bluuebunny/crossref_metadata_2025 huggingface dataset:
Management of Harlequin Syndrome Under ECPELLA Support
Authors: Giunta Matteo , Recchia Elisa G. , Capuano Paolo , Toscano Antonio , Attisani Matteo , Rinaldi Mauro , Brazzi Luca
Published: May 2024

The use of ECPELLA in patients with severe lung disease may result in an unfavorable phenomenon of differential hypoxia. The simultaneous evaluation of three arterial blood samples from different arterial line (right radial artery, left radial artery, ECMO arterial line) in patients at risk of Harlequin syndrome (also called differential hypoxemia (DH)) can localize the “mixing cloud” along the aorta. Focusing the attention on the “mixing cloud” position instead of on isolated flows of Veno-Arterial Extracorporeal Membrane Oxygenation (VA ECMO) and Impella CP makes the decision making easier about how to modify MCSs flows according to the clinical context. Herein, we present two cases in which ECPELLA configuration was used to treat a cardiogenic shock condition and how the ECPELLA-induced hypoxia was managed.
The effect of levosimendan on the right ventricular function in patients with right ventricular dysfunction undergoing mitral valve surgery
Authors: Bharathi K.S , Pruthi Gegal , Dhananjaya Manasa , Simha Parimala Prasanna
Published: May 2024

Background:

Right ventricular (RV) dysfunction is an important predictor of both immediate and long-term outcomes in valve surgeries. Levosimendan has proven beneficial in improving RV function.

Aims:

The objective was to study the effect of the addition of levosimendan to the conventional treatment on RV function in patients with RV dysfunction undergoing mitral valve (MV) surgeries.

Setting and Design:

Prospective randomized double-blinded controlled study at a tertiary care institution.

Materials and Methods:

Sixty adult patients aged 15–65 years, with preoperative transthoracic echocardiography (TTE) findings of RV dysfunction posted for elective MV surgery, were randomized into levosimendan (L) group and placebo (P) group. Patients in the L group were administered levosimendan at a rate of 0.1 mcg/kg/min after induction for 24 hrs, whereas patients in the P group were given multivitamin infusion at the same rate. Both the groups received standard inotropic therapy. The hemodynamic and echocardiographic parameters of RV function (RV size, Inferior vena cava (IVC) diameter, RV fractional area change (RVFAC) Tricuspid annular plane systolic excursion (TAPSE), and Systolic Pulmonary Artery Pressure (SPAP) were compared between the groups at 6 hrs, 24 hrs, and 7th day postoperatively.

Results:

All hemodynamic and echocardiographic parameters of RV function like RV size, IVC diameter, RVFAC, TAPSE, and SPAP improved from baseline to 24 hrs in both groups. Levosimendan caused a significant improvement in RV function compared to the P group at 24 hrs and 7th day postoperatively.

Conclusions:

The present study concludes that levosimendan is a promising option in patients with RV dysfunction undergoing MV surgeries.
Use of Methylene Blue to Treat Vasoplegia Syndrome in Cystic Fibrosis Patients Undergoing Lung Transplantation
Authors: Washington Gabriel C. , O’Donnell Christian T. , Madhok Jai , Williams Kiah M. , Hill Charles C.
Published: May 2024

Background:

Several studies have demonstrated the utility of methylene blue (MB) to treat vasoplegic syndrome (VS), but some have cautioned against its routine use in lung transplantation with only two cases described in prominent literature. Cystic fibrosis patients commonly have chronic infections which predispose them to a systemic inflammatory syndrome-like vasoplegic response during lung transplantation. We present 13 cystic fibrosis patients who underwent lung transplantation and received MB for vasoplegic syndrome while on cardiopulmonary bypass, with or without inhaled pulmonary vasodilator therapy.

Methods:

Single-center, retrospective, case series analysis of cystic fibrosis patients who underwent lung transplant and received MB for vasoplegia. We defined the primary outcome as 30-day mortality, and secondary outcomes as primary graft failure, 1-year mortality, postoperative complications, and hemodynamic response to MB.

Results:

MB was associated with a significant increase in mean arterial pressure (MAP) (P < 0.001) in all patients, and 84.6% (11/13) of the patients had either a decrease or no change in vasopressor requirement. No patients developed acute primary graft dysfunction and there was 100% 30-day and 1-year survival. One patient required Extracorporeal membrane oxygenation (ECMO) for hypoxemia and 69% (9/13) of the patients had evidence of postoperative right ventricular dysfunction, but no patients required a right ventricular assist device.

Conclusion:

This case series demonstrates the effectiveness of MB in treating vasoplegia in cystic fibrosis patients during lung transplantation, without evidence of primary graft dysfunction, 30-day or 1-year mortality. The safety of MB regarding hypoxemia and increased pulmonary vascular resistance requires further investigation.
Resisting Arrest
Authors: Klompas Allan M. , Kawajiri Hidetake , Sinak Lawrence J. , Pochettino Alberto
Published: May 2024

Although rare, iatrogenic aortocoronary arteriovenous fistulae (ACAVF) occur when a coronary graft is mistakenly anastomosed to an epicardial vein rather than its intended arterial target. Patients may be asymptomatic, demonstrate angina, dyspnea, arrhythmias, syncope, or diminished exercise capacity, and may have wide pulse pressures with evidence of coronary steal. A thorough insight into the disordered anatomy is critical to safely manage a patient for redo cardiac surgery, especially when attempting to arrest the heart. We present a case for redo cardiac surgery of an iatrogenic ACAVF confirmed perioperatively with multiple modalities and its intraoperative management.
Anesthetic Management for Transcatheter Aortic Valve Replacement
Authors: Hayanga Heather K. , Woods Kaitlin E. , Thibault Dylan P. , Ellison Matthew B. , Boh Roosevelt N. , Raybuck Bryan D. , Sengupta Partho P. , Badhwar Vinay , Hayanga J. W. Awori
Published: May 2024

Background:

General anesthesia has traditionally been used in transcatheter aortic valve replacement; however, there has been increasing interest and momentum in alternative anesthetic techniques.

Aims:

To perform a descriptive study of anesthetic management options in transcatheter aortic valve replacements in the United States, comparing trends in use of monitored anesthesia care versus general anesthesia.

Settings and Design:

Data evaluated from the American Society of Anesthesiologists’ (ASA) Anesthesia Quality Institute's National Anesthesia Clinical Outcomes Registry.

Materials and Methods:

Multivariable logistic regression was used to identify predictors associated with use of monitored anesthesia care compared to general anesthesia.

Results:

The use of monitored anesthesia care has increased from 1.8% of cases in 2013 to 25.2% in 2017 (p = 0.0001). Patients were more likely ages 80+ (66% vs. 61%; p = 0.0001), male (54% vs. 52%; p = 0.0001), ASA physical status > III (86% vs. 80%; p = 0.0001), cared for in the Northeast (38% vs. 22%; p = 0.0001), and residents in zip codes with higher median income ($63,382 vs. $55,311; p = 0.0001). Multivariable analysis revealed each one-year increase in age, every 50 procedures performed annually at a practice, and being male were associated with 3% (p = 0.0001), 33% (p = 0.012), and 16% (p = 0.026) increased odds of monitored anesthesia care, respectively. Centers in the Northeast were more likely to use monitored anesthesia care (all p < 0.005). Patients who underwent approaches other than percutaneous femoral arterial were less likely to receive monitored anesthesia care (adjusted odds ratios all < 0.51; all p = 0.0001).

Conclusion:

Anesthetic type for transcatheter aortic valve replacements in the United States varies with age, sex, geography, volume of cases performed at a center, and procedural approach.
Acute Acquired Immune Thrombocytopenia After Cardiac Surgery
Authors: Auci Elisabetta , Vetrugno Luigi , Riccardi Ilaria , Vendramin Igor , Livi Ugolino , Bassi Flavio , Bove Tiziana
Published: May 2024

Thrombocytopenia is a common condition that recognizes an infinite number of possible causes, especially in specific settings like the one covered in this case report: the postoperative period of cardiac surgery. We report a case of an old male with multiple comorbidities who underwent a coronary angioplasty procedure and aortic valve replacement. He showed severe thrombocytopenia in the postoperative days. Differential diagnosis required a big effort, also for the experts in the field. Our goal was to aggressively treat the patient with prednisolone, platelets, and intravenous immunoglobulins to maximize the prognosis. Our patient developed no complications and was discharged successfully.
Single Value of NephroCheck™ Performed at 4 Hours After Surgery Does Not Predict Acute Kidney Injury in Off-Pump Coronary Artery Bypass Surgery
Authors: Kanchi Muralidhar , Sudheshna Karanam D , Damodaran Srinath , Gunaseelan Vikneswaran , Varghese Anup D , Belani Kumar
Published: May 2024

Background:

Quantification of urinary tissue inhibitor of metalloproteinase-2 (TIMP-2) and insulin-like growth factor binding protein (IFGBP-7), which is commercially known as NephroCheck™(NC) test have been suggested as promising tools for the early detection of acute kidney injury (AKI) after cardiac surgery involving cardio-pulmonary bypass (CPB).

Objectives:

The aim of the present study was to test the hypothesis that single value of postoperative NC test performed at 4 hours after surgery can predict AKI in off-pump coronary artery bypass grafting (OPCABG) surgery.

Setting and Design:

This prospective single-center study was conducted at the tertiary cardiac center in India from December 2017 to November 2018.

Methods:

Ninety adult patients of both sex undergoing elective OPCABG were included. Anesthesia was standardized to all patients. Urine samples were collected preoperatively and at 4 hours after surgery for NC test. Urine output, serum creatinine, estimated glomerular filtration rate (eGFR) were also measured. AKI staging was based on kidney disease improving global outcomes (KDIGO) guidelines.

Statistical Analysis:

To assess the predictability of NC test for the primary endpoint, area under the receiver operating characteristic curve (ROC), was calculated.

Results:

Thirteen patients developed AKI in the study cohort (14.4%) out of which 7 patients (7.8%) developed stage 2/3 AKI and the remaining stage 1 AKI. Baseline renal parameters were similar between AKI and non-AKI group. The area under curve (AUC) of NC test at 4 hours after surgery was 0.60 [95% confidence interval (CI): 0.42-0.77]. Postoperative NC test performed at 4 hours after surgery did not predict AKI in this study population (P = 0.24). There were no significant differences in duration of mechanical ventilation, length of intensive care stay and hospital stay between the two groups (P > 0.05).

Conclusion:

NephroCheck™ test performed at 4 hours after surgery did not identify patients at risk for developing AKI following OPCABG surgery.
Multiparameters Associated to Successful Weaning from VA ECMO in Adult Patients with Cardiogenic Shock or Cardiac Arrest
Authors: Burgos Lucrecia María , Seoane Leonardo , Diez Mirta , Baro Vila Rocío Consuelo , Furmento Juan Francisco , Vrancic Mariano , Aissaoui Nadia
Published: May 2024

Venoarterial extracorporeal membrane oxygenation (VA ECMO) is a form of temporary mechanical circulatory support and simultaneous extracorporeal gas exchange for acute cardiorespiratory failure, including refractory cardiogenic shock (CS) and cardiac arrest (CA). Few studies have assessed predictors of successful weaning (SW) from VA ECMO. This systematic review and meta-analysis aimed to identify a multiparameter strategy associated with SW from VA ECMO. PubMed and the Cochrane Library and the International Clinical Trials Registry Platform were searched. Studies reporting adult patients with CS or CA treated with VA ECMO published from the year 2000 onwards were included. Primary outcomes were hemodynamic, laboratory, and echocardiography parameters associated with a VA ECMO SW. A total of 11 studies (n=653) were included in this review. Pooled VA ECMO SW was 45% (95%CI: 39–50%, I2 7%) and in-hospital mortality rate was 46.6% (95%CI: 33–60%; I2 36%). In the SW group, pulse pressure [MD 12.7 (95%CI: 7.3–18) I2 = 0%] and mean blood pressure [MD 20.15 (95%CI: 13.8–26.4 I2 = 0) were higher. They also had lower values of creatinine [MD –0.59 (95%CI: –0.9 to –0.2) I2 = 7%], lactate [MD –3.1 (95%CI: –5.4 to –0.7) I2 = 89%], and creatine kinase [–2779.5 (95%CI: –5387 to –171) I2 = 38%]. And higher left and right ventricular ejection fraction, MD 17.9% (95%CI: –0.2–36.2) I2 = 91%, and MD 15.9% (95%CI 11.9–20) I2 = 0%, respectively. Different hemodynamic, laboratory, and echocardiographic parameters were associated with successful device removal. This systematic review demonstrated the relationship of multiparametric assessment on VA ECMO SW.
Role of Epigenetics Variation with Focus on DNA Methylation in Triple-Negative Breast Cancer Patients
Authors: Reddy G. Deepthi , Brahmaiah V. , Kavitha B. Y. , Nethagani Jayalatha , Palaparthi Elizabeth Caroline , Lebaka Rajasekhar Reddy , Deepika G.
Published: May 2024

Triple-negative breast cancer (TNBC) is distinguished by the absence of human epidermal growth factor 2 receptors, estrogen, and progesterone. Due to its destructive character and inability to be treated with current endocrine medications, it has one of the worst prognoses of any breast cancer subtype. The only therapies available are chemo-and/or radiation and surgery, which necessitates the development of new biomarkers or therapeutic targets. Due to of their inherent inclination to operate as antisense regulators and interactors of whole gene set implicated in cancer, microRNAs (miRNAs) are a potential target for TNBC-focused therapy. In this paper, we summarize the role of epigenetics variation with a focus on DNA methylation in TNBC patients. Other biomarkers alterations and interactions with miRNAs may lead to the identification of novel therapy options for TNBC in the future as well.
Prevalence of obesity and physical inactivity in Assam, India: Findings from cancer risk factor monitoring survey
Authors: Nath Anita , Barman Debanjana , Sharma Arpita , Lahon Ranjan , Misra Chinmoy
Published: May 2024

Physical inactivity and obesity have been causing a serious health risk mostly in developed countries, but the threat has also been in the low- and middle-income countries. According to the World Health Organization, excessive fat deposition in the body results in overweight and obesity. Many chronic illness such as type 2 diabetes, cardiovascular disease, and cancer as well are attributed due to obesity. Physical activity has tremendous health benefits in preventing noncommunicable diseases such as cardiovascular diseases, cancer, and diabetes and is a means of primary prevention. The aim of the survey was to generate the prevalence of insufficient physical activity, overweight, and obesity as cancer risk factors and estimate health system response in Assam, Northeastern Region of India.

MATERIALS AND METHODS:

This survey was undertaken as a part of Cancer Research in the North East Region, a multidisciplinary program run by the ICMR-NCDIR, Bengaluru, to prevent and control cancer in the northeastern states. The survey adapted the multistage cluster random sampling method for the cancer profile in the PBCR covering areas in Assam. Study Population – The target population for the survey was defined as all residents aged 18 years or above.

RESULTS:

The percentage of prevalence of overweight (body mass index [BMI] ≥25.0) by place of residence shows that 21.8% were urban and 11.5% were rural. Gender wise, 10.9% were male and 17.4 were female, of the total 14.1%. Prevalence of obesity (BMI ≥30.0) by place of residence shows 4.3% urban 1.3% rural, while in terms of gender, 1.5% of males and 2.8% of females. The total percent is 2.1%. 95.0% have sufficient physical activity and 5.0% have insufficient physical activity.

CONCLUSION:

The high prevalence of good physical activity, low prevalence of obesity and overweight and higher prevalence of tobacco consumption in these areas reflect the leading sites of cancers in the registries in Assam. Lifestyle modification and behavioral changes can significantly reduce the burden of cancer and improve health benefits.
Association between QTc-interval prolongation and increased risk of cardiac arrhythmia in critically ill patients
Authors: Othman Youssef A. , Khalil Nahla S. , El-Sharkawy Fatma M. , Sayed Mohammed S.
Published: May 2024

Background

Prolongation of the QT interval is associated with lethal arrhythmias. Early identification of QT/QTc prolongation followed by appropriate clinical interventions can avert this potentially lethal arrhythmia.

Aim of the study

To assess the association between QTc-interval prolongation and increased risk of cardiac arrhythmia in critically ill patients.

Research design

A descriptive correlational research design was utilized.

Setting

The study was conducted in the Critical Care Department, Al-Manial University Hospital, Cairo University.

Patients and methods

A purposive sample consisted of 270 adult patients.

Tools of data collection

An assessment sheet consists of two parts: part I: patients’ demographic and medical data, and part II: QT-interval monitoring sheet.

Results

The mean age of the study sample was 60.16±16.05, and 53.3% were males. Also, there was a statistically significant difference in patients’ QTc mean through five observations (f=19.086; P≤0.001). Moreover, there was no significant statistical difference in patients’ QT average means through five observations by their laboratory investigations and their diagnosis (P>0.05, P=0.133), respectively.

Conclusion

The highest prolongation of QTc was in torsade de pointes, and the lowest QTc prolongation was in atrial fibrillation.

Recommendation

Nursing assessment of critically ill patients in association with QTc calculation for early detection of lethal cardiac arrhythmia.
The effect of digital citizenship and cyberloafing on under graduate nursing students academic performance
Authors: Mohamed Sara A.A. , Al- Fattah Magda A. A.-H. A. , Ragab Om Hashem G.
Published: May 2024

Background

Nursing students must be adequately aware by digital citizenship to avoid cyberloafing that directly influence on their academic performance.

Aim of the study

This study aimed to assess the effect of digital citizenship and cyber loafing on under graduate nursing student’s academic performance.

Design

A descriptive, cross-sectional correlational research design was used.

Setting

The study was conducted at Faculty of Nursing Sohag University.

Subjects

870 nursing students were selected randomly by using stratified random sample technique.

Tools

Four tools were used: Personal characteristics and academic data form, digital citizenship questionnaire, cyber Loafing questionnaire and under graduate nursing students’ academic performance audit form.

Results

The current study revealed that nearly two thirds (66.2%) of the studied students had average level of digital citizenship, less than three fifths (58.9%) of the studied students had high level of cyber Loafing and more than two fifths (42.1%) of the studied students have high level of academic performance.

Conclusion

There was a highly statistically significant negative correlation between the students’ academic performance and cyber loafing, also there is statistically significant positive correlation between the total studied students’ academic performance and digital citizenship.

Recommendations

Provide educational program for students about negative effect of cyber loafing and Provide special course about digital citizenship for faculty student.
Relationship between authentic leadership style and staff nurse’s loyalty
Authors: Ali Azza M. , El-Molla Magda , Gaber Shreen
Published: May 2024

Background

Nowadays, achievement of staff nurse’s loyalty is a critical problem that worries health organization and head nurses. Several ways are proposed to solve this problem, through improving leadership styles, especially authentic style.

Aim

To assess the relationship between authentic leadership style and staff nurse’s loyalty.

Design

A descriptive correlational design was used.

Setting

The study was conducted at New Kasr El-Aini University Hospital, Cairo University, Egypt.

Patients

A convenient sample of 200 staff nurses was selected to participate in the study.

Tools Two tools were used: (a) staff nurses’ loyalty questionnaire and (b) authentic leadership style questionnaire.

Results

The current study revealed that staff nurses’ perception of the authentic leadership style levels showed low level (48%) among their leaders, and nearly half (49.05%) of staff nurses had low loyalty level. In addition, the current study revealed that there was a statistically significance correlation between authentic leadership styles and loyalty (P<0.05).

Conclusion

The study concluded that there was a statistically significant correlation between head nurses’ authentic leadership styles and staff nurse’s loyalty.

Recommendations

A strategic plan should be created by hospital management to increase nurses’ loyalty. Hospital administrators should select head nurses based on pre-requisite criteria not only based on their years of experience, on their capabilities as a leaders to lead others in their job, and on their level of goal achievement as a leader.
Sample Management Errors in a Multispecialty Hospital-based Blood Bank
Authors: Alcantara Jerold Casem
Published: May 2024

ABSTRACT

Background and Objectives:

Specimen labeling errors along with incorrect patient identification have been described as among the most complex and demanding occurrences in laboratory diagnostics. The study aimed to describe the rates of sample identification and labeling errors in the blood center of a multispecialty hospital and identify possible measures to reduce them.

Methods:

A retrospective document review and analysis of sample identification and labeling errors were conducted in a Blood Bank Laboratory in Saudi Arabia for 4 years. The quality assurance database from the laboratory information system was used to access and review all relevant information. The one-way analysis of variance was employed to check the statistical differences between the laboratory errors and other variables in the study. The significance level was set at P < 0.05.

Results:

Overall, 74,279 samples and laboratory requests were received, with over 3107 canceled requests and rejected samples. An error rate of 0.43% was due to incorrect identification and labeling. This accounts for 10.2% of the total canceled tests. The annual labeling error ranges from 0.26% to 0.73%. Primarily, the errors were due to incomplete data (0.37%) and were noted as the leading type of error in all the departments. More than half (51.3%) of the errors happened in type and screen tests, whereas a significant proportion was also noted in crossmatch red blood cells (31.9%).

Conclusions:

The rate of sample identification and labeling errors in this study was comparable to established data and was primarily due to incomplete data or labels. Identification and labeling errors are most common in type and screen testing and crossmatch. Carefully monitoring specimen labeling quality continually can lower specimen labeling errors and determine improvements.
Blood Group Discrepancy in a Donor Due to a Rare Ax/Aweak Subgroup Phenotype with ABO*AW.31.01/*O.01.75 Genotype
Authors: Babaria Sneha Samir , Purohit Asha , Patel Vidhi S.
Published: May 2024

ABSTRACT

The most crucial blood group system in transfusion medicine is still the ABO system. Any unresolved discrepancy could result in the patient receiving blood that is incompatible and could trigger acute intravascular hemolysis. ABO subgroups are one of the astounding differences in blood grouping. The amount of A and B antigens carried by red blood cells and present in secretion varies depending on the ABO subgroup phenotype. Clinically, A1 and A2 are the two most frequently observed subtypes. Many weaker A subgroups have been described, including A3, Axe, am, and el. This example involves an Indian male donor who was initially misclassified as a Group O individual before being identified as an Ax/Aweak subgroup phenotypically. The next-generation sequencing defined the genotype of this case as ABO*AW.31.01/*O.01.75.
Pretransfusion Testing and Daratumumab: Assessing Interference Risks and Developing Solutions
Authors: Rajput Saroj , Chatterjee Tathagata , Bhargava Rahul , Rai Sanjay
Published: May 2024

ABSTRACT

Daratumumab is a monoclonal antibody; anti-CD38 is used for the treatment of multiple myeloma and other hematological disorders. Daratumumab, binds to CD 38 on red blood cells (RBCs), interfering with pretransfusion testing. This interference can lead to cross match incompatibility and panreactive indirect Antiglobulin tests (IAT).Panreactive IAT can mask presence of underlying clinically significant alloantibodies, especially in patient with history of multiple blood transfusions. This can lead to delays in transfusion, increased risk of transfusion reaction and potential risk for transfusion recipients. Daratumumab induced potential serological interference needs to be resolved by using appropriate methodologies like dithiotheritol (DDT) and enzymatic treatment of reagents or donors cells to overcome these incompatibilities. Effective communication between clinical practitioners and blood centre before starting daratumumab therapy can prevent unnecessary workload and delay in transfusion. Here, we describe the case of interference in prretransfuison testing caused by Daratumumab in the red cell compatibility testing of a patient with severe aplastic anemia and strongly positive DSA levels.
Multimodal Approach for the Treatment of Extensive Bilateral Iliofemoral Deep Vein Thrombosis
Authors: Gupta Kartik Chandrakant , Sawant Vivek , Srivastava Apurva , Bedi Varinder Singh
Published: May 2024

Iliofemoral vein thrombosis is the primary cause of deep vein thrombosis (DVTs) in the lower extremities in around 25% of the cases. Restoration of venous outflow is the primary goal in the management of DVT which can be achieved by combined endovascular techniques such as balloon venoplasty and/or stenting, thrombectomy, and pharmacomechanical thrombolysis. At presently, percutaneous mechanical thrombectomy (PMT) devices, such as rheolytic thrombectomy device, are replacing conventional approaches for clot removal. Although the use of rheolytic thrombectomy device for DVT is associated with the risk of intravascular hemolysis, we report a safe and successful use of multimodal approach using rheolytic thrombolytic device for the management of a case of bilateral iliofemoral DVT. In our study, we noticed early relief in pain and reduced lower limb edema in a week with a reduced dose of thrombolytic agent and hospital stay in a 44-year-old male who was admitted with bilateral extensive iliofemoral DVT using a multimodal approach.
A Fuzzy BWM-TOPSIS Framework for Identifying and Prioritizing Measures to Overcome Obstacles to the Regionalization of Iranian Healthcare Services
Authors: Zare Zahra , Haqbin Arash , Kalavani Khalil , Shojaei Payam
Published: May 2024

Background:

One of the most effective strategies to improve the access of community members to health services is to regionalize health services. The purpose of this study is to examine and prioritize measures that could help to counteract obstacles and problems in implementing the regionalization of healthcare in Iran.

Methods:

The study relied on a mixed research method, including qualitative and quantitative phases. First, by conducting semi-structured interviews and analyzing them through qualitative content analysis, the obstacles and measures were identified. In the quantitative phase, the obstacles identified were weighted using the fuzzy best-worst method (FBWM), and the measures were then prioritized through the fuzzy TOPSIS (FTOPSIS) method.

Results:

The obstacles were categorized into four main dimensions: “infrastructural,” “political,” “human resources,” and “managerial.” Among the 15 obstacles identified, “absence of performance guarantees” was the most important obstacle, while “insufficient education” was the least important obstacle to the regionalization of healthcare services in Iran. Meanwhile, the following eight measures that could help to overcome the obstacles were extracted from the interviews: “conducting a needs assessment,” “providing clinical guidelines,” “employing specialized human resources,” “reinforcing the referral system,” and “preparing electronic health records,” “enhancing education and information dissimilation,” “building executive support,” and “providing cost-effective equipment and technology.” “Employing specialized human resources” was also the most effective measure to overcome the obstacles.

Conclusions:

Iranian healthcare policy-makers can use the empirical findings of this investigation to accelerate the implementation of Iran's regionalization plan to improve the access of community members to healthcare services.
Presenting a Quaternary Prevention Model for the Rural Family Physician Program in Iran with an Interpretive Structural Modeling Approach
Authors: GhorbaniNia Rahil , Hekmat Somayeh Noori , Dehnavieh Reza , Bahaadinbeigy Kambiz , Arab-Zozani Morteza
Published: May 2024

Background:

Due to its ethical approach and its protection of patients and their interests, quaternary prevention can increase the quality-of-service provision and decrease costs and the wastage of resources. The present study used interpretive structural modeling (ISM) to classify the effective factors and determine a quaternary prevention model for Iran's Rural Family Physician Program.

Methods:

This study was a qualitative study with an ISM approach. Twenty-five health system experts and faculty members participated in the study. The interrelationships between the factors were determined using ISM, and after classification, the driving and dependence power of the factors were specified using MICMAC analysis.

Results:

The 20 factors were classified into five levels. The results indicated that patient interest and vulnerable groups had the highest effectiveness, and officials' and policymakers' commitment to providing serious support for family physicians had the highest affectability. The factors were placed into the two groups of linkage and dependence based on the MICMAC analysis.

Conclusions:

The new technologies are costly and sometimes only suitable for a specific group of patients. Costs and the issues of induced demand and defensive medicine necessitate a different view of health service distribution. The preventive and strategic view and the comprehensiveness of family physician services make quaternary prevention possible by providing high-risk and vulnerable groups with essential services based on patient needs and conditions with more benefit than harm.
Application of “Human Factor Analysis and Classification System” (HFACS) Model to the Prevention of Medical Errors and Adverse Events: A Systematic Review
Authors: Jalali Mahdi , Dehghan Habibollah , Habibi Ehsanollah , Khakzad Nima
Published: May 2024

Hospitals, as one of most important subsectors in human societies, are responsible for providing safe and effective medical services to clients. But sometimes these hospitals are the source of injury and death in patients by creating medical errors. In this systematic review study, the application of human factor analysis and classification system (HFACS) method in the classification of medical errors was investigated. Major electronic databases including Scopus, Web of Science, and MEDLINE were searched. All studies that investigated the application of HFACS method for coding, causation, and classification of medical errors and adverse events conducted from 2001 until February 2021 were included. A total of 108 articles were found. Due to duplication, 18 studies were removed from the review list. After reading the titles and abstracts, 50 of these publications were excluded because they had objectives different from this review. The remaining 40 publications were retrieved for further assessment. Of these, 28 publications were excluded because it did not meet the inclusion criteria. Finally, 12 articles remained for the final systematic review. We found that in 65% of the selected studies, preconditions for unsafe acts have been the major causal level of medical errors and adverse events. In the majority of the studies, communication and coordination, adverse mental states, physical environment, crew resource management, and technological environment have also been recognized as the most important causal categories in this study. As a result, to prevent medical errors and adverse events, the main focus should be on controlling the preconditions for unsafe acts including personnel factors, operator conditions, and environmental factors.
Dietary Patterns in 1125 Iranian Women: Adequacy of Energy and Micronutrient Intakes and Weight Statuses
Authors: Ajami Marjan , Salehi Forouzan , Kalantari Naser , Asadilari Mohsen , Roshanmehr Farnaz , Houshiarrad Anahita , Esmaeili Mina , Abdollahi Morteza
Published: May 2024

Background:

Women's nutrition status includes significant effects on their children and household health. The purpose of this study was to assess energy and micronutrient intake adequacy in Iranian women.

Methods:

This study was a part of the Urban HEART Study, which has jointly been developed by the World Health Organization (WHO) Centre for Health Development, Kobe, Japan. In total, anthropometric and dietary intake data were collected from 1125 women in southern Tehran municipality districts. A 24-h recall questionnaire was completed by the expert nutritionists and the participants' anthropometric statuses were assessed. Food intakes were calculated in grams per capita per day. Micronutrients and energy requirements were adapted from WHO/Food and Agriculture Organization (FAO) tables and Iran National Food Consumption Survey, respectively.

Results:

Nearly 71.5% of the women were overweight or obese [body mass index (BMI) ≥25 kg/m2]. Furthermore, 1.2% of the women were underweight (BMI <18.5 kg/m2), while 27.3% had normal weight (BMI = 18.5--24.9 kg/m2). The mean bread/cereal and vegetable intakes were significantly higher in obese group, compared to that in normal/under/overweight group (375.6 g/day ± 151.4, P = 0.05; and 331.4 g/day ± 227.5, P = 0.02), respectively]. Women in the lean group significantly consumed higher quantities of cakes/pastries and had the lowest calcium and iron adequacy ratios, compared to other groups (p = 0.001, P = 0.03, and P = 0.05, respectively).

Conclusions:

These findings suggest that Iranian women, especially those who reside in the southern areas of Tehran, need to change their dietary habits to maintain their health. Moreover, being under/normal weight does not necessarily mean following healthy diets.
Psychometric Properties of the Persian Version of Cystic Fibrosis Questionnaire: Revised in Children with Cystic Fibrosis
Authors: Havaei Naser , Modaresi Mohammad Reza , Rezaei Mandana , Asghari-Jafarabadi Mohammad , Kohzadi Ameneh , Ariafar Yalda , Ghalibaf Babak , Goljaryan Sakineh
Published: May 2024

Background:

Cystic fibrosis is a progressive, fatal disease affecting the quality of life. The cystic fibrosis questionnaire-revised (CFQ-R) is an efficient tool to monitor health-related quality of life in patients. The aim of this study was to explore the psychometric properties of the child and parent versions of the Persian version of the CFQ-R in the Iranian population.

Methods:

Fifty children with cystic fibrosis (6–11 years) and their parents were allocated in this methodological study to examine convergent validity, discriminant validity, test-retest reliability (n = 30), internal consistency, ceiling and floor effects, and agreement between two versions of the CFQ-R.

Results:

Convergent validity was confirmed for parent proxy (P < 0.05). CFQ-R discriminated patients among stages of disease severity based on lung function, age, and BMI (P < 0.05). Test-retest analysis revealed good to excellent reliability (inter-class correlation coefficient (ICC) = 0.78–0.97). In most domains, lower quality of life scores was obtained in the parent proxy compared to the child version (P < 0.05). Domain-specific correlations were found between the child version and parent proxy (P < 0.05). Internal consistency was generally confirmed (α = 0.13–0.83 in child version and α = 0.25–0.87 in parent proxy). There were no floor effects. Ceiling effects were mostly seen for physical, digestion, and body image domains in the child version and for eating, weight, and school domains in the parent proxy.

Conclusions:

The child version and parent proxy of the Persian CFQ-R are valid and reliable measures and can be applied in clinical trials to monitor the quality of life in children with cystic fibrosis. It is recommended to use both versions in conjunction to better interpret the quality of life aspects of children with cystic fibrosis.
Association between Brachial Flow-Mediated Dilation and Calcium Score in Patients with Symptomatic CAD
Authors: Tabesh Faezeh , Amooali Mozhgan , Zavar Reihaneh , Khajouei Amirreza Sajjadieh
Published: May 2024

Background:

Endothelial function plays an important role in the protection of vessels from atherosclerosis. Detection of endothelial dysfunction by non-invasive methods (flow-mediated dilation) and its association with other imaging modalities (calcium score in coronary computed tomography [CT] angiography) is still controversial. In this study, we aim to investigate the association between endothelial function evaluated by flow-mediated dilation (FMD) and calcium score evaluated by coronary CT.

Methods:

In this cross-sectional study, 124 patients with known coronary artery disease (CAD, positive calcium score) were enrolled. FMD as an indicator of endothelial function was evaluated in these participants. FMD less than 7.1%was considered abnormal. Correlation between calcium score and severity of calcification(calcium score above 100 considered as the cutoff point of the high score) and glow-mediated dilation was obtained using the linear regression model.

Results:

The association between calcium score and FMD was strongly significant (P < 0.001). Among individuals with low calcium scores, only 15 (18.1%) had abnormal FMD findings, but the majority of individuals with high calcium scores (95.1%) had abnormal FMD findings.

Conclusions:

Our findings provide strong evidence of association between FMD, a marker of vascular endothelial dysfunction, and intensity of coronary atherosclerosis, as assessed by the calcium score on the CCTA.
The Effect of Family-Centered Intervention on Key Indicators of Diabetes Management and Control in Patients with Type-2 Diabetes
Authors: Mokhtari Zeinab , Mokhtari Somayeh , Afrasiabifar Ardashir , Hosseini Nazafarin
Published: May 2024

Background:

This study is to determine the effect of the family-centered intervention (FCIS) on the key indicators of diabetes management and Control control in patients with type-2 diabetes.

Method:

The present study is a quiz- experimental study with a randomized control group. Participants were 64 patients with type-2 diabetes visiting Ali Asghar Hospital of Isfahan in 2018. The eligible patients were assigned to either the intervention group or the control group (i.e., patient-center care) through block randomization. FCIS were implemented in 4 two-hour sessions as home visits while the patients and their caregivers were present. Data were collected twice-i.e. before the intervention and 12 weeks after it- and were analyzed, by running a t-test (α = 0.05), using SPSS-21.

Results:

The mean ± SD age of participants was 50.4 ± 8.5. There was no significant difference between the two groups in the mean weight, serum levels of FBS and A1C, physical activity, energy intake, and BMI before intervention. But, a significant improvement in the mean values of these variables in the intervention group after the intervention, compared with the control group was indicated (P < 0.05).

Conclusions:

This study suggests that FCIS are more effective than patient-center care in the management and control of type-2 diabetes. Therefore, it is recommended that the family be considered in educational interventions.
Paraoxonase 1 Activity is Associated with Interleukin-6 Levels in Type 2 Diabetes: Effects of Age and Gender
Authors: Nikzad Armin , Alizadeh Ahad , Abediankenari Saeid , Kashi Zahra , Mahrooz Abdolkarim
Published: May 2024

Background:

A further understanding of the mechanisms linking inflammation to T2D and related complications can help prevent or control this silent but dangerous disease. This study was conducted to determine the association between paraoxonase 1 (PON1) activity and interleukin-6 (IL-6) in type 2 diabetes (T2D). Furthermore, we have evaluated the role of age and gender in the relationship between the PON1 activity and IL-6.

Methods:

A total of 105 people with T2D were enrolled in this study. IL-6 levels were determined using ELISA. For the PON1 activity assay, the hydrolysis rate of the substrate phenylacetate was spectrophotometrically assayed in serum at 270 nm. The determined velocities were the initial velocities of substrate hydrolysis.

Results:

PON1 activity was negatively correlated with IL-6 in total data (r = −0.34, P = 0.001). In both groups with age ≥50 and <50 years, PON1 activity was negatively correlated with IL-6, but the correlation was significant in patients aged 50 years and above (r = −0.358, P = 0.005) compared with patients with age <50 years. In both women and men, PON1 activity was negatively correlated with IL-6, but the correlation was significant in women (r = −0.318, P = 0.006) in comparison with men.

Conclusions:

Inverse association between PON1 activity and IL-6 in T2D may represent the oxidative–inflammatory interaction in this disease. Our findings highlight that at older ages and in women, the associations between lower PON1 activity and higher IL-6 concentrations are more evident, and this should be considered in patients with T2D.
Exercise Improves Clinical Symptoms, Pathological Changes and Oxidative/Antioxidative Balance in Animal Model of Colitis
Authors: Kolahi Zohreh , Yaghoubi Ali , Rezaeian Najmeh , Khazaei Majid
Published: May 2024

Background:

Ulcerative colitis is one of the major phenotypic forms of inflammatory bowel diseases. The present study aimed to investigate the effect of force swimming exercise on clinical symptoms (disease activity index; DAI), colon histopathology, inflammation and fibrosis, and oxidant/antioxidant balance in dextran sulfate sodium (DSS)-induced colitis mice.

Methods:

Male C57BL6 mice were randomly divided into five groups (n = 6 each): control, exercise, colitis, colitis + sulfasalazine, and colitis + exercise. Exercise was performed by forced swimming six weeks before and during the experiment. Colitis was induced by 1.5% DSS in drinking water. The animals were evaluated for body weight changes and DAI (including changes of body weight, stool consistency, rectal bleeding, and prolapse) during the induction of colitis and treatment. At the end of experiment, colons and spleens were evaluated by H and E and Masson Trichrome stainings. Oxidant (Malon dialdehyde; MDA), and antioxidant markers [total thiol groups, superoxide dismutase (SOD), and catalase activity] were also measured in colon tissue.

Results:

Results indicated that exercise in colitis mice significantly improved DAI, colon length, spleen weight, and histological injury score and alleviated fibrotic changes in colon tissue that were comparable to sulfasalazine group. Exercise also restored the oxidant/antioxidant balance in colitis mice by reducing MDA and increasing antioxidative markers including total thiol groups, SOD, and catalase activity.

Conclusions:

Taken together, aerobic exercise could improve clinical symptoms and colonic inflammation through, at least, the balancing the oxidative stress markers. Thus, it can be considered in management of colitis patients as effective method.
The Preventive Role of Atropine Eye Drops on Myopia Progression: A Double-Blind Randomized Clinical Trial
Authors: Medghalchi Abdolreza , Behboudi Hasan , Akbari Mitra , Moghadam Reza Soltani , Kazemnejad Ehsan , Sabnan Salah
Published: May 2024

Background:

In the present study, we investigated the effect of two doses of atropine eye drops versus placebo on myopia progression in children and adolescents.

Methods:

In this double-blind, randomized clinical trial, 67 patients aged 6 to 18 years with myopia of -2 to -6 D were enrolled and randomized to receive a placebo eye drop, atropine 0.1%, or 0.01% ophthalmic solution (one drop per night for 6 months). All participants were followed-up with for one year after the beginning of the study (at zero, one, three, six, and 12 months) and their spherical equivalent (SE), axial length (AL), anterior chamber depth (ACD), and far and near visual acuity (VA) and the eye drops side effects were recorded. A comparison among the groups was performed using SPSS software, version 24.0.

Results:

Spherical equivalent, AL, and ACD decreased and far VA improved in atropine groups to a greater extent than the placebo group (P < .05) at the 6-month follow-up. The most common side effects of atropine 0.1% eye drop included photophobia and decreased near VA. At the end of the study (six months after the cessation of atropine), a rebound effect was observed; this effect was especially severe in the 0.1% atropine group.

Conclusions:

Atropine eye drops are effective for slowing down and preventing myopia progression. However, without long-term treatment, they will have a rebound effect. A lower dose (0.01%) is suggested for reducing the side effects and rebound effects.
Carvacrol Exerts Anti-Inflammatory, Anti-Oxidative Stress and Hepatoprotective Effects against Diclofenac-Induced Liver Injury in Male Rats
Authors: Barzan Molood , Heydari Mahdi , Mirshekari-Jahangiri Hamzeh , Firouzi Hassan , Dastan Maryam , Najafi Mohammad , Khaledi Mansoor , Nouri Ali , Shah-abadi Mehran Ebrahimi
Published: May 2024

Background:

Diclofenac (DIC) is an NSAID that can cause toxic effects in animals and humans and carvacrol (CAR) is a monoterpene compound that displays effective pharmacological and biological actions. The purpose of this work was to assess the influences of CAR on DIC-induced liver injury and oxidative stress in male rats.

Methods:

The male Wistar rats were segregated into four groups. Group 1, the control group; Group 2 received DIC-only (10 mg/kg BW, p.o); Group 3, received CAR-only (10 mg/kg BW, p.o), and group 4 received DIC plus CAR. The serum levels as well as the activity of several liver-associated markers, and oxidative and anti-oxidant compounds were tested. The expression of pro-inflammatory mediators was also studied using the qRT-PCR analysis.

Results:

Our results showed that DIC treatment was associated with the elevation in the serum levels of liver-related markers together with the increase in the serum and the hepatic levels of malondialdehyde (MDA) and protein carbonyl (PC). Moreover, DIC reduced the activity of the antioxidant system in the rats and increased lymphocyte infiltration into the hepatocytes. CAR; however, protected the hepatocytes from the toxic effects of DIC by enhancing the activity of antioxidant enzymes such as catalase (CAT), superoxide dismutase (SOD), glutathione peroxidase (GPx), and Glutathione (GSH). By diminishing the expression of tumor necrosis factor (TNF)-α, CAR was also capable of preventing the inflammatory effects of DIC on liver cells.

Conclusions:

The findings of this study indicated that the administration of CAR could alleviate the noxious effects of DIC on the antioxidant defense system and liver tissue.