Tehran University Medical Journal

Background and Aim: With the introduction of long term subcutaneous administration of Deferoxamine there has been a decline in the morbidity and mortality of transfusion-dependent beta thalassemia patients. But parenteral iron chelation therapy is still a burden and a major reason for unsatisfactory compliance and places an additional psychological burden on the patients. There are some factors contributing to low compliance in these patients. To evaluate compliance to Deferoxamine and barriers of non adherence and assessment the prevalence of depression and it’s association with compliance.

Materials and Methods: 205 patients with major thalassemia in children medical center older than 6 years old were included. They were classified in 3 groups by compliance index (CI: No. of days of treatment per one month/No. of treatment days prescribed by physician). CI>75 % was considered good ,CI< 50-75%: moderate,CI<50%:weak and 3d group the patients without compliance. For assessment of depression: Beck Depression questionnaires were given to the patients older than 18 years old and Children Depression Inventories (CDI)“kovacs” were given to the rest

Results: Of 205 patients (110 females (54%) and 95 males (46%)), 13.3% were non compliant, 14% had poor compliance, 62.7% had good compliance. Females were more compliant than males (P=0.034). Compliance improved in older age groups meaningfully (P=0.037). There was negative association between compliance and serum ferritin level (P=0.02). 22% of children and 12% of Adults had severe depression according to the questionnaires. There was no association between compliance and depression. The most prevalent problem rgarding Desferal injection was local reactions in injection site (83%).

Conclusion: As oral chelation therapies are not used routinely, more investigations regarding the noncompliance must be considered and this method of chelation therapy must be encouraged. Compliance is a multifactorial problem, so the solution to which requires close interaction between the patient, the family and community.

Background: Lung separation is the basis of thoracic anesthesia, which is performed by different instruments. Checking probable malpositioning of tracheal tube needs fiberoptic bronchoscopy. The aim of this study was to compare respirator suggested compliance with fiberoptic findings in detecting major tracheal tube malpositioning.
Methods: A total of 256 patients undergoing thoracic surgery with double-lumen tracheal tube insertion in Imam Khomeini Hospital, Tehran, Iran, during 2010-11 were divided into three groups (n=86). We used left-sided double-lumen tube (DLT) for left or right-sided surgeries (groups 1 and 2), and right-sided DLT for left-sided surgeries (group 3). The position of the tubes was evaluated and compared using bag compliance versus fiberoptic bronchoscopy.
Results: The mean age of the study population was 44.7±13.4 (16-73) years, while 155 (59.9%) were male. The sensitivity, specificity, positive and negative predictive values, and the accuracy of bag compliance test for left-sided DLT in supine position were 40% (95% CI: 20-60%), 99% (95% CI: 96-99%), 84% (95% CI: 54-94%) 92% (95% CI: 88-95%) and 92% (95% CI: 87-95%), respectively. The above-mentioned variables for lateral decubitus position respectively were 27%, 98%, 76%, 89%, and 88%. Malpositioning was more prevalent in right-sided DLTs (P=0.02).
Conclusion: Based on the results of this study, and the high specificity, positive predictive value, and accuracy of bag compliance test, its use is encouraged as an alternative to fiberoptic bronchoscopy for checking DLT position, specially, in emergent surgeries or when fiberoptic bronchoscopy is unreachable due to lack of expertise or personnel.