Hospitals In Shiraz Research Articles

Unnecessary Brain CT Scan and MRI Prescriptions for Evaluation of Children Suffering from Headache Referring to Namazi Hospital of Shiraz

Background and Objectives Despite the significant role of brain magnetic resonance imaging (MRI) and computed tomography (CT) scans in diagnosing diseases, unnecessary prescriptions of these imaging techniques may lead to adverse consequences, imposing a heavy financial burden on patients and health systems. The present study aimed to assess the unnecessary use of imaging services for the evaluation of children suffering from headaches in Namazi Hospital in Shiraz in 2020.. Subjects and Methods The research population of this retrospective study included all children who were referred to Namazi Hospital with the chief complaint of headache in 2019. Since the research sample was equal to the research population, no sampling was performed, and all individuals were surveyed through the census method. The data were analyzed in SPSS software (version 19) using statistical methods. Results Of the 54 brain MRIs performed, 7.4% were necessary, and 92.5% were unnecessary. Moreover, regarding 81 brain CT scans performed, 8.6% were necessary and 91.3% were not. The indication and insurance status had a significant positive relationship with the necessity of brain MRI and CT scan prescriptions (P<0.05). The total financial burden imposed by unnecessary brain MRIs and brain CT scans of the studied patients in Shiraz Namazi Hospital was 158,298,588 Iranian Rials in 2020. Conclusion The results pointed out that over 90% of the brain MRIs and CT scans prescribed for children with headaches were unnecessary, which could impose unnecessary patient costs. Therefore, it seems essential to use effective clinical guidelines for the proper administration of brain MRI and CT scans.

Evaluation of maternal and neonatal outcomes of pregnant women with COVID-19 at Sayad Shirazi Hospital, Gorgan, in 2020-2022

Evaluation of maternal and neonatal outcomes of pregnant women with COVID-19 at Sayad Shirazi Hospital, Gorgan, in 2020-2022

The Effect of Music Therapy on Pain, Anxiety, Perceived Stress, and Biochemical Parameters in Hospitals Among Patients with Cancer

Background: Diagnosis of cancer and its long and hard treatment process induce great stress and anxiety in patients. Cancer patients may also suffer from severe pain due to their primary disease, metastases, or the received treatments. However, the patients’ chief physical complaint is the main aspect that physicians pay attention to, and the mental health of these patients is usually neglected. Objectives: This study aimed to predict the effect of music therapy (MT) on pain, perceived stress, anxiety, and biochemical parameters in patients with cancer. Methods: This semi-experimental study was conducted on cancer patients referring to the Oncology Clinic at Amir Hospital in Shiraz (affiliated with Shiraz University of Medical Sciences) from April to September 2016. A total number of sixty cancer patients were recruited using a random sampling method and divided into two groups of control and intervention. Patients in the intervention group listened to light music for at least 20 minutes for 8 weeks (two continuous sessions weekly). After the intervention group, a follow-up test and questionnaires were conducted on both groups. Data were analyzed by SPSS version 21 using the t-test, chi-square test, and paired t-test. Results: The results of this study showed that the control group had no significant difference regarding the McGill Pain Questionnaire (MPQ) (P-value = 0.797), cortisol (P-value = 0.841), and the Perceived Stress Scale (PSS) (P-value = 0.001) variables before and after the study, but it had a significant increase in the Beck Anxiety Inventory (BAI) (P-value = 0.026). Our findings indicated a significant difference in the MPQ, BAI, and cortisol variables in the MT group (P-value ≤ 0.001). In general, the PSS showed no significant difference between the two groups. Conclusions: The results of the present study showed that MT for eight weeks, selected by patients from a list, could significantly reduce patients’ anxiety, pain, and perceived stress. Therefore, we recommend the inclusion of this intervention in the routine care of patients with cancer.

Lived Experiences of Physicians Working in Hospitals during the COVID-19 Crisis: A Qualitative Study

Background: With the onset of the coronavirus pandemic in 2019, healthcare workers were at the forefront of dealing with the disease. Medical centers were faced with limited facilities and insufficient information. A number of medical staff became infected with the disease, and some lost their lives. This study was conducted to understand the perceived impact of the pandemic on physicians working in healthcare facilities of Shiraz and Yazd Universities of Medical Sciences during the COVID-19 pandemic. Methods: The present study was a qualitative one conducted in the teaching hospitals of Shiraz and Yazd in the southwest of Iran in 2020-2021. Purposive sampling was used to select the participants and the process continued until data saturation was reached. Data were collected through semi-structured interviews with 21 physicians working in hospital wards during the COVID-19 crisis. Data were analyzed using the seven-step analytical method proposed by Colaizzi. Results: Four themes and eleven subthemes emerged from data analysis. The main themes included managerial weakness, burnout, distorted doctor-patient relationship, and misinfodemic. Conclusion: The preparedness of the medical system and the infrastructure needed to deal with the coronavirus pandemic were not as expected. The COVID-19 crisis also highlighted the lack of information and support for physicians as a significant challenge.

Association of demographic characteristics with mental anxiety caused by the spread of the COVID-19 pandemic in candidate patients for cataract surgery

Introduction: The increasing outbreak of COVID-19 disease has challenged global public health and caused a pathological fear of its contracting. The unknown origin of COVID-19, long incubation period, high death rate, rapid transmissions, and the lack of definitive or preventive treatment caused great fear and anxiety among the world population. Objectives: This study aimed to evaluate the correlation between demographic characteristics and mental anxiety caused by the COVID-19 pandemic among candidate patients for cataract surgery. Patients and Methods: This descriptive-analytical study selected 258 candidates for cataract surgery patients referred to Shahid Dastgheib and Khalili hospitals in Shiraz. The data were collected using a demographic and the Corona Disease Anxiety Scale questionnaire. Analytical tests were used for data analysis, including Mann-Whitney U, Spearman’s correlation, Kruskal-Wallis, and univariate and multivariate linear regression. Results: Most participants were women with a mean age of 62.8 ± 15.9 years. There was no statistically significant correlation between age, education level, and history of COVID-19 with mental anxiety (P > 0.001). In contrast, gender and job indicated a statistically significant correlation. Housewives and retired people experienced higher levels of mental anxiety (P < 0.001). Multivariate linear regression explored that amongst all demographic characteristics, only female gender was an independent risk factor for patients’ mental anxiety. Conclusion: Considering the mental health of patients applying for surgery by gender status during the COVID-19 pandemic is very important.

Design and evaluation of an educational mobile program for liver transplant patients

BackgroundLiver transplantation, the last treatment for advanced liver failure, necessitates patient education due to its wide range of complications and subsequent disabilities. The present study was development-applied research and aimed to design a mobile-based educational program to provide liver transplant patients with critical health information.MethodsIn the first phase of the study, the crucial educational components were collected from the literature and organized in the form of a questionnaire using library studies and available global guidelines. The validity and reliability of this researcher-made questionnaire were confirmed by a panel of experts (n = 15), including gastroenterologists and liver specialists working in the Motahari liver clinic and AbuAli Sina Hospital in Shiraz. The application was designed followed by analyzing the data gathered from the first phase. To evaluate the mobile phone program’s usability, to evaluate the application, 30 liver transplant patients were randomly selected.ResultsMost educational components covered in the questionnaire were deemed necessary by experts in the first phase. As a result, the educational contents were classified under 10 categories. The application had a good level of usability since the participants’ satisfaction score was 8.1 (out of 9 points).ConclusionsDue to the increase in liver transplantation and the use of mobile phones, applications increase the patient’s role in their health, and their awareness. It also leads to a better interaction and follow-up of the patient, the treatment staff of the medical centers.

Compliance with standard precautions, sharp injuries, and blood and body fluid exposure among healthcare workers

Background & Aim: Healthcare workers are exposed to certain infectious diseases through needlestick injuries and exposure to blood and other bodily fluids. This study aimed to determine the prevalence of needlestick injuries and blood and other body fluids exposure among healthcare workers at Namazi Hospital in Shiraz, Iran.
 Methods & Materials: This cross-sectional study was conducted on 656 Healthcare workers, including students and staff in medical, nursing, laboratory, service, and operating room groups, at the Namazi Hospital, in 2019. A questionnaire with four parts, including demographics, questions about using sharps containers, needle recapping, masks, and glasses, and the experience of sharps injuries or blood and body fluid exposure and reporting them, was distributed using the quota sampling method. To analyze the results, the T‑test and Chi-square test were performed.
 Results: Nearly 75.2% of the participants always used sharps containers, and 21.7% never recapped syringes. Sharps injuries and blood and body fluid exposure occurred in 40.7% and 39.8% of the participants. Occupation (P<0.001), being a student (P: 0.048), and age (P: 0.008) were associated with sharp injuries. Occupation (P: 0.001), gender (P: 0.016), and age (P<0.001) differed in exposed and no exposed participants to blood and body fluids. The prevalence of reporting exposure was not significantly different between men and women, occupation groups, students and staff, and different ages (P> 0.05).
 Conclusion: Hospital managers should provide effective educational interventions to protect against occupational hazard exposures. Also, they should provide protective equipment for Healthcare workers.

The Coagulopathy-Predicting Factors in Acute Trauma Patients Using the Generalized Estimation Equations Model

Introduction: Coagulation disorder is one of the major phenomena following the trauma which can deteriorate the condition of the patients. The aim of this study is to determine some factors predicting the incidence of coagulation disorder among acute trauma patients.
 Methods: The generalized estimation equations were used to determine the predictors of blood coagulation disorders in a sample of 736 people over 16 years of age with acute trauma in Shahid Rajaei Hospital in Shiraz. The response variable was converted based on PT, PTT, INR, and fibrinogen level criteria as a two-state variable (with/without coagulation disorder). In the data analysis, the correlation of the coagulation disorder was considered in the first and second stages.
 Results:The prevalence of coagulation disorders (mild, moderate and severe) was 19% in two stages and coagulation disorders (moderate and severe) was 7.5%. Motor vehicle accident was the most common cause of injury.The variables of blood sugar, diastolic blood pressure, pH, and sodium had a significant effect on coagulation disorders (mild, moderate, and severe). Moreover, blood phosphorus, age, and pupillary reflex had a significant effect on coagulation disorders (moderate and severe).
 Conclusion: Predictors of coagulation disorders (mild-moderate-severe) include blood sugar, diastolic blood pressure, pH, and sodium. Moreover, blood phosphorus, age, and pupil reflex are predictors of moderate and severe coagulopathy. this model that taking into account the exchangeable correlation of first- and second-stage coagulopathy had a better fit than the model ignoring this correlation.

The Effect of Fall-Prevention Multimedia Training on the Fear of Falling, Home Safety, and the Quality of Life in Older Adults: A Randomized, Parallel, Controlled Trial

Background: Falling is a common aging-associated problem. Over one-third of older adults have experienced at least one episode of falling, and its prevalence increases with age. Objectives: This study was conducted to determine the effect of fall-prevention multimedia training on the fear of falling, home safety, and the quality of life in older adults presenting to a designated healthcare center. Methods: Design: Parallel, double-blind, randomized, controlled trial. Setting: The orthopedic outpatient clinic of Dena Hospital in Shiraz, Fars province, Iran. Participants: 100 older adults, including 50 randomly allocated to the intervention group (multimedia training) and 50 to the control group (standard teaching) by permuted block randomization. Measurements: For data collection, a demographic information form, the fear of falling inventory, the home falls and accidents screening tool (HOME FAST), and LEIPAD (an instrument for assessing the quality of life in older adults) were completed before and three months after the intervention. The level of significance was set at 0.05. Results: The comparison of the pre-and post-intervention scores of the three assessed outcomes between the study groups showed a significant difference between the mean scores of home safety before and after the intervention (P < 0.001) in the intervention group; however, there were no significant differences in the scores of fear of falling (P = 0.30) and quality of life (P = 0.32). In the control group, there were no statistically significant differences in the mean scores of the three outcomes before and after the intervention. Calculating the standardized mean difference revealed the significant effect of the intervention on home safety (Cohen’s d = 0.84, 95% CI: 0.43 - 1.3). Conclusions: Given the potential effectiveness of multimedia training in the improvement of older adults’ fear of falling and quality of life, especially concerning home safety, this type of training should be emphasized in future educational programs.

Predicting Readmission of Cardiovascular Patients Admitted to the CCU using Data Mining Techniques

Background: Cardiovascular (CV) diseases account for a large number of readmissions. Objective: Using data mining techniques, we aimed to predict the readmission of CV patients to Coronary Care Units of 4 public hospitals in Shiraz, Iran, within 30 days after discharge. Methods: To identify the variables affecting the readmission of CV patients in the present cross-sectional study, a comprehensive review of previous studies and the consensus of specialists and sub-specialists were used. The obtained variables were based on 264 readmitted and non-readmitted patients. Readmission was modeled with predictive algorithms with an accuracy of >70% using the IBM SPSS Modeler 18.0 software. Cross-Industry Standard Process for Data Mining (CRISP-DM) methodology provided a structured approach to planning the project. Results: Overall, 47 influential variables were included. The Support Vector Machine (SVM), Chi-square Automatic Interaction Detection (CHIAD), artificial neural network, C5.0, K-Nearest Neighbour, logistic regression, Classification and Regression (C&R) tree, and Quest algorithms with an accuracy of 98.60%, 89.60%, 89.90%, 88.00%, 85.90%, 79.90%, 78.60%, and 74.40%, respectively, were selected. The SVM algorithm was the best model for predicting readmission. According to this algorithm, the factors affecting readmission were age, arrhythmia, hypertension, chest pain, type of admission, cardiac or non-cardiac comorbidities, ejection fraction, undergoing coronary angiography, fluid and electrolyte disorders, and hospitalization 6-9 months before the current admission. Conclusion: According to the influential variables, it is suggested to educate patients, especially the older ones, about following physician advice and also to teach medical staff about up-to-date options to reduce readmissions.

The relationship between personality traits and labor pain intensity and type of delivery among multiparous and nulliparous women

AimThe Personality traits of pregnant women and their husbands is related to their attitudes towards labor and the type of delivery. Therefore, the present study aimed to investigate the relationship between Personality traits and labor characteristics (pain intensity, and type of delivery) among multiparous and nulliparous women. Materials and methodsThis cross-sectional study was conducted on 210 multiparous and nulliparous women, selected via convenience sampling, who were 37–42 weeks pregnant and have referred to Shiraz hospitals for delivery. Data collection tools were a personal and midwifery information questionnaire, Goldberg’s big-five personality scale, and Visual Analogue Scale (VAS) of pain that were completed through interviews. Data were analyzed by SPSS software using descriptive tests to describe the data and Pearson correlation test to analyze them. ResultsMost women (190, 90.5%) had normal delivery and (129, 61.4%) experienced the highest pain level (VAS=10). There was no significant relationship between Personality traitss and pain intensity variable. There was a significant positive relationship between extraversion and type of delivery (p = 0.036). Other Personality traits had no significant relationship with the type of delivery. ConclusionPersonality traits have not been studied in terms of pregnancy and birth outcomes compared to other health outcomes. Such research can help professionals and physicians design and target programs that best fit the demographic characteristics they may need, such as those with high extroversion.

Evaluation of facial anthropometric characteristics in infants born in north of Iran

ObjectiveAnthropometric measurements of newborns are essential indicators of their health, as natural changes throughout their lives limit them. This study aimed to investigate the morphological characteristics of the head and facial region of newborns using internationally accepted cephalometric techniques. MethodsA descriptive and cross-sectional study was conducted on 1225 one-day-old, full-term, clinically healthy infants born at Shahid Sayad Shirazi Hospital, Gorgan. Two nurses from the neonatal ward were trained in the correct method of measuring anthropometric indicators. They were evaluated and confirmed by a pre-test within 24 h of the baby's birth. ResultsThe mean cephalic index was 74.8 ± 9.11 in males and 74.43 ± 9.63 in females, while the mean prosopic index was 82.57 ± 9.72 and 83.14 ± 9.89, respectively. The Fars, Turkman, and Sistani ethnic groups had different mean cephalic and prosopic indices, with the dolichocephalic type being the dominant type in both sexes and all ethnic groups. The hyperbrachial cephalic type was rare. The prosopic hyperauricular type was the dominant type based on the prosopic index, and the leptoprosobic type was rare in both genders and ethnic groups. ConclusionThe study found significant differences in the main dimensions of the head and face among the three ethnic groups of Fars, Turkmen, and Sistani living in Gorgan city. These findings suggest that ethnicity can impact the diversity of newborns' head and face shapes.

CANCER PREDICTION IN INFLAMMATORY BOWEL DISEASE PATIENTS BY USING MACHINE LEARNING ALGORITHMS

Colon cancer is one of the most common spread cancers in the world, which leads to total death of 10%. Prediction of onset of cancer, and the cause of its development in these patients can be of an enormous help and relief to those affected, as they can get back their “normal” life. Data mining and machine learning are important intelligent tools for classification, prediction and hidden relation extraction between patient information. We collected data from Shahid Faghihi Hospital in Shiraz. Features collected are as follows: Gender, age, duration of cancer before surgery, number of times the patients used bathroom, taking anti-inflammatory drug prednisolone, duration of drug use and dosage, kind of surgery and number of times consulted and retreatment of surgery, incontinence, etc. After pre-processing and data cleaning stages, effective features were extracted, and also occurrence of cancer predicts by using different classification algorithms. Then association rule mining algorithms like Apriori were used for obtaining any internal hidden relation between entries. Approaching them with different algorithms and assessing them with support vector machine was with highest prediction accuracy (84%). Due to unbalanced dataset, we chose cost sensitive support vector machine. In another aspect, after applying Apriori algorithm, the conditions of non-inflammation were extracted based on dataset features. Some significant outcomes are in what follows. If surgery treatment or diagnosed was less than 5 years, the possibility of developing colon cancer is lower. Also, as the duration of disease increases, the possibility of reoperation increases, as confirmed by the interiors. Since this issue with these features was raised for the first time in this paper at the suggestion of internists, early detection of cancer and also the extraction of effective laws can be of help to the medical community. In future, to get higher accuracy, the improvement of the dataset in terms of number of samples and colonoscopy image features is considered.

Comparison of the Quality of Life and Post-traumatic Stress in Postmenopausal and Non-menopausal Women after Hysterectomy in Selected Hospitals of Shiraz University of Medical Sciences in 2020

Background: Hysterectomy is one of the most common gynecological surgeries that affect women's mental health and quality of life. Objective: This study aimed to investigate the correlation between the quality of life and posttraumatic stress in hysterectomized postmenopausal and non-menopausal women. Materials and Methods: This cross-sectional analytical study was conducted from August to December 2019 on hysterectomies postmenopausal and non-menopausal women. There were 77 subjects in each group with a mean age of 52.55 ± 1.098. They were selected via convenience sampling at Hazrat Zeinab (PBUH) and Shahid Dr. Faghihi Hospitals in Shiraz. They were evaluated in a two-month follow-up using the Impact of Event Scale-Revised (Weiss & Marmar, 1997) and WHO Quality of Life-BREF (WHOQOL-BREF) questionnaires. Data were analyzed in SPSS-16 software using descriptive and inferential statistics (independent t-test, paired t-test, and Pearson or Spearman correlation coefficients). Results: Unlike the first stage of the study (before and a week after the surgery, P = 0.289), there was a significant negative relationship in the quality of life and post-traumatic stress between postmenopausal and non-menopausal women (P = 0.001) in the second stage (two months after the surgery). Hysterectomy increased the mean score of post-traumatic stress in postmenopausal and nonmenopausal women after the surgery (P = 0.179), while the quality of life improved and stress decreased two months later (P = 0.0001). Conclusion: Hysterectomy improved the quality of life in postmenopausal and significantly in nonmenopausal women. Hence, due to the correlation and significant negative relationship between post-traumatic stress and quality of life, midwives, families, and society need to pay attention to women’s quality of life.

Prediction prolonged mechanical ventilation in trauma patients of the intensive care unit according to initial medical factors: a machine learning approach

The goal of this study was to develop a predictive machine learning model to predict the risk of prolonged mechanical ventilation (PMV) in patients admitted to the intensive care unit (ICU), with a focus on laboratory and Arterial Blood Gas (ABG) data. This retrospective cohort study included ICU patients admitted to Rajaei Hospital in Shiraz between 2016 and March 20, 2022. All adult patients requiring mechanical ventilation and seeking ICU admission had their data analyzed. Six models were created in this study using five machine learning models (PMV more than 3, 5, 7, 10, 14, and 23 days). Patients’ demographic characteristics, Apache II, laboratory information, ABG, and comorbidity were predictors. This study used Logistic regression (LR), artificial neural networks (ANN), support vector machines (SVM), random forest (RF), and C.5 decision tree (C.5 DT) to predict PMV. The study enrolled 1138 eligible patients, excluding brain-dead patients and those without mechanical ventilation or a tracheostomy. The model PMV > 14 days showed the best performance (Accuracy: 83.63–98.54). The essential ABG variables in our two optimal models (artificial neural network and decision tree) in the PMV > 14 models include FiO2, paCO2, and paO2. This study provides evidence that machine learning methods outperform traditional methods and offer a perspective for achieving a consensus definition of PMV. It also introduces ABG and laboratory information as the two most important variables for predicting PMV. Therefore, there is significant value in deploying such models in clinical practice and making them accessible to clinicians to support their decision-making.

Evaluation of the Risk Factors of Nosocomial Pneumonia and the Prevalence of Antibiotic Resistance in Trauma Patients in Need of Immediate Intervention

Background: Pneumonia is the most common nosocomial infection reported worldwide in intensive care units. This study aimed to evaluate the risk factors of nosocomial pneumonia and the frequency of antibiotic resistance in trauma patients who need immediate intervention. Patients and Methods: This prospective cohort study was conducted in Shahid Rajaei Trauma Hospital in Shiraz between 2020 and 2021. All the trauma patients who needed immediate intervention (levels 1 and 2 based on the Canadian Emergency Department Triage and Acuity Scale) and had no symptoms of infection were included. Patients who were discharged or died before 48 hours were excluded. Results: The results demonstrated that major trauma (Injury Severity Score [ISS] ≥16), intubation, and use of invasive mechanical ventilation increase nosocomial pneumonia and death rate. The most common causes of nosocomial infections were Acinetobacter baumannii (23%) and coagulase-negative staphylococcus (18.5%). The highest levels of antibiotic resistance were related to cefoxitin, erythromycin, ciprofloxacin, and trimethoprim-sulfamethoxazole. Conclusions: Major trauma, intubation, and invasive mechanical ventilation were the effective factors in the development of nosocomial pneumonia. Continuous monitoring for mentioned risk factors and strict surveillance of antibiotic prescription can decrease the prevalence of nosocomial infections and subsequent deaths.

Prevalence of anemia and its associated factors among patients with type 2 diabetes mellitus in a referral diabetic clinic in the north of Iran

BackgroundPurposeThis study intended to investigate the prevalence of anemia and its associated factors among patients with type 2 diabetes mellitus (T2DM) in Gorgan, Iran.MethodsThis cross-sectional study was conducted on 415 (109 men) patients with T2DM referred to the referral diabetes clinic of Sayad Shirazi Hospital in Gorgan in 2021. Demographic information, anthropometric indices, past medical history, and some laboratory data on cell counts, serum blood glucose, HbA1c, creatinine, lipid/iron profiles, and urinary albumin were collected. The univariable and multivariable logistic regression analysis was applied to compute odds ratios (ORs) and 95% confidence intervals (CI) for potential associated factors, using SPSS version 21. The multivariable Model was adjusted for obesity, Hb A1c, T2DM duration, using glucose-lowering drugs (GLDs), chronic kidney disease (CKD), albuminuria, hypertriglyceridemia, and hypercholesterolemia. ResultsThe prevalence of anemia was 21.5% [95%CI: 17.6-25.7] among our total participants. The corresponding values for men and women were 20.2 (13.1-29.0) and 21.9 (17.4-27.0), respectively.The adjusted model revealed that obesity (OR, 1.94 [95% CI, 1.17–3.23]), T2DM duration for more than five years (OR, 3.12 [1.78–5.47]), albuminuria (OR, 6.37 [3.13–10.91]), chronic kidney disease (OR, 4.30 [ 2.83–7.29]) and hypertriglyceridemia (OR, 1.72 [ 1.21–2.77]) were significantly associated with prevalent anemia among patients with T2DM. Moreover, using insulin separately or in combination with oral GLDs associated positively with the prevalence of anemia with ORs of 2.60 [1.42-6.42] and 1.87 [1.30-4.37] , respectively.ConclusionAnemia had a high prevalence among patients with T2DM in the north of Iran (about 22%), which is associated with obesity, hypertriglyceridemia, duration of T2DM, and diabetic kidney disease.

Mental Health Status of Healthcare Workers During the Coronavirus Disease 2019 Pandemic: A Survey of Hospitals in Shiraz, Iran

Background:Healthcare workers (HCWs) directly or indirectly involved in the coronavirus disease 2019 (COVID-19) treatment process may experience severe mental consequences of the pandemic. Hence, this study aimed to evaluate the mental health status of HCWs in hospitals affiliated with Shiraz University of Medical Sciences, Iran. Materials and Method:This cross-sectional study was performed on 503 HCWs from five hospitals in Shiraz, including one COVID-19 front-line hospital, two COVID-19 second-line hospitals, and two without COVID-19 wards. Then, to assess the levels of anxiety, depression, insomnia, and post-traumatic stress disorder (PTSD) among HCWs, the Persian versions of the Hospital Anxiety and Depression Scale (HADS), Insomnia Severity Index (ISI), and Global Psychotrauma Screen (GPS) questionnaires were placed, respectively. Results:The mean age of participants was 33.94±8.26 years, and 252 (50.1%) were females. Anxiety, depression, insomnia, and moderate to high levels of PTSD were observed in 40.4%, 37.8%, 24.5%, and 71% of participants, respectively. A history of mental disorders was associated with all four outcomes (P<0.05). Females gender and living with elderly and/or children were correlated with anxiety and PTSD (P<0.05). Working at COVID-19 front- and second-line hospitals were similarly linked to higher insomnia and PTSD levels (P<0.05). Also, working in COVID-19 wards or non-clinical settings was associated with anxiety and depression (P<0.05). Conclusion:Most of the HCWs in this study may experience mental difficulties. Some factors may increase their risk of experiencing these difficulties. Hence, in the crisis era, mental health monitoring and identification of groups with predisposing factors are required to provide appropriate care as quickly as feasible.

Needs assessment of self-care training based on mobile phone to design an application for liver transplant patients

Introduction: Patients who receive a liver transplant will face various limitations and challenges during their lives, which they often do not have enough information about and which affect the quality of life of patients. The use of health applications is increasing. The aim of this study is to identify the educational needs for designing an application program for liver recipient patients.
 Methods: This was a Practical study that was conducted in a descriptive method. The research tool was a researcher-made questionnaire, whose validity and reliability were checked and confirmed. The research community was gastroenterology and liver specialists, and 18 people were purposefully selected from among the specialists working in the liver clinic of Motahari and Abu Ali Sina Organ Transplantation Hospital in Shiraz. Data analysis was done using descriptive statistics with SPSS version 23.
 Results: Educational items were determined in the form of 10 main axes. The results showed that among the main concepts of the disease, most of the necessary cases were recognized. However, items including liquids, types of exercise, skin cancer, cytomegalovirus symptoms, swallowing stimulants and spicy substances, correct brushing were not deemed necessary.
 Conclusion: educational needs in the form of transplant drugs, nutrition, exercise, cancer, cytomegalovirus, gastrointestinal complications after liver transplantation, diabetes, oral and dental care, motherhood, sexuality, were determined, considering the emphasis on the patient's participation in his health. And the use of the application program, determining the educational needs of transplant patients increases awareness and better management of the disease.

The Prevalence of maxillary fractures in trauma patients referred to Shahid Rajaei Hospital in Shiraz from 2011 to 2021

Introduction: Maxillofacial fractures are one of the most common fractures in the body due to trauma. Maxillary fractures, especially Lefort fractures, are common fractures. The aim of this study is to evaluate the prevalence and etiology of Lefort fractures in patients referred to Shahid Rajaei Hospital during 2011 to 2021.
 Materials and Method: In this cross-sectional study, 2700 patients who referred to the maxillofacial surgery department of Shahid Rajaei Hospital in Shiraz between 2011 to 2021 due to trauma and fractures of the jaw and face were examined. 903 cases were related to patients with upper jaw fracture and were included in the study. The demographic information of the patients, including age, sex, cause of trauma, and also the type of fracture, were extracted from their records. The etiology of maxilla fracture was divided into three groups: vehicle accidents, violence and interpersonal conflict, and accidents during work and sports. Finally, in order to analyze the data, it was done through statistical tests.
 Results: 65% of patients were male and 35% were female. The average age of people was 38.5 years. Lefort I fracture was reported in 25% of patients, Lefort II fracture in 31% and Lefort III fracture in 11% of patients. 46% of patients had fractured maxilla due to vehicle accidents, 26% of patients due to interpersonal violence, and 27% of patients due to accidents during work and sports.
 Conclusion: The prevalence of Lefort fracture in men is significantly higher than in women. In our society, injuries caused by road accidents, especially car accidents, are the most common causes of Lefort fractures. The most common type of Lefort fracture is Lefort II fracture. Of course, the cause of injury has an important effect on the pattern of injury.