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Volume 61, Issue 1 (4-2003)
Complications of Coronary artery disease remain the most common cause of morbidity and mortality after vascular surgical procedures. Goldman risk factor analysis has been suggested as peri-operative noninvasive screening method to detect significant coronary artery disease in emergent vascular procedures.
Methods and Materials: In this study, the accuracy of the Goldman scale was assessed with regard to the development of cardiac complications such as asymptomatic ischemic change in ECG, arrhythmia, myocardial infarction and cardiac death. We studied 100 patients that were required emergent vascular procedures from 2000-2001. Data about perioperative complications were extracted and analyzed using SPSS computer program.
Results: Our study indicated there is not statistical correlation between cardiac death, infarction, arrythmia, ECG change, age, sex and cardiac class.
Conclusion: We concluded that Goldman scale could not be regarded as a screening method to predict peri-operative cardiac complications in emergent vascular procedures.
Volume 62, Issue 3 (6-2004)
Background: GDM (Gestational Diabetes Mellitus) is the most important medical complication in pregnancy. Its prevalence is about 1-14 percent. It is necessary to follow up patient with GDM in order to detect any Glucose intolerance and improve their long term outcome. The aim of this research is to find the relationship between GDM and metabolic disorder (such as glucose intolerance. Lipoprotein profile disorder and androgen disorder), which are known as cardiovascular risk factors. Improvement of these agents is achieved by changing the life style.
Materials and Methods: In this study 107 patients with recent GDM were assessed 6 months after delivery. Fasting Glucose, glucose intolerance, lipid profile, and androgens were measured. Clinical and obstetrical history based on GDM recurrence, history of macrosomia, amount of insulin to control blood sugar, breastfeeding and contraception after delivery, menstrual changing, hirsutism status were assessed and analyzed statistically. (ANOVA, x2, Fisher test)
Results: The result of this study shows 19.6 percent diabetes and 15.9 percent impaired glucose tolerance test that point out significant relationship between the recurrence of GDM, obesity, macrosomia, as well as the need of more insulin in pregnancy with prevalence of Diabetes after delivery. In patents with Diabetes and IGT comparing to normal group, lipid profile disorders such as high total cholesterol, LDL cholesterol, triglyceride and low level of HDL cholesterol were seen. There was a significant relationship between diabetes after delivery and high prevalence of hypertension.
Conclusion: Considering the high prevalence of diabetes in patients with gestational diabetes and interfering of some cardiovascular risk factors. We suggest correct follow up planning of patients with GDM by health care provider after discharge, and appropriate training of biomedical personals in this field.
Volume 64, Issue 8 (8-2006)
Background: Autosomal-dominant polycystic kidney disease (ADPKD), a common hereditary disease, is characterized by the progressive development and enlargement of multiple cysts in both kidneys, and typically resulting in end stage renal disease (ESRD) by the fifth decade of life. Post-transplant diabetes mellitus (PTDM), a common complication after transplantation with an incidence rate of 2.5-20%, is associated with poor graft and patient survival. In few studies, PTDM has been more frequent in ADPKD transplanted patients. In the present study, we investigated whether there is any association between PTDM and ADPKD in our patients.
Methods: In this prospective study, 140 non-diabetic and nonsmoker successfully transplanted patients (27 ADPKD and 113 non ADPKD patients) were enrolled during three years. Both groups were matched for age, sex, body mass index (BMI), duration of renal replacement therapy before transplantation and also immunosuppressive protocols after transplant. Post-transplant diabetes mellitus was defined as Clinical Practice Guidelines advocated by Canadian Diabetes Association. All patients were followed for 12 months.
Results: PTDM occurred in 11.1% of ADPKD patients and in 13.1% of control group which was statistically insignificant (P > 0.05). The development of PTDM in ADPKD group was not related to sex, age, and hypertension, duration of renal replacement therapy before transplantation, BMI and serum creatinine levels (P > 0.05).
Conclusion: Post-transplant diabetes mellitus appears not to be associated with autosomal-dominant polycystic kidney disease as an etiology of end stage renal disease.
Volume 65, Issue 12 (3-2008)
Background: Myeloperoxidase (MPO), an iron-containing protein, is found in the azurophilic granules of neutrophils (PMNs), and catalyzes the conversion of hydrogen peroxide and chloride ions (Cl) into hypochlorous acid, which plays an important role in oxygen-dependent bacterial killing. The enzyme was first isolated in 1941, and deficiency of MPO was first described in 1954. Fewer than 5% of patients with MPO deficiency contract severe infections, which are usually fungal infections in diabetes mellitus (DM) patients. Besides the disorder in antifungal activity, diminished rate of bacterial (S. aureus) killing, and carcinogenesis, it seems that MPO deficiency is also related to atherosclerosis, degenerative neurologic diseases, as well as other disorders. In this study, we compared the levels of the MPO enzyme in the peripheral neutrophils of infected and non-infected DM patients at Imam Khomeini Hospital during 2005-2006. We compared these two groups the prevalence of MPO deficiency in each group, in order to then determine any correlations this may have with infection.
Methods: In this case-control study, 50 patients were in the infected group (case group) and 50 were in the control group. Patients were chosen using simple sampling methods. Data was gathered from blood samples, using a qualitative test to determine MPO deficiency (Kaplow stain), laboratory results (BUN, Cr, PMN, HbA1c), interviews and completion of a questionnaires, as well as hospital records. Data were analyzed with SPSS software using T test and chi-square test, with a confidence index of 0.05.
Results: In spite of differences seen in stained slides, the MPO enzyme was positive in all of the patients, and no differences were seen between the two groups.
The average patient age and the duration of DM in the case group were more than those of the control group. No statistical differences in the type of DM and glycosylated hemoglobin (HbA1c) levels were found between the two groups. Body mass indexes (BMI) and PMN counts were higher in the case group. The most prevalent infections were in the skin and soft tissue, bones and joints, as well as chronic respiratory infections (TB), pneumonia, urinary infections, CNS infections, gastrointestinal and intra-abdominal infections, mucormycosis, and sepsis.
Conclusions: We found no correlation between MPO enzyme deficiency and age, sex, type or duration of DM, HbA1c levels and BMI.
Volume 65, Issue 12 (3-2008)
Background: Proper nutrition has an important role in the physical and psychological development of children. The aim of this survey is to compare the nutrition of a community to the recommended daily amount (RDA) to determine deficiencies and present recommendations for improvement.
Methods: In this cross-sectional study conducted in Tehran, Iran, 788 children, all seven years of age, were selected via cluster sampling and evaluated using standard questionnaires with a 24-hr recall regarding the frequency and type of food intake. Then by measurement of weight and height, their anthropometric and DMFT (decayed/missing/filled teeth) indices were determined using the Kruskal-Wallis one-way analysis of variance, and Mann-Whitney U and chi-square tests.
Results: Relative to the RDA, 23.6% of children had low intake of Ca, and 3.2% and 5.2% were deficient for Fe and Zn, respectively. Anthropometric measurements showed that 15.7% were malnourished based on weight for age, 10.5% based on height for age and 16.8% based on weight for height indices. The DMFT indices for children with dietary Ca levels under 75% of the RDA were significantly higher than those with sufficient Ca intake (P<0.001). The mean DMFT indices for dental development were 0.22 for permanent teeth (four molars SD=0.64) and 4.64 for primary teeth (SD=3.24). We found a significant correlation between DMFT indices and low Fe intake: the DMFT indices of children with iron deficiency were much higher than those with sufficient iron intake.
Conclusions: Children in Tehran do not receive enough Ca Fe and Zn from their diets. This problem causes mild malnutrition and increases the risk of dental caries.
Volume 66, Issue 9 (12-2008)
Background: Urinary Tract Infection (UTI) is one of the major etiological factors of permanent kidney impairment, resulting in renal scarring and severe and pernicious side effects, such as arterial hypertension and renal failure. The purpose of this study was to clarify the impression of renal parenchyma involvement by first UTI (on the basis of acute DMSA scan) and vesicoureteral reflux (VUR-on the basis of VCUG/ RNC) on the renal scar formation (on the basis of late DMSA scan).
Methods: Children diagnosed with their first UTI at the Children's Hospital Medical Center, Tehran, Iran, were evaluated. For each patient, we recorded age, sex, results of VCUG/RNCs and acute DMSA scan, as well as those of a late DMSA scan performed 4-6 months later. The results of acute and late DMSA scans were compared along with the results of VCUG/RNCs.
Results: This study included a total of 103 children, of whom 16 (15.5%) were boys and 87 (84.5%) were girls. The mean age was 27.2±27.7 months. The frequency of renal scars in kidneys with mild (28.6%, 8.7%) and moderate (33.3%, 18.2%) pyelonephritis with or without VUR was not significantly different, while the frequency of renal scars in kidneys with severe pyelonephritis (84.6%, 23.1%) in the presence of VUR was significantly higher than non-refluxing kidneys with severe pyelonephritis (p=0.005). Furthermore, the frequency of renal scars in refluxing kidneys increased significantly with the severity of pyelonephritis (normal 8.3%, mild 28.6%, moderate 33.3%, and severe 84.6% p=0.001). This pattern was not significant in non-refluxing kidneys (0%, 10.3%, 18.2%, and 23.1%, respectively p=0.062).
Conclusion: The present study indicates that the incidence of renal scarring increases with pyelonephritis severity in patients with VUR. Furthermore, we can estimate the risk of renal scar formation from the results of acute DMSA scan and VCUG/RNC.
Volume 69, Issue 2 (5-2011)
Background: Urinary tract infection 0 in children causes renal scarring and permanent damage to the organ. In this study, we compared the diagnostic value of magnetic resonance urogram for urinary tract anomalies with other conventional imaging methods in children with UTI. Methods: In this case-control study, 190 children (mean age 3.23±3.59 yrs) with UTI were recruited from the Pediatric Ward of Rasul-e-Akram Hospital during 2007-2009. The patients were divided into two groups based on the applied imaging technique: MRU (cases) and conventional imaging groups (controls). Results: Abnormal imaging detection rates for Ultrasonography were 32%, X-ray of kidneys, ureters and bladder (KUB) 9%, Intravenous Pyelogram (IVP) 26%, Voiding Cystoure therogram (VCUG) 54%, Dimercaptosuccinic Acid scan (DMSA) indicating non-obstructive (reflux) uropathy in 76% (mean age 3.5 yrs) and MRU 43% (mean age 1.6 yrs), respectively. A meaningful correlation was observed between MRU and DMSA scan with IVP results (Kappa=0.75). KUB and Ultrasonography had similar results in cases with abnormal MRU and DMSA scan (P=0.121). MRU had strong agreement with VCUG and IVP for the detection of obstructive uropathy and scar due to congenital malformation even during intrauterine life but not with sonography results. Conclusion: Sonography had poor results for the diagnosis of urinary tract anomalies in comparison with MRU. Use of dynamic MRU for the diagnosis of congenital anomalies (hydronephrosis, obstruction, pyelonephritis, renal scar) in children with UTI seems to be of better help, although higher costs and the need for sedation during MRU still are its disadvantages
Volume 72, Issue 1 (4-2014)
Background: The intestinal absorption of fatty acids may take place through simple diffusion as well as through protein carrier mediated transport, although the relative importance of each pathway is dependent on the ambient condition of entrocytes. Cad-mium ion influences the absorption of fatty acids in entrocytes. However, the effect of cadmium ion on the absorption of fatty acids in different pH values has not been evalu-ated yet. Especially, the luminal pH of small intestine has an essential role in the ab-sorption of fatty acids. In the present study we aimed to evaluate reciprocal effects of cadmium ion and pH of intestine lumen on the absorption of fatty acids in rat model. Methods: In this experimental research, 3 months old Wistar rats (45 rats) were used for experiments. After killing the rats, their intestine was removed and the duodenum and jejunum segments were dissected. Everted Gut Sacs (EGS) were prepared from these duodenum and jejunum segments. The sacs were filled with buffer solution and incubated in a medium containing an appropriate concentration of oleic acid. Then the amounts of oleic acid that had been absorbed into the EGSs in the presence and absence of cadmium ions under different conditions of pH, was measured. Results: Findings of the study demonstrated that the luminal pH of small intestine was effective on the oleic acid uptake and the inhibitory effect of cadmium ions on the up-take of the acid was influenced by pH condition, so that this inhibitory effect was 32% and 36% at the alkaline pHs 7.5 and 9.2, respectively (P< 0.05). At the acidic pHs, 2.5 and 4.5, the inhibitory effect reduced to 11% and 5%, respectively (P< 0.05). Conclusion: Cadmium ion decreased fatty acid uptake by small intestine in rats, and the acidic pH of intestine lumen could attenuate the inhibitory effect of cadmium ion.
Volume 77, Issue 6 (9-2019)
Methods: This study was conducted using a systematic review and meta-analysis at Tehran University of Medical Science in August 2019. Seven electronic databases were searched and evaluated for original research papers published between March 2006 and 2018 on patients’ unnecessary admission to a hospital. Finally, 12 articles were selected and analyzed using comprehensive meta-analysis software.
Results: All studies used the appropriateness evaluation protocol (AEP) for assessing patients’ unnecessary hospitalization in the hospitals. Overall, 2.7% of hospital admissions were rated as inappropriate and unnecessary (CI 95%: 1.5-4.9%). The highest unnecessary patients’ admissions were 11.8% in a teaching hospital in Meshginshahr city in 2016, (CI 95%: 8.8%-15.8%) and the lowest unnecessary patients’ admissions was 0.3% in a teaching hospital in Yasuj city in 2016 (CI 95%: 0%-3.6%). Unnecessary patient admission in public hospitals was higher than private hospitals. A significant statistical correlation was observed between unnecessary patient admission, and sample size (P<0.05).
Conclusion: The rate of unnecessary hospital admission in Iran is low. However, hospital resources are wasted due to unnecessary admissions. Expanding the primary health care network, reducing hospital beds, introducing an effective and efficient patient referral system, using a fixed provider payment method, and promoting residential and social services care at macro level, and establishing utilization management committee, using the appropriateness evaluation protocol, establishing short-stay units, and implementing quality management strategies at the hospital level are useful strategies for reducing avoidable hospital admissions.
Volume 78, Issue 7 (10-2020)
Methods: This qualitative study performed by phenomenological method in three educational hospitals in Kerman from April to September of 2017. Data collection was performed through semi-structured interviews using targeted sampling among all patients who were hospitalized at internal medicine wards, nurses who were working in those wards, and in charge physicians. In total twenty patients, fifteen nurses, and five physicians were selected for interviews. The including criteria were for patients, the history of hospitalization at least once, during one month after the initial hospitalization, and for service providers, familiarity with the subject, work experience in the relevant department of at least three years for nurses and five years for physicians. A seven-step clustering method was used to analyze the data.
Results: The analysis of the interviews led to the identification of three main themes and 11 sub-themes. The main themes included patients' characteristics, manpower and clinical factors, hospital, and environmental factors. Some of the sub-codes included economic and living conditions, marriage status, insurance coverage, patients' beliefs and expectations, the presence or absence of underlying disease, education, lifestyle habits, dietary beliefs of hospitalized patients, lack of trust in medical staff, communication and cultural barriers, ignorance of service providers in treatment, lack of facilities, lack of motivation in medical staff, stressors and finally lack of hospital equipment.
Volume 78, Issue 8 (11-2020)
Methods: This cross-sectional observational study was conducted for 6 months from September 2017 to March 2018. To determine the frequency of different medication errors, a quoting sampling method was applied to select and observe 400 cases of IV drug administrations. All nurses from any studied department were included in this study. Different stages of preparation and administration of the observed drugs were compared to an instructed checklist prepared by the clinical pharmacist.
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Results: Totally, 75 nurses were recruited from ICU-1 (N=29), ICU-2 (N=18), ICU-3 (N=19), and nephrology (N=9) departments. Type of department and occupation were the influential factors on nursing errors; also, a significant relationship was found between different work shifts and the occurrence of nurses’ errors, mostly seen in the evening work shift (P=0.037). The mean of nurses’ errors in IV drug administration was not correlated with other factors including age, work history, and the number of patients managed by each one. Also, a positive correlation was found between the number of nurses in each work shift and the number of errors (P=0.008).
Conclusion: Medication errors in each stage of drug administration may lead to the hazardous clinical outcome or serious side effects such as thrombosis, infection or eventually lead to morbidity or mortality. Therefore, being aware of these errors and establishing observational policies can prevent unpleasant events related to drug administration. |
Volume 81, Issue 1 (4-2023)
Methods: This qualitative study was conducted through interviews with 26 policymakers and cosmetic surgery service providers in Tehran from April to September 2022. Sampling was purposeful and snowball. The interviews were semi-structured and thematic analysis was used to analyze the data obtained from the interviews. The inclusion criteria for the interviewees' entry were knowledge and experience in the subject and willingness to participate.
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Results: Challenges under the four categories of service providers (improper education, non-specialist providers, moral hazards, deficiencies in the way laws are written, and the ineffectiveness of the complaint handling process), service receivers (being influenced by deceptive advertisements, low level of public health literacy and lack of mental health), the place of providing services (performing surgeries in non-standard places and non-integrated information system) and medicines, products and medical equipment (insufficient control over supply, distribution and use and price fluctuations) were categorized. Experts considered the major part of the challenges to be related to the service providers. In the category of service recipients, "being influenced by deceptive advertisements" was the main problem mentioned by the experts. Performing surgeries in non-standard places, including limited surgery centers, non-sterile places, and unauthorized places, is among the unsolved problems regarding the place of providing services. In relation to medicines, products, and medical equipment, the main problem was insufficient supply, distribution, and use supervision.
Conclusion: The main effective measure to solve the challenges is to strengthen the supervision of the health system administrator with internal and external coordination and cooperation. In this regard, it is recommended to develop educational, ethical, and legal frameworks, regulate regulatory laws, public awareness, clinical interviews and psychological counseling, especially before cosmetic surgery, and the establishment of an integrated electronic health record system. |
Volume 81, Issue 10 (1-2024)
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Methods: This integrated review was performed according to Whittemore and Knafl (2005) method in five stages including problem identification, literature search, data evaluation, data analysis, and presentation. In order to find relevant articles, PubMed, Web of Science, CINAHL, Scopus databases and Google Scholar search engine were searched. The search was conducted using the keywords "stroke," "readmission," "recurrence," "re-hospitalization," "review," and "systematic review," for the period between January 2023 and September 2023, following the PRISMA guidelines. In addition to providing a qualitative synthesis of readmission factors categorized into categories, a conceptual model of these factors was also presented.
Results: Out of a total of 3785 article titles, 38 articles were included in the study for the final analysis after screening and removing duplicates. The most important risk factors for readmission in four categories: (1) knowledge deficit about the comorbidities (such as hypertension, atrial fibrillation, diabetes), (2) unhealthy diet and medicine, (3) high-risk behaviors (smoking, alcohol consumption, and tobacco use disorder), and (4) psychological distress (depression and worry about the future). In addition, the conceptual model showed that the most important preventable factor in readmission of stroke patients is of knowledge deficit about comorbidities (especially hypertension). Conclusion: The most important preventable risk factors that are effective in the readmission of stroke patients are knowledge deficit regarding clinical risk factors, especially high blood pressure, high-risk behaviors and unhealthy diet and medicine. Therefore, more detailed care and follow-up programs should be designed for stroke patients after discharge. |
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