Maternal Attitude and Knowledge Regarding Painless Labor: A Report from a Referral Hospital in Northern Iran

Background

Pregnant women's knowledge about labor analgesia and the acceptance rate of this method are still undesirable in developing countries.

Objectives

This study aimed to examine pregnant women's knowledge, attitude, and acceptance of painless labor.

Methods

The present observational study was conducted in a referral university hospital in Northern Iran from September 2022 to April 2023. Eligible women were interviewed; the data were analyzed in SPSS v. 22 and expressed in numbers and percentages. A P-value < 0.05 was considered significant.

Results

The data from 369 eligible women with an average age of 30.39 ± 5.42 years were analyzed. Of these women, 7.6% had minimal information about labor analgesia, and 92.4% declared they were almost aware of the procedure. Only 6 women (1.8%) believed that the anesthesiologists were responsible for performing labor analgesia, while 218 (63.9%) considered it the duty of obstetricians-gynecologists. Besides, 294 women (86.2%) requested this method, and 259 (76%) were ready to pay for it. Moreover, 166(48.7%) had no fear of the procedure. Nonpharmacologic methods were the first choice for 164 (48.1%), while Entonox was the last choice for 26 (7.6%). A significant association was observed between maternal level of education and willingness to pay for painless delivery (P = 0.006), knowledge of who performs it (P = 0.015), requesting a painless delivery (P = 0.0001), options related to the preferred method for painless delivery (P = 0.001), and being ready to pay for a painless delivery service (P = 0.0001).

Conclusions

Despite the poor maternal knowledge regarding the process of painless labor, the majority of the women requested the method and were ready to pay for it. These promising findings encourage the application of practical strategies to remove barriers.

Role of Overcorrecting Minus Lens Therapy in Intermittent Exotropia for Prevention of Constant Exotropia in Children Under the Age of 7 Years

Background

The basis of the overcorrecting minus lens is to induce compliance and consequently prevent constant exotropia. Some previous studies advocated early surgical therapy and others suggested over-minus treatment. Our purpose is to evaluate the success rate of the over-minus lens.

Methods

This descriptive cross-sectional study was carried out on 106 patients under the age of 7 years with intermittent exotropia (IXT) who attended Amir-Al-Momenin Hospital at Guilan University of Medical Sciences, Iran. The data was gathered by a form including sex, age, level of cycloplegic refraction, the amount of deviation before and after using the over-minus glasses, visual acuity, the amount of the over-minus glasses, duration of treatment, recovery, and follow-up. The success rate was defined as decreasing exotropia to less than ten prism diopters or exophoria.

Results

A total of 106 patients with a mean age of 2.25 ± 0.74 years were enrolled in this study. The mean exotropia before and after treatment was 20.96 ± 8.20 and 12.16 ± 11.04 prism diopters, respectively, and there was a statistically significant difference (P < 0.002). The mean refractive spherical and astigmatic errors (cycloplegic refraction) were +1.34 ± 1.07 and -0.32 ± 0.72 diopters, respectively. At the end of the follow-up, exotropia increased in 5.6% of patients, there was no change in 15% of patients with a mean deviation of 25.0 ± 6.06 prism diopters, and 79.24% of patients were treated successfully.

Conclusions

According to the results of this study, treatment of IXT by over-correcting lenses can be a safe procedure and effective in preventing exotropia.

The effect of aminophylline on the recovery profile after hysterectomy: A randomized controlled double-blinded study

Background and Aims

In anesthesia practice, aminophylline is clinically used to treat bronchospasm. However, due to its antagonistic effect on adenosine, studies have recently focused on the drug's ability to enhance the recovery profile. The aim of this study was to investigate the hypothesis that the administration of aminophylline leads to better recovery after general anesthesia in hysterectomy.

Methods

This randomized controlled double-blinded study, was conducted at Alzahra academic hospital in Guilan, Iran. During December 2022 to March 2023, 70 eligible women scheduled for elective abdominal hysterectomy were divided into two groups. Group A: received 3 mg/kg IV aminophylline diluted in 100 mL of normal saline and Group C: received 100 mL IV normal saline. The time to recovery of consciousness, tracheal extubation and discharge from post anesthesia care unit were recorded. In addition, heart rate, and mean arterial blood pressure were measured at 10 point times including; baseline (T0), immediately before the administration of aminophylline (T1), every 5 min until the end of the surgery(T2,T3,T4,T5,T6), and every 15 min in PACU(T7,T8,T9).

Results

There was no significant difference in terms of demographic data between the study groups. Comparing the two groups, the time of ROC was shorter in Group A than group C; 5.95 ± 1.12 and 8.5 ± 1.77 for Groups A and C, respectively (p < 0.001). The extubation time was shorter in Group A than group C; 7.79 ± 1.48 and 10.55 ± 3.02, for Groups A and C, respectively (p < 0.001). In addition, the discharge time was also shorter in group A than Group C; 30.17 ± 5.24 and 37.57 ± 4.41 for Groups A and C, respectively (p < 0.001). Not serious side effects were reported among 71.4% of cases in Group A and 51.4% in Group C (p = 0.086).

Conclusion

Administration of aminophylline at a dose of 3 mg/kg IV improves the recovery profile after abdominal hysterectomy without serious adverse effects.

The utero-tonic effects of low dose intravenous ketamine in cesarean section under spinal anesthesia; A randomized double-blind clinical trial

Background

Recently, the prevalence of cesarean section (CS) has been on the rise and the proper uterine tone is an important issue. We investigated the effects of intravenous (IV) ketamine on intraoperative bleeding and the need for oxytocin in CS under spinal anesthesia (SA).

Methods

This study, took place at Alzahra hospital during 2020. Pregnant women candidate for elective CS under SA were divided into two groups of ketamine and placebo. In group K, after umbilical cord clamping, 0.25 mg/kg ketamine and in group P 2ccs normal saline was injected. Mean arterial pressure and heart rate were recorded at baseline, before and 5 minutes after cord clamping and at the end of the surgery. The drop in hemoglobin values, the administrated units of oxytocin and side effects were also recorded.

Results

No significant difference was found in terms of patients' demographic data (P ≥ 0.05). The mean units of administrated oxytocin in group K was 34.61±6.63 and in group P; 48.47±12.15, which was significantly different (P=0.0001). The drop in Hb was less in group K, however not statistically significant (P=0.094). The need for methergine was significantly higher in group P (P=0.0001). The mean HR was significantly higher in group P (P=0.027), however, no significant difference was observed regarding the MAP (P=0.064). The incidence of hallucination (4.8%) and nystagmus (21%) was significantly higher in group K (P= 0.0001), but nausea and vomiting were more significant in group P (P= 0.027).

Conclusion

Prophylactic administration of low-dose ketamine in CS under S.A could significantly reduce the administrated oxytocin units and the need for additional utero-tonics and was associated with less drop in Hb values.

Knowledge, attitude and practice of physicians towards herbal remedies in Rasht, north of Iran

The World Health Organization has recommended the integration of Complementary and Alternative Medicine (CAM) with modern medicine, as part of the global "health for all" approach. Herbal treatments are the most common and known methods of CAM. Based on the critical role of physicians in true and safe application of these products, this research evaluated knowledge, attitude, and practice (KAP) of physicians in Rasht towards herbal remedies. This was a cross sectional study, performed between April 2017 and May 2019 on all physicians, who worked in Rasht city, northern Iran. A researcher-made questionnaire with 2 main parts, including a demographics section and research questions was used. A total of 142 (38%) individuals responded to the questionnaires. Mean KAP scores were 6.47 ± 6.17, 27.80 ± 3.26, and 5.02 ± 5.54, respectively. In none of these fields, significant differences were seen in participants regarding demographic variables, experience, work place, academic relevance, and field of work (P > .05). Physicians of Rasht city, with different work environments and regardless of demographic characteristics, had a positive view towards herbal remedies, without enough knowledge to consult their patients.

Atracurium as an Alternative to Succinylcholine in Electroconvulsive Therapy: A Randomized Clinical Trial

Background: Electroconvulsive Therapy (ECT) is a successful treatment option for various psychiatric disorders. It is performed under general anesthesia where succinylcholine is the preferred muscle relaxant in this process. However its several contraindications and potential adverse effects, and the fact that it is not always available should be considered. Therefore, finding an effective and safe alternative is crucial. Objectives: This study aims to assess the safety and efficacy of atracurium in ECT. Materials & Methods: This single-blind clinical trial was conducted at Shafa hospital affiliated to Guilan University of Medical Sciences from November 2020 to April 2021. Participants were 67 eligible patients with ECT, randomly assigned into two groups receiving succinylcholine (0.5 mg/ kg), and atracurium (0.2 mg/kg). Seizure duration, hemodynamic parameters, the time to return to spontaneous breathing, and recovery time were assessed and compared between the two groups. Results: Seizure duration was longer in the succinylcholine group (P=0.071), while the time to return to spontaneous breathing (P=0.0001) and the recovery time (P=0.0001) were significantly longer in the atracurium group. The trend of changes in the Mean Arterial Pressure (MAP) and Heart Rate (HR) were significant over time; however, the difference between the two groups was significant only in HR one minute after the seizure induction (P=0.001). None of patients was reported serious adverse effects. Conclusion: When succinylcholine can't be used, atracurium can be a safe alternative in the ECT process.

Frequency of Pulmonary Anthracosis and its Related Factors in Autopsy Specimens in Guilan, Iran, in 2019

Background

Anthracosis is caused by several factors and is a risk factor for cancer and tuberculosis. This study investigated the prevalence of anthracosis and the associated factors in autopsy specimens from the Guilan Office of the Iranian Legal Medicine Organization.

Materials and Methods

This retrospective study examined the medical records of autopsy specimens (>18 years) in the Guilan Office of the Iranian Legal Medicine Organization in 2019 for pulmonary anthracosis. Data were extracted from the autopsy findings, and demographic characteristics, occupational information, tuberculosis or pulmonary cancer history, and anthracosis were recorded in a checklist. SPSS version 16 was used to analyze the collected data.

Results

The study included 190 autopsy specimens with a 32.1% anthracosis prevalence. Forty-five (23.7%) subjects had anthracofibrosis. Individuals with agricultural carriers or who worked in tobacco fields had the highest prevalence of anthracosis. The frequency of pulmonary cancer and tuberculosis was significantly higher in the specimens with anthracosis (anthracosis group) than in the non-anthracosis group (P<0.05). The use of traditional cooking and heating methods, as well as exposure to carbon and smoke in the workplace, were significantly higher in the anthracosis group than in the non-anthracosis group (P<0.05).

Conclusion

The results of the current study revealed that occupational exposure, tuberculosis, pulmonary cancer, and traditional indoor cooking and heating methods were all associated with anthracosis.

Comparison Between ASCVD Versus WHO Risk Score in Predicting of 10-Year Cardiovascular Risk in an Iranian Adult: A Hospital-Based Cross-Sectional Study

Cardiovascular disease (CVD) mortality has increased in the Iranian population. Word Health Organization (WHO) risk score was recently used in Iranian prevention and control of non-communicable disease programs for risk assessment. The purpose of the study was to compare the 10-year cardiovascular risk using atherosclerotic cardiovascular disease (ASCVD) and WHO risk score. In a cross-sectional study, data from patients with cardiac symptoms without any documents related to CVD were collected from the outpatient clinic. The proportion of subjects with high CVD risk according to ASCVD and WHO risk score and also agreement between two scores was presented. The sensitivity and specificity of ASCVD according to the WHO risk score as a national risk assessment tool were calculated. The study included 284 subjects with a mean age of 53.80 (8.78) years and 68 % of women. The frequency of subjects with high CVD risk based on ASCVD and WHO was 35% and 6%, respectively. The agreement between the two scores was moderate (κ=0.45), with the most agreement in identifying low-risk subjects. The sensitivity and specificity of ASCVD according to the WHO risk score was 95.3% and 75.1%, respectively. The present finding showed that Agreement between two risk scores was moderated, especially in stratifying low-risk subjects. But, the ASCVD risk score categorized more people as a high risk rather than the WHO tool. Assessment of the accuracy of the WHO risk score with comparing predicted risk with observed risk in a cohort study for the Iranian population is necessary.

Outcomes of Phaco-viscocanalostomy in Primary Open Angle Glaucoma versus Pseudoexfoliation Glaucoma

Purpose

Viscocanalostomy represents an alternative to standard penetrating glaucoma surgery. The aim of this study is to compare the outcomes of combined phacoemulsification and viscocanalostomy in eyes with primary open-angle glaucoma (POAG) versus eyes with pseudoexfoliation glaucoma (PEXG).

Methods

In this prospective non-randomized comparative study, eyes with cataract and POAG or PEXG were enrolled. Pre- and postoperative data including best corrected visual acuity (BCVA), intraocular pressure (IOP), and the number of antiglaucoma medications administered were recorded at each visit. All patients underwent phacoviscocanalostomy. Complete success was defined as the IOP of 21 mmHg or less without the administration of medication while a qualified success reported the same IOP parameters either with or without the administration of medication.

Results

Fifty-four eyes with POAG and fifty-four with PEXG underwent phacoviscocanalostomy. The mean follow-up time was 23.36 ± 8.8 months (range, 6-40 months). The mean postoperative IOP reduced significantly in both groups, although the mean IOP reduction was significantly greater in PEXG eyes (14.7 ± 8.9 vs 10.1 ± 7.7 mmHg) (P = 0.05). At the final follow-up visit, the mean postoperative IOP was 14.1 ± 2.1 and 16.6 ± 3.5 mmHg in the PEXG and POAG eyes, respectively (P = 0.001). A complete success rate of 88.9% and 75.9% was achieved in PEXG and POAG eyes, respectively (P = 0.07). The qualified success rate was 100% in the PEXG and 85.2% in POAG groups (P = 0.03).

Conclusion

Phacoviscocanalostomy achieved significant IOP reduction and visual improvement in both POAG and PEXG patients. Our results indicated that in terms of IOP reduction, this procedure was more effective in treating PEXG.

Knowledge and Attitude of the Faculty Members and Residents of Guilan University Towards Medical Errors, Barriers, and Predisposing Factors

Background: Patient safety is among the main goals in a health system. Medical errors are considered a significant threat to patient safety. An effective strategy to reduce this risk is reporting these errors even when the patient is not affected. This study investigated the main barriers to reporting medical errors and related factors. Methods: This cross-sectional descriptive study was conducted in academic hospitals afflicted with Guilan University of Medical Sciences (GUMS) in 2020. University faculty members and residents enrolled in the survey, and a questionnaire was filled out via a face-to-face interview by the responsible resident of anesthesiology. Results: Overall, 366 individuals, 156 faculty members, and 210 residents completed the questionnaires. Overall, 271 (74.2%), 134 (85.9%) faculty members, and 137 (65.6%) residents, the main barrier to report medical errors was concerning legal consequences. Furthermore, the other important factors were concerning losing job credit (63.4%) and losing the patient’s trust (61.2%). Moreover, the main predisposing factors of medical errors were high workload and a large number of patients (83.3%), long work shifts, and physicians fatigue (80.8%). High job stress and the lack of feeling of support from higher authorities (70.5%), and the lack of adequate equipment and appropriate medical facilities (56%) were the most related factors based on their perspective. Conclusion: According to the obtained findings, the main barrier to reporting medical errors was legal consequences. Moreover, the main predisposing factors were high workload, many patients, long working shifts, and physicians’ fatigue. Attempts should be made to plan programs to improve the current conditions.

Knowledge and Attitude of the Faculty Members and Residents of Guilan University Towards Medical Errors, Barriers, and Predisposing Factors

Background: Patient safety is among the main goals in a health system. Medical errors are considered a significant threat to patient safety. An effective strategy to reduce this risk is reporting these errors even when the patient is not affected. This study investigated the main barriers to reporting medical errors and related factors. Methods: This cross-sectional descriptive study was conducted in academic hospitals afflicted with Guilan University of Medical Sciences (GUMS) in 2020. University faculty members and residents enrolled in the survey, and a questionnaire was filled out via a face-to-face interview by the responsible resident of anesthesiology. Results: Overall, 366 individuals, 156 faculty members, and 210 residents completed the questionnaires. Overall, 271 (74.2%), 134 (85.9%) faculty members, and 137 (65.6%) residents, the main barrier to report medical errors was concerning legal consequences. Furthermore, the other important factors were concerning losing job credit (63.4%) and losing the patient’s trust (61.2%). Moreover, the main predisposing factors of medical errors were high workload and a large number of patients (83.3%), long work shifts, and physicians fatigue (80.8%). High job stress and the lack of feeling of support from higher authorities (70.5%), and the lack of adequate equipment and appropriate medical facilities (56%) were the most related factors based on their perspective. Conclusion: According to the obtained findings, the main barrier to reporting medical errors was legal consequences. Moreover, the main predisposing factors were high workload, many patients, long working shifts, and physicians’ fatigue. Attempts should be made to plan programs to improve the current conditions.

Knowledge, Attitude, and Performance of Pregnant Women Regarding General Anesthesia Neurotoxicity in Children under Three: A Report from an Academic Hospital

Background: Recently, concerns about general anesthesia (GA)-related neurotoxicity has been growing in societies. Parents’ information obviously plays an important role to make right decision for elective surgeries on children aged under three years old. Objectives: The aim of this survey was to evaluate the knowledge, attitude, and performance of pregnant women about the GA-related neurotoxicity in children aged under three years old. Methods: This descriptive study was conducted at Alzahra Teaching Hospital in Guilan, Iran, during 2020. The eligible pregnant women admitted to this center were interviewed, and a questionnaire containing 10 items was filled out by the responsible resident of anesthesiology. Results: In this research, a total of 361 pregnant women were enrolled and underwent a face-to-face interview. The mean age of the participants was 31.4 ± 7 years, 64.5% were living in urban areas, 82.5% were housewives, and 65.7% were multipara. Moreover, 83.7% of participants believed that receiving information in this regard was crucial, and 81.7% preferred physicians as the source of information. Only 8% of mothers had received information regarding the issue. A significant correlation was observed between the habitat, employment, the level of education, knowledge, and attitude status, and the source of receiving information. Conclusions: According to our results, the knowledge, attitude, and performance of pregnant women were not optimal and needed to be improved through practical strategies.

Pharmacological Treatments of Bell's Palsy in Adults: A Systematic Review and Network Meta-Analysis

OBJECTIVE

We aimed to simultaneously compare all available medical treatments for Bell's palsy using both direct and indirect data.

METHODS

The literature was searched from January 1, 1990, until March 1, 2020, with no language restrictions. Randomized clinical trials comparing pharmacological interventions were included in the current network meta-analysis. We estimated summary risk ratios (RRs), 95% credible interval (CrI), and the surface under the cumulative ranking curve (SUCRA) using network meta-analyses with random effects in a Bayesian framework. The primary outcomes were complete recovery in short-term (≤3 months) and intermediate/long-term (>3 months) after randomization. The secondary outcome was synkinesis.

RESULTS

In total, 21 trials comprising 2,839 participants were retrieved. In terms of good recovery, corticosteroids plus antivirals were the most effective treatment compared to placebo, with RRs ranging between 1.25 (95% CrI: 1.10, 1.43) for the short-term and 1.26 (95% CrI: 1.11, 1.45) for the intermediate/long-term recovery. For synkinesis, only corticosteroids plus antivirals (RR 0.35; 95% CrI: 0.19, 0.65) were associated with fewer synkinesis rates than placebo. The certainty of the evidence for good recovery and synkinesis was very low-low and moderate-high, respectively.

CONCLUSIONS

This network meta-analysis showed that combined therapy remains the best regimen for a good recovery outcome and the only efficacious regimen for synkinesis. More research is needed to confirm these findings. Laryngoscope, 131:1615-1625, 2021.

Investigating Risk Factors for the Development of BK Virus Infection in Kidney Transplant Recipients in Guilan Province during 2007-2015

PURPOSE

Polyomavirus nephropathy has been recognized as an important cause of silent loss of kidney transplant function in up to 50% of kidney recipients (1). The present study aimed to evaluate the risk factors associated with BK virus infection in kidney transplant recipients.

MATERIALS AND METHODS

Clinical information, urinary Decoy cells, and blood polymerase chain reaction (PCR) tests were collected for polyomavirus infection in 223 kidney transplant recipients undergoing surgery at Razi hospital at Guilan University of Medical Sciences between 2007 and 2015. Kidney biopsies were performed in patients with BKPyV- DNAemia more than 10,000 Copies/ml or increased plasma creatinine.

RESULTS

Among 223 patients, 116 (52%) were male. The mean age of participants was 49.57±13.48 years. Out of 223 participants, 41 (18.4%) had Decoy cells in their urine, and 182 (81.6%) did not, 15 of whom (6.7%) had viral genome in their blood. Only did 3 patients out of 10 have BK Virus nephropathy in their kidney biopsy. Among risk factors, it was found that post-transplant duration (P< 0.001) and the use of anti-thymocyte globulin (P= 0.001) were the most significant risk factors for finding decoy cells in patients' urine.

CONCLUSIONS

Post-transplant time, particularly the first 6 months, was found as the most important risk factor for the reactivation of polyomavirus infection in our patients because of strong immunosuppression and use of anti-thymocyte globulin (for prophylaxis or rejection treatment). It is concluded that kidney transplant recipients should be monitored in episodically after transplantation.

Systematic Review and Meta-Analysis of the Effects of Soy on Glucose Metabolism in Patients with Type 2 Diabetes

OBJECTIVE

This study aimed to assess the effects of soy consumption on glucose metabolism in patients with type 2 diabetes.

METHODS

A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Review (PRISMA) principles. Literature published between 1990 and 2019 was searched. Primary outcomes were the effect of soy on fasting plasma glucose (FPG), insulin, and HbA1c. The data were pooled using random effects models. Heterogeneity was assessed using Cochran's Q and I2 statistics. Also, the Cochrane Collaboration's tool for assessing risk of bias was used, and sensitivity analysis and meta-regression were conducted. Publication bias was evaluated using Egger and Begg tests.

RESULTS

Sixteen randomized clinical trials (RCTs) with a total of 471 participants were regarded as eligible and included in the study. Soy consumption had no significant effects on FPG, insulin, and HbA1c. After the "trim-and-fill" method was applied, soy revealed a significant effect size on FPG (adjusted Cohen's d: -0.18; p = 0.03). Also, subgroup analyses using studies with parallel design showed a significant improvement (moderate effect size) in FPG and insulin. Sensitivity analysis indicated the robustness of our findings. Among secondary outcomes, the results showed a significant effect of soy on HOMA-IR and total cholesterol levels.

CONCLUSIONS

Although this systematic review and meta-analysis indicated no beneficial effects of soy consumption on FPG, insulin, and HbA1c in patients with type 2 diabetes, pooling of parallel studies showed different results from crossover studies. The quality of evidence revealed low levels of confidence for primary outcomes. Therefore, further research is recommended.

Frequency of chemoradiotherapy-induced mucositis and related risk factors in patients with the head-and-neck cancers: A survey in the North of Iran

BACKGROUND

In this study, we aimed at evaluating the frequency of chemoradiotherapy-induced mucositis (CIM, RIM) and its related risk factors in patients with the head-and-neck cancers (HNCs).

MATERIALS AND METHODS

In this cross-sectional prospective descriptive study, we evaluated a total of 54 HNCs patients referred to the Oncology Chemoradiotherapy Department of Razi and Amiralmomenin University Hospitals of Rasht, for site and grade (WHO classification) of CIM/RIM, based on their demographic features and possible risk factors. SPSS software version 18 and statistical tests (i.e., Fisher's exact test) were used, and the level of significance was considered as P < 0.05.

RESULTS

Finally, patients enrolled in the study were 34 men and 20 women (40-72-year-old), of which 43 cases (79.6%) showed signs and symptoms of CIM/RIM (mostly aged 60-69-year-old). Grade 2 mucositis was the most frequent type (18 cases: 33.3%) and mouth floor was the most common site of CIM/RIM (15 patients: 34.9%). Age (P = 0.023), gender (P = 0.012), and the severity of pain (P = 0.018) were significantly related to mucositis in patients with HNCs who underwent chemotherapy or radiotherapy.

CONCLUSION

Mucositis, especially in the oral cavity, is a common complication of chemoradiotherapy in HNCs patients. Age, gender, and the severity of pain are significantly associated with the frequency of CIM/RIM.

Efficacy and tolerability of fourteen-day sequential quadruple regimen: pantoprazole, bismuth, amoxicillin, metronidazole and or furazolidone as first-line therapy for eradication of Helicobacter pylori: a randomized, double-blind clinical trial

The optimal pharmacological regimen for eradication of Helicobacter pylori (H. pylori) has been investigated for many years. This study aimed to evaluate the efficacy and tolerability of bismuth-based quadruple therapy (B-QT) and a modified sequential therapy (ST) regimens in eradication of H. pylori. A randomized, double-blind trial was conducted on 344 patients. Patients with H. pylori infection and without a history of previous treatment were randomized to receive 14-day B-QT (bismuth subcitrate 240 mg, pantoprazole 40 mg, amoxicillin 1000 mg, and clarithromycin 500 mg twice daily) or 14-day ST (bismuth subcitrate 240 mg, pantoprazole 40 mg, amoxicillin 1000 mg, and metronidazole 500 mg twice a day for seven days followed by bismuth subcitrate 240 mg, pantoprazole 40 mg, amoxicillin 1000 mg, and furazolidone 100 mg twice a day for additional seven days). Drug adverse effects were assessed during the study. H. pylori eradication was determined eight weeks after the end of treatment using ¹⁴C-urea breath test. Based on per-protocol and intention-to-treat, the eradication rate was significantly higher (p<0.05) in the B-QT regimen 91.9 % (95 % CI; 88.1-94.0) and 90.2 % (95 % CI; 86.3-92.9), respectively compared to the ST regimen 80.8 % (95 % CI; 76.6-84.9) and 78.1 % (95 % CI; 73.7-82.4), respectively. The severity of vomiting and loss of appetite were significantly higher in ST regimen (p<0.05). The B-QT regimen was more effective and safer than the ST regimen. Conclusively, it is suggested to assess the efficacy and safety of this regimen in longer studies, larger population, and in other communities.

General Anesthesia-Related Neurotoxicity in the Developing Brain and Current Knowledge and Practice of Physicians at Guilan Academic Hospitals

Background

Recent articles about the topic of the anesthetic agents-related neurotoxicity have currently attracted the attention to the issue in the anesthesiology community. However, specialists in other fields should also be aware of this potential risk.

Objectives

This study aimed to evaluate the knowledge and practice of physicians at Guilan academic hospitals regarding general anesthesia-related neurotoxicity.

Methods

Firstly, the responsible anesthesia resident explained the purpose of this work to Guilan faculty and residents and if they agreed to participate a questionnaire containing 12 items was filled via a face to face interview.

Results

A response rate of 100% was achieved (271 responders from 271 eligible study responders). Also, 89 (33.1%) responders were attending, 180 (66.9%) were residents, 112 (41.6%) were female, and 157 (58.4%) were male. The mean years of experience was 8.8 ± 4.82 (2 - 28 years). According to the achieved data, the majority of the precipitants did not believe in GA toxicity.

Conclusions

This paper revealed that the current curriculum does not sufficiently address the anesthesia-related neurotoxicity problem. Indeed, the need for training and communication with non-anesthesia medical colleagues was highlighted.

Correlation of corneal elevations measured by Scheimpflug corneal imaging with severity of keratoconus

Purpose

To evaluate the correlation of corneal elevation and difference elevation with severity of keratoconus.

Methods

Anterior and posterior corneal elevations with both conventional and enhanced best-fit spheres (using rotating Scheimpflug camera) were measured. Front and back difference elevation were extrapolated from difference map of Belin/Ambrỏsio Enhanced Ectasia Display of the Scheimpflug system. Data from corneal elevations and difference elevations were correlated with maximum keratometry, minimal corneal thickness, and severity of keratoconus as assessed by Amsler-Krumiech classification of keratoconus.

Results

Ninety eyes of 55 keratoconus patients of different clinical stages were evaluated. There was a significant positive correlation between keratoconus severity and corneal elevations (anterior and posterior elevation as measured with both conventional and enhanced best-fit spheres) and also between keratoconus severity and corneal elevation differences (P < 0.001 and r > 0.625 for all). Maximum keratometry (Kmax), mean keratometry (Kmean), and all corneal elevations and difference elevations were highly correlated (P < 0.001 and r > 0.840 for all). A significant negative correlation was found between minimum corneal thickness and all corneal elevations and difference elevations (P < 0.001 and r < 0.711 for all). Receiver operating characteristic (ROC) curve analyses showed that anterior and posterior difference elevations have the best predictive accuracy for grading keratoconus severity.

Conclusion

Evaluation of corneal elevation and difference elevation data obtained from Scheimpflug corneal imaging is useful for grading severity of keratoconus.

Comparison of cardiovascular risk factors among coronary artery bypass graft patients in 2010 and 2016: A single-center study in Guilan province, Iran

BACKGROUND

There has been a change in the risk factor profile of patients with coronary artery disease (CAD) in the western world. We sought to compare the risk factor profile of patients undergoing coronary artery bypass graft (CABG) surgery in northern part of Iran in 2010 and 2016.

METHODS

In a cross-sectional study, medical records of 296 CABG patients in 2010 and 500 patients in 2016 were collected from a referral university hospital in Guilan province, Iran. We compared the risk factor profile using chi-square test or independent t-test as needed in the two time points, 2010 and 2016.

RESULTS

The age of CABG patients significantly decreased from 62.49 ± 8.05 to 58.09 ± 9.20 over time. The frequency of hypertension (HTN) (66.2% vs. 59.1%, P = 0.045), diabetes mellitus (DM) (51.8% vs. 43.6%, P = 0.025), smoking (35.6% vs. 28.0%, P = 0.028), and patients with multimorbidity (31.8% vs. 26.7%, P = 0.001) increased in the second period compared to the first period of study. Whereas, the prevalence of hypercholesterolemia and positive family history of coronary heart disease (CHD) remained stable over time (49.6% vs. 49.0%, P = 0.870; 10.5% vs. 11.1%, P = 0.810, respectively).

CONCLUSION

We observed a dramatic increase in DM, HTN, and cigarette smoking as well as the multimorbidity prevalence in 2016 compared to 2010. Even with considering all study limitations, primary and secondary prevention program to decrease cardiovascular disease is required.

Reliability and Validity of the 14-point mediterranean diet adherence screener among the Iranian high risk population

INTRODUCTION: The aim of study was to assess the reliability and validity of the14-point Mediterranean Diet Adherence Screener (MEDAS) among Iranian high risk population. METHODS: Study was conducted in north of Iran a country with a Shiite majority with religious constraints, so we modified the MEDAS in the Farsi version. We applied reliability analysis using the Kuder – Richardson 20 and the alpha coefficient of Cronbach, with SPSS to interpret the effects of each item of MEDAS in its internal consistency. RESULTS: After correcting the item scores, coefficients of Kuder-Richardson-20 was calculated 0.559. The mean±SD of 13 items MEDAS was 5.73±1.88. None of Corrected Item-Total Correlation coefficients were negative. 43%, 53% and 4% participants had low, medium and high adherence to a Mediterranean diet respectively. CONCLUSION: In spite of making a few changes in questions, the coefficients of Kuder-Richardson-20 did not decrease in reliability analysis. The MEDAS was translated for the first time into Farsi. Administering this tool in future researches will help to understand how Iranian adhere to the mediterranean diet, aiming at improving cardiovascular health.

SLC6A3 polymorphism and response to methylphenidate in children with ADHD: A systematic review and meta-analysis

Methylphenidate (MPH) is the most commonly used treatment for attention-deficit hyperactivity disorder (ADHD) in children. However, the response to MPH is not similar in all patients. This meta-analysis investigated the potential role of SLC6A3 polymorphisms in response to MPH in children with ADHD. Clinical trials or naturalistic studies were selected from electronic databases. A meta-analysis was conducted using a random-effects model. Cohen's d effect size and 95% confidence intervals (CIs) were determined. Sensitivity analysis and meta-regression were performed. Q-statistic and Egger's tests were conducted to evaluate heterogeneity and publication bias, respectively. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used to assess the quality of evidence. Sixteen studies with follow-up periods of 1-28 weeks were eligible. The mean treatment acceptability of MPH was 97.2%. In contrast to clinical trials, the meta-analysis of naturalistic studies indicated that children without 10/10 repeat carriers had better response to MPH (Cohen's d: -0.09 and 0.44, respectively). The 9/9 repeat polymorphism had no effect on the response rate (Cohen's d: -0.43). In the meta-regression, a significant association was observed between baseline severity of ADHD, MPH dosage, and combined type of ADHD in some genetic models. Sensitivity analysis indicated the robustness of our findings. No publication bias was observed in our meta-analysis. The GRADE evaluations revealed very low levels of confidence for each outcome of response to MPH. The results of clinical trials and naturalistic studies regarding the effect size between different polymorphisms of SLC6A3 were contradictory. Therefore, further research is recommended.

Acupuncture for chronic nonpulsatile tinnitus: A randomized clinical trial

BACKGROUND

There is challenge to find an effective treatment for tinnitus. Few studies were done on the effects of acupuncture on tinnitus. This study evaluated the effect of acupuncture on chronic non-pulsatile tinnitus.

METHODS

This randomized double-blind clinical trial was conducted from December 2014 to September 2015. Patients suffering from chronic non-pulsatile tinnitus were randomly allocated into two groups: acupuncture vs. placebo. They were treated in 15 sessions and at the end of the fifteenth sessions and 3 weeks after completion of the treatment, visual analog scale (VAS) for tinnitus loudness and tinnitus severity index (TSI) questionnaires were completed.

RESULTS

The case group included 26 males and 18 females, and in the control group there were 27 males and 17 females: with mean age of 49.11±1.07 and 55.20±8.33 years, respectively (p=0.005). TSI and VAS before treatment were 43.84±2.81 and 9.56±0.43 in cases and 43.52±2.94 and 9.54±0.45 in controls, respectively. Both measures improved after 15 sessions in cases to 24.82±1.04 and 2.88±0.33, and to 33.16±1.24 and 7.86±0.23 in controls. The changes of TSI and VAS were significant in all groups (p<0.001). TSI and VAS in acupuncture group were lower than placebo group in each session (p<0.001), except TSI in the tenth session (p=0.392).

CONCLUSIONS

Acupuncture is effective in reducing the loudness and severity of tinnitus and can be a useful treatment for nonpulsatile chronic tinnitus.

Nutritional intake, depressive symptoms and vitamin D status in hypertensive patients in the north of Iran: A case-control study

OBJECTIVE

We investigated vitamin D status, body size, nutritional intake and depression status in hypertensive patients in the north of Iran that have special dietary habit and lifestyle according to their culture and geographical situation.

MATERIALS AND METHODS

This study was conducted on 127 patients with newly recognized hypertension and the 120 normal participants, in the north of Iran. Anthropometric data was measured and demographic characteristics, dietary intake, depression and medical status were collected by valid questionnaires. Blood samples were measured for 25-hydroxyvitamin D.

RESULTS

Hypertensive patients had significantly lower serum 25-hydroxyvitamin D than control group (16±8.7ng/mL vs. 19.8±8.4ng/mL; P=0.04). In adjusted model, serum 25-hydroxyvitamin D of less than 30ng/mL was associated with an almost 4-fold odds of hypertension. The odds of hypertension in depressed patients was 1.2 times higher than in those without depression (p=0.002). After adjusted logistic regression analysis for energy intake, significant association was observed between hypertension and some dietary nutrients, including cholesterol, fiber and vitamin D intake. There was no significant association between hypertension and body weight, waist circumference as well as BMI.

CONCLUSION

The vitamin D status was lower in the most individuals and it causes a considerable increase in the risk of hypertension. Undesirable intake of some nutrients and depression also increase the risk of developing hypertension. Health training about suitable dietary habits, easier access to vitamin D supplementation and screening for depression in patients with hypertension are cost-effective tools to improve outcomes in Iran.

The effects of oropharyngeal-lingual exercises in patients with primary snoring

Primary snoring (PS) is one of the sleep breathing disorders with suboptimal results of treatment. It is recommended that Oropharyngeal exercises can be a therapeutic choice for the patients with mild to moderate degrees of PS. We assessed the effects of oropharyngeal-lingual (OPL) exercises on patients with primary snoring (PS) referred to Amiralmomenin University Hospital, Rasht, Iran in 2012. Fifty-three patients with PS underwent the sets of OPL exercises for 3 months, 5 days a week, and 30 min a day under the supervision of a speech therapist. Severity of the snoring was assessed by use of Visual Analogue Scale (VAS) and Snoring Scale Score (SSS) criteria before and after the exercises, and data were analyzed using SPSS version 17. Mean SSS before the study was 7.01 ± 1.72, while it was 3.09 ± 2.7 after the study; and the mean VAS scores were 8.54 ± 1.89 and 4.69 ± 2.94 before and after the study, respectively (P = 0.0001). There was a significant relationship between having conflicts with roommates (P = 0.0001), duration of snoring occurrence (P = 0.0001), severity of snoring (P = 0.0001) before and after the intervention. In conclusion, doing the OPL exercises significantly decreases the severity of PS.

The role of the fragmented QRS complexes on a routine 12-lead ECG in predicting non-responsiveness to cardiac resynchronization therapy

Objective:

Cardiac resynchronization therapy (CRT) is introduced as a promising therapeutic option in heart failure (HF) patients with ventricular dyssynchrony. The challenge, however, is identifying the patients who are suitable candidates for this procedure. Fragmented QRS (fQRS) is associated with subendocardial fibrosis and myocardial scars. In this study, we aimed to evaluate the role of fragmented QRS complex on a routine 12-lead ECG as a predictor of response to CRT.

Methods:

Sixty-five consecutive patients with HF who underwent CRT, were studied. Patients’ resting 12-lead ECGs were analyzed to find presence of fQRS by a cardiologist. Echocardiographic response to CRT was defined as ≥15% decrease in left ventricular end-systolic volume (LVESV) after CRT implantation. Response to CRT was compared between patients with and without fQRS.

Results:

The study group included 27 women (41.5%) and 38 men (58.5%) with a mean (±SD) age of 62±12 years. 27 patients (41.5%) had fQRS in their basal ECGs. Totally 46 patients (70.8%) responded to CRT in a way that the mean left ventricular ejection fraction (%) significantly increased, and left ventricular end diastolic volume (LVEDV) significantly decreased after CRT (p<0.001 and p=0.001 respectively). In multivariate logistic analysis, lack of fQRS was found to be a predictor of response to CRT (OR: 4.553, 95% CI: 1.345-15.418, p=0.015).

Conclusion:

We showed that the fQRS complex, as a sign of myocardial scar, predicts non-responsiveness to CRT. Therefore, fQRS may help selecting of CRT candidates.

Reliability and validity of the Persian (Farsi) version of the Risk Perception Survey-Diabetes Mellitus

Knowledge of patients' risk perceptions is essential for the management of chronic diseases. This study aimed to assess the reliability and validity of a Persian (Farsi) language translation of the Risk Perception Survey-Diabetes Mellitus. After forward-backward translation the RPS-DM was randomly administered to 106 adult patients with diabetes who were enrolled in a teaching referral clinic in the north of the Islamic Republic of Iran (Rasht). Internal consistency and exploratory factor analysis were applied. The minimum value for internal consistency was 0.50 for risk knowledge and the highest value was 0.88 on the optimistic bias subscale. Principal component analysis showed that the items of the composite risk score matched with the same items in the English language version, except for question numbers 16, 24 and 25. The Persian version of RPS-DM is the first standardized tool for measuring risk perception and knowledge about diabetes complications in the Islamic Republic of Iran.

The family medicine specialty, learning from experience

Family medicine has been accepted as a model for Iranian health-care reform, but many debates have been raised since its establishment. Despite many successes achieved, this area of medicine is very challengeable. Family practice as a specialty is an innovation that has been introduced by the ministry of health and medical education in Iran. Although this approach seems sophisticated, learning from experience is the first step to avoid difficulties that may occur from this selection. Our goal is to declare strengths, weaknesses, opportunities, and threats of family medicine specialty.

Surveillance, control and management of infections in intensive care units in Southern Europe, Turkey and Iran--a prospective multicenter point prevalence study

OBJECTIVE

We aimed to compare the features of intensive care units (ICUs), their antimicrobial resistance patterns, infection control policies, and distribution of infectious diseases from central Europe to Mid-West Asia.

METHODS

A cross-sectional point prevalence study was performed in 88 ICUs from 12 countries. Characteristics of ICUs, patient and antibiotic therapy data were collected with a standard form by infectious diseases specialists.

RESULTS

Out of 749, 305 patients at least with one infectious disease were assessed and 254 patients were reported to have coexistent medical problems. When primary infectious diseases diagnoses of the patients were evaluated, 69 had community-acquired, 61 had healthcare-associated, and 176 had hospital-acquired infections. Pneumonia was the most frequent ICU infection seen in half of the patients. Distribution of frequent pathogens was as follows: Enteric Gram-negatives (n = 62, 28.8%), Acinetobacter spp. (n = 47, 21.9%), Pseudomonas aeruginosa (n = 29, 13.5%). Multidrug resistance profiles of the infecting microorganisms seem to have a uniform pattern throughout Southern Europe and Turkey. On the other hand, active and device-associated infection surveillance was performed in Turkey more than Iran and Southeastern Europe (p < 0.05). However, designing antibiotic treatment according to culture results was highest in Southeastern Europe (p < 0.05). The most frequently used antibiotics were carbapenems (n = 92, 30.2%), followed by anti-gram positive agents (vancomycin, teicoplanin, linezolid, daptomycin, and tigecycline; n = 79, 25.9%), beta-lactam/beta lactamase inhibitors (n = 78, 25.6%), and extended-spectrum cephalosporins (n = 73, 23.9%).

CONCLUSION

ICU features appears to have similar characteristics from the infectious diseases perspective, although variability seems to exist in this large geographical area.

Supine percutaneous nephrolithotomy: pro

PURPOSE

To share the experience of the authors with the urological family in the world by the review of literature on supine percutaneous nephrolithotomy (PCNL).

MATERIALS AND METHODS

We have searched all the available databases, including PubMed or MEDLINE and Embase Biomedical Database to find any English articles related to supine PCNL from 1998 to 2010. Of 17 studies, 11 were case series and 6 were comparative.

RESULTS

A total of 1914 patients were studied. Only the results of mean operation time were significant. Supine PCNL offers several advantages, including less operation time, less patient handling, needing only one drape, easier access to the urethra and upper calyces, facilitation of drainage of stone fragment with the Amplatz sheath, less anterior kidney displacement due to lying the kidney in its normal anatomical position, less risk of the colon injury, more tolerable for the patients with pulmonary or cardiovascular disease, and better for morbid obese patients. The overlap density of the vertebrae in the semi-supine position can be avoided. Furthermore, the fluoroscopy tube is far from the puncture site; thus, the space is open for the surgeon to work and the surgeon can perform the procedure in a more comfortable seated position.

CONCLUSION

The study showed that PCNL in the supine position is feasible. Although supine PCNL has numerous advantages, it is not routine in many surgical centers throughout the world. The practice of supine PCNL will be popular when the academic centers be encouraged to start it.