were similar in regard to age (P=0.54), but the duration of surgery was different in the two groups (P=0.038) and was longer in the group that received tizanidine. The mean of pain was different between the two groups, after 4 hours and was significantly higher in the group that received tizanidine (P=0.043). The mean of pain was not significantly different between the two groups after 8 hours (P=0.95) or one day after surgery (P=0.79).
Conclusion: Although some researchers have reported that taking tizanidine before some surgeries may reduce postoperative pain, in this study the administration of tizanidine before surgery was not effective in reducing pain after septoplasty.
Abolghasem Pourreza, Ali Mohammad Mosadeghrad , Masoumeh Parvizi-Shad ,
Volume 78, Issue 5 (8-2020)
Volume 78, Issue 5 (8-2020)
Abstract
Background: Medical errors are those mistakes committed by healthcare professionals due to wrong execution of a planned healthcare action or execution of a wrong healthcare action plan whether or not it is harmful to the patient. Medical errors may cause patients to suffer and have huge financial costs for the healthcare system. Identifying and measuring medical errors and adverse events are essential for improving patient safety. The objectives of this research were to measure medical errors and adverse events rates, to identify their severity and also analyze their underlying causes in a general educational hospital in Tehran, Iran by using The Global Trigger Tool.
Methods: A descriptive, cross-sectional, and retrospective approach was used in this study. The medical records of 377 hospitalized patients between April 2015 and March 2016 were examined using simple random sampling method. Patient’s records were reviewed by a nurse using The Global Trigger Tool. Then, a physician authenticated the findings of the adverse events and rated their severity. The causes of adverse events were identified using brain storming and Ishikawa Cause And Effect Diagram.
Methods: A descriptive, cross-sectional, and retrospective approach was used in this study. The medical records of 377 hospitalized patients between April 2015 and March 2016 were examined using simple random sampling method. Patient’s records were reviewed by a nurse using The Global Trigger Tool. Then, a physician authenticated the findings of the adverse events and rated their severity. The causes of adverse events were identified using brain storming and Ishikawa Cause And Effect Diagram.
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Results: A total of 205 triggers were detected, and 60 adverse events were identified. About 15.9 percent of patients experienced an adverse event. The rate of adverse events was 19.1 per 100 admissions and 5.7 per 100 Admission days or hospitalization days. Almost half of the adverse events were in the E and F categories (temporary harm). Bleeding, nosocomial infections, and patient fall were the leading adverse events. Employees and working processes were the underlying causes of the medical errors and adverse events. The Global Trigger Tool found 100 times more adverse events than the voluntary reporting method.
Conclusion: The adverse event rate of this study was high. Hospital managers should take appropriate actions to reduce medical errors and adverse events and enhance patient safety. The Global Trigger is a Powerful, reliable, strong tool for identifying adverse events and measuring their severity. |
Masoumeh Abbasabadi-Arab , Ali Mohammad Mosadeghrad , Hamid Reza Khankeh, Akbar Biglarian,
Volume 79, Issue 7 (10-2021)
Volume 79, Issue 7 (10-2021)
Abstract
Background: The preparedness and safety of hospitals in disasters are essential to maintain the health and survival of the community. Numerous studies have shown that the level of preparedness of Iranian hospitals is moderate and low. Lack of comprehensive hospital standards for disaster preparedness is one of the reasons. This study aimed to develop hospital accreditation standards for hospital disaster risk management.
Methods: This comparative study was conducted between April and September 2016. Hospital disaster risk management accreditation standards were extracted from the hospital accreditation standards of 11 countries including the United States, Canada, Australia, Malaysia, India, Thailand, Egypt, Turkey, Saudi Arabia, Denmark and Iran. Overall, 27 hospital disaster risk management accreditation standards were introduced. The opinions of 22 disaster risk management experts were used to assess the content validity of the proposed disaster risk management accreditation standards.
Results: Differences were observed in the quality and quantity of those countries’ disaster risk management standards. The national accreditation standards of the United States, Australia, and Canada had comprehensive standards and covered all aspects of the disaster risk management cycle. Finally, 27 standards were proposed for developing Iranian hospitals’ disaster risk management accreditation standards. The CVI & CVR validity of the proposed standards were acceptable.
There were significant differences in the quantity and quality of hospital disaster risk management accreditation standards in selected countries. The most comprehensive standards belonged to the US National Standards (12 standards and 113 sub-standards), followed by the Australian and Canadian accreditation standards. The accreditation standards of the developing countries and Iran were not comprehensive and did not meet the international goals of disaster risk management. The proposed hospital disaster risk management accreditation standards had high content validity.
Conclusion: Disaster risk management accreditation standards in Iran and developing countries need to be revised and upgraded. Comprehensive standards based on international experiences and expert opinions were introduced in this study that can be used to develop hospital accreditation standards in Iran and other countries.
Methods: This comparative study was conducted between April and September 2016. Hospital disaster risk management accreditation standards were extracted from the hospital accreditation standards of 11 countries including the United States, Canada, Australia, Malaysia, India, Thailand, Egypt, Turkey, Saudi Arabia, Denmark and Iran. Overall, 27 hospital disaster risk management accreditation standards were introduced. The opinions of 22 disaster risk management experts were used to assess the content validity of the proposed disaster risk management accreditation standards.
Results: Differences were observed in the quality and quantity of those countries’ disaster risk management standards. The national accreditation standards of the United States, Australia, and Canada had comprehensive standards and covered all aspects of the disaster risk management cycle. Finally, 27 standards were proposed for developing Iranian hospitals’ disaster risk management accreditation standards. The CVI & CVR validity of the proposed standards were acceptable.
There were significant differences in the quantity and quality of hospital disaster risk management accreditation standards in selected countries. The most comprehensive standards belonged to the US National Standards (12 standards and 113 sub-standards), followed by the Australian and Canadian accreditation standards. The accreditation standards of the developing countries and Iran were not comprehensive and did not meet the international goals of disaster risk management. The proposed hospital disaster risk management accreditation standards had high content validity.
Conclusion: Disaster risk management accreditation standards in Iran and developing countries need to be revised and upgraded. Comprehensive standards based on international experiences and expert opinions were introduced in this study that can be used to develop hospital accreditation standards in Iran and other countries.
Fereidoon Memari, Seyed Hassan Emami Razavi , Fakhredin Kiani, Zahra Khzaeipour,
Volume 79, Issue 9 (12-2021)
Volume 79, Issue 9 (12-2021)
Abstract
Background: Time management is effective in controlling stress especially for medical residents. Time management in the surgical field and residential education is very important as they are directly involved in treating patients. Proper time management will help decrease work-related stress and increase efficacy, although there is no time management in medical courses. There are few studies in Iran in this field. So, we designed this study to assess the effects of time management on improvement of educational and therapeutic services in surgical residents of Imam Hospital.
Methods: This before–after study was done in Imam hospital between February-March 2015. In this before-after study, 18 surgical residents of Imam Hospital (residents of 1-4 years), were enrolled. Their activities were evaluated in 11 scopes. To evaluate the effects of this self-evaluation, 5 scopes were assessed by the staff. The time during two weeks spent on each item was claimed as a percentage of 336 hours in two weeks. The self-assessment results and their effects on their scores were considered. Data regarding age, sex, and marital status were also gathered. Data were analyzed using SPSS software.
Methods: This before–after study was done in Imam hospital between February-March 2015. In this before-after study, 18 surgical residents of Imam Hospital (residents of 1-4 years), were enrolled. Their activities were evaluated in 11 scopes. To evaluate the effects of this self-evaluation, 5 scopes were assessed by the staff. The time during two weeks spent on each item was claimed as a percentage of 336 hours in two weeks. The self-assessment results and their effects on their scores were considered. Data regarding age, sex, and marital status were also gathered. Data were analyzed using SPSS software.
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Results: Eighteen residents were enrolled in this study. Ten residents were male (55.6%) and eight were female. Six (33.3%) were married. The mean age was 30±3.7 years. Resting time and emergency room time were significantly higher in the first-year residents while studying time was higher in the fourth-year residents. Second-year residents spend more time in training classes than others. The mean score at the beginning and the end of the study was highest in the forth-year residents and lowest in the first-year residents. All scores at the end of the study were significantly higher than the beginning except clinical judgment. The increase of the mean overall score was significantly higher in the fourth-year group and lowest in the first-year group.
Conclusion: Time management could improve the educational performance of surgical residents. |
Sahar Karimpour Reyhan , Mahsa Abbaszadeh, Alireza Esteghamati ,
Volume 83, Issue 1 (4-2025)
Volume 83, Issue 1 (4-2025)
Abstract
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Hyperthyroidism is one of the most important endocrine disorders, characterized by increased activity of the thyroid gland and excessive production of thyroid hormones. These hormones play a key role in regulating the body’s metabolism; therefore, their excess leads to a wide range of clinical manifestations. The most common symptoms include anxiety, restlessness, weight loss despite normal or even increased appetite, palpitations, excessive sweating, fine tremors of the hands, sleep disturbances, and heat intolerance. Some patients may also experience mood changes such as irritability and nervousness. On physical examination, rapid tendon reflexes, tachycardia, moist and thin skin, and in many cases the presence of goiter (thyroid enlargement) may be observed. The condition is more common in women than men and is most frequently seen between the ages of 20 and 50 years. Once hyperthyroidism is confirmed, the underlying cause of thyrotoxicosis must be determined. The most common cause is Graves’ disease, an autoimmune disorder that leads to diffuse thyroid enlargement and overproduction of hormones. Toxic multinodular goiter and solitary toxic adenoma are other important causes. For definitive diagnosis, blood tests measuring TSH, T3, and T4 are essential. In hyperthyroidism, TSH is typically suppressed while T3 and T4 are elevated. In addition to laboratory testing, thyroid ultrasound can help evaluate the structure of the gland, and a thyroid radioactive iodine uptake scan can further differentiate between different causes and determine disease activity. Several treatment options are available for managing hyperthyroidism. Antithyroid drugs such as methimazole or propylthiouracil inhibit the synthesis of thyroid hormones. Beta-blockers are often prescribed to control cardiovascular symptoms and reduce palpitations. Radioactive iodine therapy is a common and effective method that destroys the overactive thyroid tissue. In rare cases, or when other treatments fail, thyroidectomy (surgical removal of part or all of the thyroid gland) may be required. Overall, hyperthyroidism is a manageable condition, but it requires accurate diagnosis, careful selection of therapy, and close follow-up with a specialist. Patient cooperation and adherence to treatment play a crucial role in controlling symptoms and preventing long-term complications. This review will focus on describing the symptoms, causes, diagnostic methods, and treatment options.
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Fatemeh Eftekharian, Arnoosh Ghodsian, Reza Sahraei,
Volume 83, Issue 6 (9-2025)
Volume 83, Issue 6 (9-2025)
Abstract
Background: Dermatomyositis is a rare inflammatory muscle disease with systemic manifestations, in which muscle weakness, dysphagia, and pulmonary and cardiac involvement are common problems. The aim of this report is to examine the challenges and management of general anesthesia in a patient with dermatomyositis with the rare complication of buried bumper syndrome after PEG placement and gallbladder surgery.
Case Presentation: A 53-year-old male patient was referred to the operating room of Seyed al-Shohada Hospital in Jahrom for gallbladder stone surgery due to abdominal pain in April-May 2024. The patient had presented to the hospital approximately one month prior with complaints of myalgia and progressive lower limb weakness. He subsequently developed severe dysphagia. Based on clinical and paraclinical evaluations, a diagnosis of dermatomyositis was ultimately made and confirmed. Due to the swallowing difficulty, a Percutaneous endoscopic gastrostomy (PEG) tube was placed for him. His treatment regimen included high-dose corticosteroid pulse therapy and Intravenous immunoglobulin (IVIG). One month later, the patient was readmitted with acute abdominal pain. Imaging studies revealed multiple gallstones, leading to a referral to a general surgeon for operative management. Additionally, a complication related to the PEG tube, known as Buried Bumper Syndrome, was considered as a potential cause of the abdominal pain. Given the patient's history of dermatomyositis and swallowing disorder, a comprehensive re-evaluation was performed in the operating room. Cricoid pressure (Sellick maneuver) was applied to prevent aspiration. The surgery was successfully completed, and the patient remained hemodynamically stable throughout the procedure.
Conclusion: General anesthesia in patients with dermatomyositis requires careful preoperative evaluation, continuous muscle and hemodynamic monitoring, selection of appropriate doses of muscle relaxants, and use of stress doses of steroids. In addition, attention to specific complications such as buried bumper syndrome after PEG and proper airway management and prevention of aspiration are of particular importance. The present report emphasizes that multifaceted and planned management can lead to successful outcomes in these patients.
Case Presentation: A 53-year-old male patient was referred to the operating room of Seyed al-Shohada Hospital in Jahrom for gallbladder stone surgery due to abdominal pain in April-May 2024. The patient had presented to the hospital approximately one month prior with complaints of myalgia and progressive lower limb weakness. He subsequently developed severe dysphagia. Based on clinical and paraclinical evaluations, a diagnosis of dermatomyositis was ultimately made and confirmed. Due to the swallowing difficulty, a Percutaneous endoscopic gastrostomy (PEG) tube was placed for him. His treatment regimen included high-dose corticosteroid pulse therapy and Intravenous immunoglobulin (IVIG). One month later, the patient was readmitted with acute abdominal pain. Imaging studies revealed multiple gallstones, leading to a referral to a general surgeon for operative management. Additionally, a complication related to the PEG tube, known as Buried Bumper Syndrome, was considered as a potential cause of the abdominal pain. Given the patient's history of dermatomyositis and swallowing disorder, a comprehensive re-evaluation was performed in the operating room. Cricoid pressure (Sellick maneuver) was applied to prevent aspiration. The surgery was successfully completed, and the patient remained hemodynamically stable throughout the procedure.
Conclusion: General anesthesia in patients with dermatomyositis requires careful preoperative evaluation, continuous muscle and hemodynamic monitoring, selection of appropriate doses of muscle relaxants, and use of stress doses of steroids. In addition, attention to specific complications such as buried bumper syndrome after PEG and proper airway management and prevention of aspiration are of particular importance. The present report emphasizes that multifaceted and planned management can lead to successful outcomes in these patients.
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