Hospital In Birjand Research Articles

Family Caregivers' Experiences of Living with Hemodialysis Patients: A Descriptive Phenomenology.

Several challenges are experienced by caregivers of patients with chronic kidney disease undergoing hemodialysis treatment. These difficulties pertain to the patients, their hemodialysis treatment, and other caregiving responsibilities and concerns. Given the adverse effects of caring for individuals with such conditions on the lives of caregivers, this study aims to investigate the experiences of hemodialysis patients' family caregivers. A qualitative study with a descriptive, phenomenological approach was conducted in the hemodialysis department of a teaching hospital in Birjand, Iran, in 2022. Fourteen participants were selected through purposive sampling. The data were collected through semistructured interviews and analyzed using Colaizzi's method. The participants were caregivers of dialysis patients who had a 6-month history of caring for patients and were first-degree relatives of the patient. A total of 278 initial codes emerged, which were categorized into three overarching themes and eight subthemes based on the research purpose and question. The overarching themes comprised caregiver time and cost strain, social challenges faced by the caregiver, and life challenges faced by the caregiver. Caregivers of patients with chronic kidney disease face problems in multiple dimensions and are susceptible to developing new problems. The majority of caregivers in this study were extremely vulnerable women; if they experience difficulties, the family's foundation will be weakened. Therefore, caregivers should be included in patients' treatment plans. The expression of caregivers' experiences can help solve the problems they are facing and also helps hospital managers and health planners better plan to solve problems.

The Role of Inflammatory Indices in Predicting Infections and Guiding Treatment in Neutropenic Patients With Solid Tumors

Introduction: This study explores the link between inflammatory markers and hospital outcomes in febrile neutropenic patients with solid cancers- a complication caused by systemic chemotherapy that can lead to hospitalization and requires timely diagnosis and treatment to reduce fatalities. Methods: This study was conducted in 2017 at Vali-e-Asr Hospital in Birjand with 22 participants. Blood samples were collected to measure inflammatory indexes. The study documented various hospital outcomes, including duration of neutropenia and fever correction, length of hospital stays, ICU admission or mechanical ventilation, and mortality. Accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for each marker. Results: According to the findings, there was no significant difference in the mean duration of neutropenia, the duration of fever, or the length of hospital stay comparing procalcitonin (PCT; P=0.96, P=0.36, P=0.66, respectively), polymorphonuclears (PMNs; P=0.11, P=0.94, P=0.52, respectively), and erythrocyte sedimentation rate (ESR; P=0.41, P=0.24, P=0.17, respectively). Further, the performance metrics calculated for PCT, ESR, and PMNs were an accuracy of 50%, 50%, and 40.90%, sensitivity of 88.8%, 100%, and 88.8%, specificity of 23.07%, 15.38%, and 7.6%, PPV of 44.4%, 45%, and 40%, and NPV of 75%, 100%, and 50%, respectively. Conclusion: Our findings suggested that there was no significant relationship between inflammatory factors and hospital outcomes. However, further research is needed to explore the prognostic value of these markers in a larger and more diverse patient population.

Evaluating the Effectiveness of Ibuprofen from 2 Different Brands in Patent Ductus Arteriosus Closure in Preterm Neonates

Background: Patent ductus arteriosus (PDA) is a common condition in premature babies, with a prevalence rate of 30 - 60%, and often requires medical or surgical intervention. Objectives: This study aimed to assess the effectiveness of 2 different brands of ibuprofen in PDA closure in preterm infants weighing less than 1500 g. Methods: This single-blind clinical trial study was performed on 75 premature neonates with PDA in the pediatric ward of Vali-Asr Hospital in Birjand from March 2014 to March 2019. Patients were treated with two brands of ibuprofen at doses of 10 mg/kg for the first day and 5 mg/kg for the second and third days (24 and 48 hours afterward). Before and three days after the last dose, the children were examined by pediatric cardiologist echocardiography. The data were input into SPSS version 23 and analyzed using descriptive statistics, such as mean and SD. Inferential statistics, such as the chi-square test, were also employed with a significance level of P-value < 0.05. Results: There was a significant difference between the rate of PDA closure, 78.8% in the Pedea group vs. 54.8% in the Ibuprofen group (P = 0.03). In the Ibuprofen group, there was no difference in drug efficacy in PDA closure between male and female neonates (P = 0.663). Also, in the Pedea group, there was a significant difference in terms of efficacy between male and female neonates (P = 0.049). No significant difference was observed in PDA closure between the two medications based on their sizes (P = 0.616 in small size, P = 0.266 in medium size, and P = 0.175 in large size). Conclusions: Pedea is more effective than Ibuprofen. It reduces complications and the need for surgery. However, there was no significant relationship between the two drugs based on the PDA sizes. Therefore, it seems logical to use the Iranian brand of ibuprofen, considering the benefits equal to the foreign one.

Pharmaceutical toxicity is a common pattern of inpatient acute poisonings in Birjand City, East of Iran

Information on the pattern of acute poisonings in hospitals of Birjand city, Iran, is limited. This study aimed to address this knowledge gap by examining the admissions in a major poisoning center in eastern Iran. This cross-sectional study included patients admitted to the Imam Reza Hospital in Birjand over 12 months. Medical records of the poisoned patients were reviewed, and the study variables were used for data analysis. During the study period, 534 cases of acute poisonings were evaluated. The patient's ages ranged from 12 to 84 years, with a high rate of poisonings between 15 and 35 years. The female predominance in poisoning cases was 52.1%. Most cases of poisonings occurred in spring, and the common route of exposure was oral (93.1%). The incidence of poisoning in married couples, uneducated patients, and residents of urban areas was 56.5%, 90.1%, and 74.6%, respectively. Patients with a previous medical history experienced addiction and psychiatric disorders. Intentional poisoning accounted for 23.4% of acute poisoning cases referred to the hospital in the current study. The main groups of toxicants were pharmaceutical products (48.1%), narcotics (25.8%), chemical products (10.1%), envenomation (7.1%), and alcohol (1.7%). The mean hospital stay was 2.5 ± 3.0 days, and the final treatment outcome was complete recovery, except for one patient intoxicated by warfarin and alprazolam. Our results indicate that the high toxicity cases were related to pharmaceutical product and opioids abuse, especially methadone (8.4%), alprazolam (7.9%), clonazepam (7.5%), and acetaminophen (9.9%) taken orally and more commonly happened at home. Due to the high rate of deliberate poisonings, especially among young adults and students, monitoring drug distribution and exceptional attention to mental health should be seriously considered by national health authorities to prevent suicide attempts.

The Efficacy of Melatonin and Clonidine in Preventing Emergence Delirium in the Elderly Undergoing Orthopedic Surgery, Neurosurgery, and General Surgery: A Placebo-controlled Randomized Clinical Trial

Background: Emergence delirium (ED) is a complication after surgeries due to general anesthesia. Objectives: This study aimed to evaluate the efficacy of melatonin and clonidine, which are hypothesized to have a curative effect on ED. Methods: This randomized, placebo-controlled, double-blind, three-way parallel clinical trial was performed in Imam Reza Hospital in Birjand, Iran in 2019 - 2020 who were selected using convenience sampling. The inclusion criteria were age > 65 years and preoperative Abbreviated Mental Test (AMT) score ≥ 8. The exclusion criteria were suffering from any chronic diseases. Participants were divided into 3 groups: Placebo, clonidine, and melatonin groups who received placebo, 100 μg clonidine, and 5 mg melatonin, respectively. A first dose was administered at bedtime before surgery, a second dose 90 minutes before the procedure. An AMT and Mini-mental State Examination (MMSE) were administered to determine ED. Results: This study included 150 patients with a mean and standard deviation of 74.6 ± 6.8 years. According to AMT and MMSE, there was no significant difference in the level of ED between groups on the first, second, and third days after surgery (P > 0.05). Emergence delirium levels in the clonidine and melatonin groups were lower than in the placebo group. According to AMT and MMSE, ED was not significantly correlated gender, age, and type of surgery. Emergence delirium was significantly associated with postoperative bleeding and electrolyte disturbance (P < 0.05). Conclusions: Melatonin and clonidine did not affect the occurrence of ED in the elderly undergoing surgery, but these medications could slightly reduce their occurrence.

Effect of Common Chicory Essence and Phototherapy on Serum Bilirubin Levels in Preterm Infants Admitted to Neonatal Intensive Care Unit: An In Vitro Study

: Jaundice is a common neonatal disorder that occurs in most term and preterm infants. Chicory or dandelion flower has long been used in the treatment of jaundice. This study aimed to investigate the effect of common chicory essence and phototherapy on serum bilirubin levels in preterm infants admitted to the neonatal intensive care unit (NICU) of Valiasr Hospital in Birjand, Iran. This in vitro study was conducted on preterm infants with gestational age of less than 37 weeks and weight less than 2500 g. Bilirubin levels in blood samples from 21 infants were measured before and after the addition of chicory essence or distilled water. Then, phototherapy was performed, and bilirubin levels were measured again. Data were analyzed using SPSS (version 21). The mean weight of infants was 1542.8 ± 453.5 g. In the chicory essence group, the mean total serum bilirubin was 5.29 ± 1.55 and 0.18 ± 0.07 mg/dL before and after the intervention, respectively (P < 0.001). The mean indirect serum bilirubin was 4.96 ± 1.59 and 0.18 ± 0.07 mg/dL before and after the intervention, respectively (P < 0.001). The mean changes in total bilirubin in the distilled water and chicory groups were 5.15 ± 1.70 and 5.43 ± 1.99 mg/dL, respectively (P = 0.62). The results showed that both distilled water and chicory essence decreased direct and total serum bilirubin concentrations. The indirect bilirubin changes were not significant, and there was no difference in the total bilirubin changes between the two groups. Totally, the chicory essence had no effect on reducing the serum bilirubin level in preterm infants.

Compliance of operating room sterilization procedures with valid Scientific guidelines

introduction: Infections caused by surgeries have always been considered a primary concern of medical centers and are associated with irreversible complications. Using appropriate sterilization procedures reduces these complications. This study aimed to investigate how compliant are the current sterilization procedures of operating room (OR) environment and instruments with valid scientific standards. Methods: This cross-sectional, descriptive-analytical study examined ophthalmology, gynecology, and otorhinolaryngology ORs of Valiasr Hospital in Birjand. With the presence of the researcher in the OR, a standard 41-item checklist consisting of three parts (environmental cleaning, equipment cleaning, and sterilization procedure) was completed for each OR in each shift. The data were analyzed using the Mann-Whitney and Kruskal-Wallis test by SPSS(Version18) in significant level (a=0.05). Results: A total of 50 questionnaires were filled out for ORs. The highest number of questionnaires were completed for the gynecology OR, and the most elective surgeries were performed in the morning shift. There was no significant difference between the median score of OR instruments cleaning and that of valid scientific guidelines in terms of steralization (P> 0.05). The median scores of sterilization procedures and steps in hospital ORs were significantly different from those of scientific guidelines in the field of sterilization of surgical operations (P <0.05). Conclusion: The study findings indicate cases of mismatch between the quality of infection control and sterilization in the ORs of Vali-asar Hospital in Birjand and those recommended by valid scientific standards and guidelines.

Evaluation of the relation between myopia and central corneal thickness in patients admitted to vali-e-asr hospital in birjand, iran

Introduction: Considering the increasing prevalence of myopia and the subsequent complications, and due to the dearth of studies on the correlation between myopia and gender with corneal thickness in Iran, this study aimed to determine this relationship in patients admitted to the ophthalmic clinic of Vali-e-Asr Hospital, Birjand, Iran. Methods: This descriptive-analytic epidemiologic study was conducted on 100 patients admitted to Vali-e-Asr ophthalmic clinic in Birjand, Iran, for one year since January 2017. According to the degree of myopia, the patients were divided into three groups of low (0-3 D), moderate (3-6 D), and high myopia (6≤D). Corneal thickness was measured using Orbscan and Pentacam. The data were analyzed in SPSS software (Version 19) through ANOVA and T-test to determine the possible relationship between myopia and central corneal thickness. A p-value equal to and less than (P≤0.05) was considered statistically significant. Results: Overall, 100 patients (49 males and 51 females) were enrolled in this study. Moderate myopia had the highest frequency in both eyes. The results of the T-test revealed that no significant difference was observed in the mean corneal thickness measured by Pentacam between the two genders (P=0.18 in the right eye and P=0.32 in the left eye). Based on the ANOVA findings, the mean corneal thickness measured by Pentacam was not significantly different among the myopia categories (P=0.05 in the right eye and P=0.51 in the left eye) Conclusions: The study results revealed that there was no significant relationship between myopia and gender with corneal thickness.

Effect of Magnesium Sulfate Addition to Intrathecal Marcaine on Pain Management After Cesarean Section

Background: The cesarean section plays an important role in reducing mortality rates and postpartum complications in the mother and fetus in certain deliveries. Objectives: The aim of this study was to determine the effect of magnesium sulfate supplementation on intrathecal marcain on pain control after cesarean section. Methods: This randomized clinical trial study was performed on 42 women candidates for cesarean section in Vali-e-Asr Hospital in Birjand in 2018. In each group, vital signs and pain score were assessed every 15 minutes using the Visual Intensity Pain Scale (VAS) 1,2,3,4,8,12 hours after surgery. Data were collected and analyzed using the Friedman test, t-test for independent groups, Mann-Whitney, and chi-square by SPSS software. Results: The mean age of women candidates for cesarean section was 29.11 ± 5.42 years. The mean VAS score in both groups at different times was statistically significant. At 1 and two hours after surgery, the mean VAS score in magnesium sulfate and marcaine groups was significantly higher than marcaine group and in three hours after the surgery, it was significantly less than the Marcain group but there was no significant difference in other times. Changes in pain intensity in the magnesium sulfate and marcaine groups were significantly greater than the marcaine group. Conclusions: Addition of magnesium sulfate to intrathecal marcaine has a significant effect on pain management after cesarean section.

Investigating the Factors Associated with the Level of Expression of Estrogen and Progesterone Receptors in Patients Suffering from Colorectal Cancer.

Background The present study was performed to investigate the factors related to the expression level of estrogen and progesterone receptor in patients with colorectal cancer. Material and Methods. This crosssectional study was performed on 54 patients suffering from colorectal cancer referring to Imam Reza Hospital in Birjand during 2018-2019. After the biopsy performed during surgery, the specimen was sent for immunohistochemistry, and the status of receptors was determined. Eventually, the data were analyzed by SPSS 22. Results Out of the 54 patients studied, 64.8% were male. The mean age of the patients was 62.28 ± 14.03 years. The level of expression of beta-estrogen receptors and progesterone receptors had a significant relationship with age, consuming drugs of abuse, and familial history (P = 0.001). Also, the level of expression of estrogen and progesterone receptors of patients with a more advanced stage of cancer was significantly lower (P = 0.001). Conclusion The extent of expression of estrogen and progesterone receptors affects the progression and prognosis of disease. Thus, through hormone therapy, a step can be taken to reduce the progression and even to treat colorectal cancer.

Comparison of Blood Lead Concentrations in Mothers of Children with Congenital Heart Disease and Mothers of Healthy Children.

Congenital heart disease (CHD) is the most prevalent congenital defect that causes several problems for patients and their families and medical specialists. It is important to investigate CHD risk factors due to their significantly destructive load on society. This study aims to determine the association between maternal lead exposure and conceiving a child with CHD. This case-control study was performed on a total of 246 mothers in the pediatric clinic of Vali-e-Asr Hospital in Birjand, Iran. One hundred forty-six mothers with CHD children were defined as the case group, and 100 age-matched mothers with healthy children were considered the control group. All the mothers were between 20 and 40years old, and their children were under the age of 6months. Demographic data was collected from mothers using a well-designed questionnaire. In addition, all mothers were referred to the laboratory for measuring blood lead concentrations. The mean blood lead concentration (BLC) of mothers in the group of children with heart problems was 4.11 ± 10.02 with a median of 2.50μg/dL and in the control group was 2.66 ± 2.06 with a median of 2.30μg/dL. The Mann-Whitney test results showed that mothers' lead concentration in the group of children with heart problems was significantly higher than the control group (z = 2.13, p = 0.03). The chi-square test results showed that lead concentrations in the two groups were significantly different from each other (χ2 = 9.11, p = 0.01). The results of our study showed that mothers of children with CHD had higher blood concentrations than mothers of healthy children.

Comparison of pulse oximetry and clinical examination for proper tissue perfusion in congenital heart patients

Introduction: One way of monitoring angiographic organ is the clinical examination that is dependent on the accuracy of the person performing it; Therefore, human error may be high and require frequent examination is at least 24 hours after angiography. Meanwhile, checking for arterial or intravenous blood gases due to the small size of the vein and the arteries in children is difficult, unlike adults is difficult and requires skill and mastery in the field of venipuncture. Therefore, it is advisable to use simpler and less costly methods such as pulse oximeters to monitor organs that are more accurate and comfortable for the staff and patient. Therefore, this study was conducted to compare post angiography puls oximetry and physical exam in cardiac congenital of pediatric patients. Methods: This study was conducted with 45 patients with congenital heart disease undergoing diagnostic or therapeutic angiography. They were selected by convenience sampling method from among patients referring to the angiography department of Vali-e-Asr Hospital in Birjand, Iran, in 2016. Trained personnel performed the clinical examinations, including temperature, color, and pulse check (dorsalis pedis and tibialis posterior) for both the angiographic and control organs. Pulse oximetry was also performed concurrently using the Massimo pulse oximeter for both organs and continued for up to 6 hours after angiography. Demographics form and patients' clinical records were used to collect data. The obtained data were analyzed in SPSS software (V: 23) using the Kappa test. Results: The agreement between the pulse oximetry of the angiographic and control organs was mild only at one, two, and six hours after angiography, and was moderate three hours after angiography (kappa=0.656 after three hours). Conclusions: Although there was no clinical agreement between pulse oximetry and clinical examination, Butaccording our findingspulse oximetry is moreaccurate, and given the results in the first one to two hours after angiographyevaluation of organ is more sensitivity.

Giant Brain Hydatid Cyst in an Adult: A New Case Report

Cystic echinococcosis is an important zoonotic disease that occurs in humans and mammals in general, which causes considerable economic loss and poses health concerns in different parts of the world. The patient involved in this case report was a 28-year old man living in Birjand city who had been suffering from intermittent headache, nausea and vomiting for the past two weeks. The other symptoms presented by the patient were dizziness, blurred vision, seizures and imbalance. The patient only complained of headache in the last two weeks and had no symptoms of visual or speech impairment. He had a history of consuming raw vegetables, but did not have canine contact. In brain computed tomography and magnetic resonance imaging, a large cyst was evident in his brain. The patient was admitted to Razi Hospital in Birjand and followed-up by surgical treatment of the hydatid cyst, with no complications observed. Keywords: Hydatid cyst, brain, Birjand.

Diagnostic value of clinical and laboratory symptoms in the diagnosis of acute appendicitis in patients with suspected acute appendicitis referring to Imam Reza Hospital in Birjand

Introduction: Appendicitis is a challenging condition for emergency specialists and surgeons to diagnose. If it is not treated in time, the inflamed tissue of the appendix ruptures, causing peritonitis and shock. This study evaluated the diagnostic value of clinical and laboratory symptoms in the diagnosis of acute appendicitis. Methods: This descriptive cross-sectional study was carried out on a total of 134 patients with suspected appendicitis referring to the Emergency Department of Imam Reza Hospital in Birjand, Iran, within 2013 and 2015 using convenience sampling. The data collection tool was a questionnaire covering patients’ demographics, clinical signs, and laboratory and pathology test results. Sensitivity and specificity, positive predictive value, negative predictive value, likelihood ratio, area under the receiver operating characteristic (ROC) curve (AUC), and cut-off point of each test (i.e., white blood cell, aspartate transaminase, alanine transaminase, C-reactive protein, polymorphonuclear leukocytes, lymphocytes, total and direct bilirubin, iron, and total iron-binding capacity) were analyzed using SPSS software (version 18) and MedCalc software (version 19). A p-value of 0.05 was considered statistically significant. Results: In this study, 68 and 66 participants were male and female, respectively. The mean age of the patients was 24. (44±11).26 years. Pathological examination showed that six patients underwent a negative appendectomy. A positive appendectomy was noted in 128 subjects. Histopathological results confirmed the perforation of the appendix in 78 patients. Among the laboratory tests, only the accuracy of serum iron was fair in the diagnosis of acute appendicitis (AUC numerical value in the ROC curve=0.787). The accuracy of other tests based on the AUC numerical value in the ROC curve was poor or failed. Conclusions: Although the accuracy of serum iron based on the numerical value of AUC in the ROC curve was diagnostically fair for acute appendicitis, it is suggested to carry out further studies with larger sample sizes in order to draw definitive conclusions given the small sample size in this study.

Comparison of the effect of levofloxacin-based three-drug regimen with clarithromycin-based four-drug regimen in the treatment of Helicobacter pylori infection in Birjand: Short Communication

Given the high prevalence of Helicobacter pylori infection in Iran, eradicating it with an effective, low-cost, and easy diet is one of the challenges ahead The aim of this study was designed to compare the effect of "levofloxacin-based regimen “with” clarithromycin-based regimen” in the treatment of Helicobacter pylori. This quasi-experimental study was performed on 161 patients with Helicobacter pylori infection referred to the gastrointestinal clinic of Vali-asr Hospital in Birjand. Patients were randomly divided into two groups A (levofloxacin, pantoprazole and amoxicillin) and B (amoxicillin, pantoprazole, clarithromycin and bismuth sub citrate) and were treated for 14 days. 4 weeks after the end of treatment, the urease breath test was performed to check for eradication In levofloxacin group, 67 patients (91.8%) and in clarithromycin group 55 patients (70.5%), eradication was performed which was statistically significant. (p=0.001). Also, there was no statistically significant difference between the two groups in terms of complications (p=0.3). The results showed that the levofloxacin-based regimen could be used as an alternative to four clarithromycin-based therapies due to its greater efficacy in eradicating Helicobacter pylori despite the lower number of drugs and similar side effects.

Prognostic indicators in critically ill poisoned patients: development of a risk-prediction nomogram.

The prognosis of acutely poisoned patients is a significant concern for clinical toxicologists. In this study, we sought to determine the clinical and laboratory findings that can contribute to predicting the medical outcomes of poisoned patients admitted to intensive care units (ICUs). This retrospective study was performed from January 2009 to January 2016 in the ICU of Vali-e-Asr Hospital in Birjand, Iran. We included all patients with the diagnosis of acute poisoning admitted to the ICU. Demographic data, laboratory results, the Sequential Organ Failure Assessment (SOFA), and acute physiology score + age points + chronic health points (APACHE) II, and the Simplified Acute Physiology Score (SAPS) II, and outcome were collected. Univariate analysis (Mann-Whitney or t-test), multiple logistic regression, receiver operating characteristics (ROC) curve analysis, and Pearson's correlation test were performed using SPSS, STATA/SE 13.0, and Nomolog software programs. The multiple logistic regression analysis revealed that five factors were significant for predicting mortality including age (OR 95% CI: 1.1[1.05-1.12], p<0.001), Glasgow Coma Score (GCS) (OR 95% CI: 0.71[0.6-0.84], p<0.001), white blood cell (WBC) count (OR 95% CI: 1.1[1.01-1.12], p=0.04), serum sodium (Na) (OR 95% CI: 1.08[1.01-1.15], p=0.02), and creatinine levels (Cr) (OR 95% CI: 1.86 [1.23-2.81], p=0.003). We generated a five-variable risk-prediction nomogram which could both predict mortality risk and identify high-risk patients. Age, GCS, WBC, serum creatinine, and sodium levels are the best prognostic factors for mortality in poisoned patients admitted to the ICU. The APACHE II score can discriminate between non-survivors and survivors. The nomogram developed in the current study can provide a more precise, quick, and simple analysis of risks, thereby enabling the users to predict mortality and identify high-risk patients.

Prognostic indicators in critically ill poisoned patients: development of a risk-prediction nomogram.

Objectives The prognosis of acutely poisoned patients is a significant concern for clinical toxicologists. In this study, we sought to determine the clinical and laboratory findings that can contribute to predicting the medical outcomes of poisoned patients admitted to intensive care units (ICUs). Methods This retrospective study was performed from January 2009 to January 2016 in the ICU of Vali-e-Asr Hospital in Birjand, Iran. We included all patients with the diagnosis of acute poisoning admitted to the ICU. Demographic data, laboratory results, the Sequential Organ Failure Assessment (SOFA), and acute physiology score + age points + chronic health points (APACHE) II, and the Simplified Acute Physiology Score (SAPS) II, and outcome were collected. Univariate analysis (Mann-Whitney or t-test), multiple logistic regression, receiver operating characteristics (ROC) curve analysis, and Pearson's correlation test were performed using SPSS, STATA/SE 13.0, and Nomolog software programs. Results The multiple logistic regression analysis revealed that five factors were significant for predicting mortality including age (OR 95% CI: 1.1[1.05-1.12], p<0.001), Glasgow Coma Score (GCS) (OR 95% CI: 0.71[0.6-0.84], p<0.001), white blood cell (WBC) count (OR 95% CI: 1.1[1.01-1.12], p=0.04), serum sodium (Na) (OR 95% CI: 1.08[1.01-1.15], p=0.02), and creatinine levels (Cr) (OR 95% CI: 1.86 [1.23-2.81], p=0.003). We generated a five-variable risk-prediction nomogram which could both predict mortality risk and identify high-risk patients. Conclusions Age, GCS, WBC, serum creatinine, and sodium levels are the best prognostic factors for mortality in poisoned patients admitted to the ICU. The APACHE II score can discriminate between non-survivors and survivors. The nomogram developed in the current study can provide a more precise, quick, and simple analysis of risks, thereby enabling the users to predict mortality and identify high-risk patients.

Comparison of the effect of chamomile and chlorhexidine glucosan cleansing on dental plaque and mucosal lesions of ventilated patients in the intensive care unit

Background and Aims: The use of methods with minimal complications and risk is of utmost importance in the promotion of oral hygiene in the care of intensive care unit (ICU) patients. The present study aimed to compare the effect of chamomile mouthwash and chlorhexidine gluconate on dental plaque and oral mucosal lesions of patients under ventilator in the intensive care unit. Materials and Methods: This randomized controlled clinical trial was conducted on 50 eligible patients who were selected via available sampling method from among trauma patients in the ICU of Imam Reza (AS) Hospital in Birjand. They were assigned to two groups of chamomile extract 10% (n=25) and chlorhexidine gluconate 0.2% (n=25) by block randomization. In each group, the solution was used three times a day every 8 hours for 5 days. The instruments were the Backas Assessment Checklist (BOAS) and the Mucosal Plate (MPS). Results: In both groups, the mean total score of oral mucosal lesions and dental plaque significantly decreased 2 and 5 days after the intervention, compared to the pre-intervention (P&lt;0.001); nonetheless, the two groups were not significantly different in this regard (P&gt;0.05). Furthermore, there was no statistically significant difference in the mean changes in the total scores of oral mucosal lesions and dental plaque at different times in the two groups (P&gt;0.05). Conclusion: Chamomile mouthwash and chlorhexidine mouthwash have similar beneficial effects on dental plaque and oral mucosal lesions of ventilated patients admitted to the ICU.

Seroepidemiology of Helicobacter pylori in patients with gastrointestinal disorders referring to Imam Reza Hospital in Birjand, Iran: Short Communication

Helicobacter pylori (HP) is the most common human pathogen. Due to differences in HP prevalence in different geographical areas, this study was conducted to investigate the seroprevalence of HP in patients with gastrointestinal disorders referring to Imam Reza Hospital in Birjand, Iran, in 2018. After blood sampling of 2,550 patients, the anti-HP antibody titer was measured by a commercial kit. The positive serum response of HP in this study was shown in 1,045 individuals (41%). The results of the present study showed that there was no significant relation between serum positive reaction and gender. In addition, the immunoglobulin G (IgG) antibody with 83% was the most abundant antibody in individuals with positive seropositive reaction. Epidemiological studies, especially serum IgG, can highly help with the detection of HP infection, particularly in individuals with clinical symptoms (P&lt;0.05).

Comparison of blood lead concentrations in patients with acute ischemic stroke and healthy subjects

Background and ObjectivesStroke is the main cause of mortality and long-term disability in the general population. With the increased application of metals in industries and human environment, lead has become a health hazard. In this study, we aimed to evaluate the relationship between the blood concentration of lead and the incidence of acute stroke. Materials and MethodsWe performed this study during 2016−17 at Vali-e-Asr Hospital in Birjand, Iran, among 80 ischemic stroke patients visiting the hospital and 80 healthy gender- and age-matched controls. Blood lead concentration (BLC) was measured using graphite furnace atomic absorption spectrometry. ResultsBLC medians in the case and control groups were 20.65 [5.37−34.87] μg/dL and 2.65 [1.75−13.85] μg/dL, respectively (p < 0.05). The case group had significantly lower mean levels of HDL and phosphors, whereas the mean levels of white blood cells and uric acid were higher in this group. After adjusting for lipid profile and fasting blood sugar, multiple logistic regression indicated that the serum levels of uric acid and BLC were significant for predicting ischemic stroke. It is estimated that the odds ratio of ischemic stroke increases by 1.04 per 1 μg/dl increase in BLC. ConclusionThis study showed that lead can be a risk factor for ischemic stroke. Since it does not have any beneficial effects on the health of individuals, screening serum concentrations of lead can be considered as a preventive strategy for those at risk of stroke.