Imam Khomeini Hospital Research Articles

The effects of emotional work on job burnout with the mediating role of work-family conflict among nursing staff

Background and aims: Nurses are at risk for job burnout (JB) due to the characteristics of their work. The aim of this study was to evaluate the effects of emotional work (EW) on JB with the mediating role of work-family conflict (WFC) among nursing staff. Methods: This was an applied survey. Study population consisted of all 195 nursing staff of Imam Khomeini hospital, Bandar Turkman, Iran. Participants were 129 nursing staff selected through stratified random sampling. The Haag Emotional Work Scale, the Maslach Burnout Inventory, and the Mousavi and Alvani’s WFC questionnaire were used for data collection. Data were analyzed through the structural equation modeling and confirmatory factor analysis performed via the SPSS (v. 22.0) and the AMOS (v. 22.0) software. Results: EW had significant effects on JB (path coefficient: 0.57) and WFC (path coefficient: 0.27). WFC also had significant effects on JB (path coefficient: 0.74) and had significant mediating effects on the EW-JB relationship. Conclusion: Strategies to boost nursing staff’s morale can reduce their stress, JB, and WFC.

Anxiety, Depression and Their Contributing Factors Among Nurses Infected with COVID-19 in Iran: A Cross-Sectional Study

Background: The 2019 coronavirus disease (COVID-19) epidemic is a great challenge in healthcare workers, especially nurses, due to their more frequent and closer contact with patients. Objective: The aim of this study was evaluation of anxiety and depression and their causes in nurses with COVID-19 infection in different wards of hospital. Methods: This cross sectional study was carried out between February 1st to October 30th, 2020 among nurses with COVID-19 infection in different wards of Imam Khomeini Hospital (university hospital), Tehran, Iran. They were contacted by phone and data were collected using a self-administered, valid, structured questionnaire consisted of sociodemographic characteristics and clinical symptoms. Psychological complications included anxiety and depression levels were also assessed and association with other sociodemographic variables was evaluated. Results: A total of 158 nurses entered the sturdy, out of which 112 (70.2%) were females. Among all participants, 72.8% and 42.4% confess anxiety and depression, respectively. Frequency of women with moderate to severe anxiety was significantly greater than that of men (p<0.001). The infected nurses who worked in low-risk departments experienced a greater proportion of moderate to severe depression (p = 0.004). In addition, the most prevalent reason for anxiety and depression was fear of infecting family members. Conclusions: The nurses bored a significant burden of psychological burden during COVID-19 pandemic, markedly when they also get infected and experience clinical symptoms. Therefore, the government and other staff should provide some facilities and supportive administrative work for reducing anxiety and depression and improving their psychological health.

The effects of cognitive behavioral therapy on self-esteem among couples with infertility

Background and aims: Infertility is the inability to conceive after one-year sexual activity without contraception. It can be associated with different psychological consequences. The aim of this study was to evaluate the effects of cognitive behavioral therapy (CBT) on self-esteem among infertile couples. Methods: This randomized controlled trial was conducted in 2018 with a two-group pretest-posttest design. Participants were thirty infertile couples (60 individuals) who referred to the infertility clinic of Imam Khomeini hospital, Ahvaz, Iran. Couples with score 21 or less for the Eysenck Self-Esteem Questionnaire were randomly allocated to a 30-person control and a 30-person intervention group. Participants in the intervention group received CBT in eight sixty-minute weekly sessions, while their counterparts in the control group received no education. A demographic questionnaire and the Eysenck Self-Esteem Questionnaire were used for data collection. The data were analyzed through the SPSS software (v. 24.0) and the chi-square, independent-sample t, and paired-sample t tests. Results: There was no significant difference between the intervention and the control groups respecting the pretest mean score of self-esteem (12.93±3.31 vs. 12.8±2.58; P=0.863). The posttest mean score of self-esteem in the control group was 12.76±2.47 with no significant change compared with the pretest (P=0.907), while the mean score of self-esteem in the intervention group significantly increased to 21.43±3.54 at posttest (P<0.001). The posttest mean score of self-efficacy in the intervention group was significantly more than the control group (P<0.001). Conclusion: CBT can significantly improve self-esteem among couples with infertility

Surgical early complications of the laparoscopic insertion of peritoneal dialysis catheter: A cross-sectional descriptive two-center study in Ahvaz, southwest of Iran

Objectives: This study aimed to investigate the surgical complications of this technique of peritoneal dialysis catheter insertion in Imam Khomeini and Golestan hospitals in Ahvaz, southwest of Iran, in the period between 2007 and 2019. Methods: In this retrospective cross-sectional analytic-descriptive study, we examined end-stage renal disease (ESRD) patients who underwent laparoscopic peritoneal dialysis catheter insertion between 2007 and 2019. Patients' records and follow-up information recorded in the hospital dialysis unit were reviewed and early infectious and mechanical complications of peritoneal dialysis catheter insertion were analyzed. Results: In this study, 290 patients (144 males and 138 females) with ESRD who have a mean age of 46±19.7 years (1-90 years) were recruited, of whom 8 patients were excluded due to incomplete information in their records, and 68 patients (24.1%) had an early complication of surgery. Surgical complications included: Catheter exit-site infections in 20 patients (7.1%), peritonitis in 18 patients (6.4%), catheter exit-site leakage in 17 patients (6%), catheter occlusion without migration in 16 patients (5.7%), catheter migration in 7 patients (2.5%), and hemoperitoneum in 7 patients (2.5%). Conclusions: Due to the low complications of laparoscopic surgery in the insertion of a peritoneal dialysis catheter, this technique is recommended as a safe surgical procedure with low complications.

Prevalence of Metabolic Syndrome and Related Factors in Patients with Non-alcoholic Fatty Liver

Objectives: This study was designed to investigate the prevalence of metabolic syndrome in patients diagnosed with non-alcoholic fatty liver disease (NAFLD) referring to the gastrointestinal and endocrinology clinics of Golestan and Imam Khomeini Hospitals, Ahvaz. Methods: The current cross-sectional study was performed on patients with NAFLD referring to the gastroenterology and endocrinology clinics of Golestan and Emam Khomeini hospitals, Ahvaz in the second half of 2020. Demographic information included age, gender, lumbar posture (while standing and the waist be in the upper edge of the iliac crest at the end of a normal exhalation using a non-elastic meter), grading fatty liver evidenced by ultrasound, and blood pressure and laboratory parameters, including triglyceride (TG), fasting blood sugar (FBS), and high-density lipoprotein (HDL) was recorded in the checklist. Data analysis was performed using SPSS 26.0 software. Results: This study was performed on 130 patients with an average age of 46.22 ± 14.27 years. Patients comprised 42 men (32.8%) and 88 women (67.2/%). Also, 63.84% of the patients with NAFLD had metabolic syndrome, and 56.2, 69.6, and 81.8% with grades 1, 2, and 3 of fatty liver, respectively had metabolic syndrome. There was a significant difference in terms of mean height and weight in both gender. There was a significant relationship between age and FBS, so that the levels of FBS increased statistically significantly with age (P < 0.05). Gender had a statistically significant relationship with HDL and waist circumference (P = 0.038). There was no statistically significant relationship between blood pressure, TG, HDL, FBS, and waist circumference, and different grades of fatty liver (P > 0.05). Conclusions: The current study showed a significant number of patients with NAFLD had metabolic syndrome, so that the most common symptom of metabolic syndrome was low HDL levels, followed by high FBS levels, blood pressure, and TG levels and waist circumference size. Nevertheless, it was not probable to assess whether NAFLD precedes the progress of metabolic syndrome.

The Effect of a Training Program Based on Roy’s Adaptation Model on the Adaptation of Patients Undergoing Coronary Artery Bypass Graft in Intensive Care Units

Background: One of the effective nursing measures for enhancing the quality of life (QOL) and adaptation of patients undergoing coronary artery bypass graft (CABG) is the use of Roy’s adaptation model (RAM). Objectives: This study aimed to determine the effect of a training program based on Roy’s adaptation model on the adaptation of patients undergoing CABG. Methods: This quasi-experimental study was performed on 60 patients admitted to the intensive care units (ICUs) of Imam Khomeini Hospital and Golestan Hospital in Ahvaz, southwest of Iran, in 2020. Patients were selected based on inclusion criteria and randomly assigned into intervention and control groups. A four-session training program based on RAM was held for the intervention group. Data were analyzed using SPSS ver. 22. Results: The mean scores of physiological, self-concept, role function, and independence and interdependence dimensions in the experimental group before the intervention were 48.76 (6.36), 23.76 (4.10), 19.60 (2.93), and 25.60 (3.54), respectively. After the intervention, the mean scores in the mentioned dimensions were 101.26 (5.23), 50.80 (3.82), 39.10 (4.15), and 25.47 (3.99), respectively, indicating an upward trend (P < 0.05). Also, the mean score of total adaptation before the intervention was 117.73 (12.00), which rose to 216.63 (7.88) after the intervention (P < 0.05). Conclusions: The results showed that RAM plays an important role in the adaptation of patients undergoing CABG surgery. Thus, this model can provide a suitable framework for examining and providing care for patients undergoing CABG in ICUs.

Preoperative Axillary Ultrasound-guided Wire Localization and Lymphoscintigraphy for Sentinel Lymph Node Biopsy in Breast Cancer Patients

Background: Breast cancer has the highest incidence and mortality among female malignant tumors. Breast cancer with negative axillary lymph nodes has been diag- nosed mainly at an early stage. Sentinel lymph node biopsy (SLNB) is a standard screening technique for patients with early-stage breast cancer and clinically nega- tive lymph nodes. Lymphoscintigraphy (sentinel lymph node mapping) has been reg- ularly used as the standard method for SLNB. Today, ultrasound-guided wire locali- zation (USGWL) is a well-established technique with superior outcomes. Therefore, we attempted to determine whether preoperative UGWL and lymphoscintigraphy (blue dye and isotope injection) improve SLN detection and false-negative rate in breast cancer patients undergoing SLNB and identify clinical factors that may affect the diagnostic accuracy of axillary ultrasound (AUS). Methods: Between December 2018 and June 2019, 55 patients with clinical T1- 3N0 breast cancer eligible for an SLNB at Imam Khomeini Hospital in Tehran were included in our study. Tumor characteristics and demographic data were collect- ed by reviewing medical records and questionnaires prepared by our surgical team. The day before SLNB, all patients underwent ultrasound-guided wire localization of SLN. Lymphoscintigraphy was performed with an unfiltered 99mTc-labelled sulfur colloid peritumoral injection followed by methylene blue dye injection. The results were analyzed based on the permanent pathology report. Results: Among the 55 patients, 71.8% of SLNs were detected by wire localization, while 57.8% were found by methylene blue mapping and 59.6% by gamma probe detection. Compared with wire localization and isotope injection, the methylene blue dye technique had a low sensitivity (72.2%), while both wire localization and isotope injection reached 77.8%. The sensitivity, specificity, and accuracy of UGWL were 77.8%, 42.1%, and 65.4%, respectively. Otherwise, methylene blue dye and isotope injection accuracy was 47.3% and 50.1%, respectively. Furthermore, there was a significant relationship between BMI, tumor size, laterality, reactive ALN, and the accuracy of preoperative AUS. But there was no significant correlation between age, weight, height, tumor biopsy, tumor location, the time interval between methylene blue dye and isotope injection to surgery, and also the type of surgery to the accuracy of preoperative AUS. Conclusion: Preoperative UGWL can effectively identify SLNs compared to lym- phoscintigraphy (blue dye and isotope injection) in early breast cancer patients un- dergoing SLNB.

Epidemiology, risk factors, species distribution, and antifungal susceptibility of candidemia among hospitalized patients with COVID-19.

Background and Purpose: The pandemic of COVID-19 has caused a worldwide health crisis. Candidemia is a potentially lethal condition that has not yet been enough discussed in patients with COVID‐19. The current study aimed to investigate the prevalence of candidemia among Iranian COVID‐19 patients and characterize its causative agents and the antifungal susceptibility patternMaterials and Methods: The present cross-sectional survey was carried out from March 2020 to March 2021 at Imam Khomeini Hospital, Tehran, Iran. Blood specimens were obtained from patients with confirmed coronavirus infection who also had criteria for candidemia and were examined for any Candida species by conventional and molecular techniques. Susceptibility of isolates to amphotericin B, voriconazole, itraconazole, fluconazole, caspofungin, and 5-flucytosine was tested using the CLSI broth dilution technique.Results: In total, 153 patients with COVID-19 were included and candidemia was confirmed in 12 (7.8 %) of them. The majority of patients were ≥ 50 years of age (n=9) and female (n=8). Moreover, 6 out of the 12 patients were diabetic. The presence of central venous catheters, broad-spectrum antibiotic therapy, ICU admission, and mechanical ventilation was observed in all patients. The C. albicans (n=7, 58.3 %) and C. dubliniensis (n=2, 16.7%) were the most common isolated species. Amphotericin B and 5-flucytosine were the most active drugs. Despite antifungal treatment, 4 out of 12 patients (33.3 %) died.Conclusion: Due to the high mortality, the early diagnosis and proper treatment of candidemia are essential requirements for optimal clinical outcomes in COVID-19 patients.

Role of Tumor Subtypes in Response to Neoadjuvant Chemotherapy in Non-metastatic Breast Cancer.

Neoadjuvant chemotherapy (NAC) is an integral part of breast cancer treatment. Determination of the factors that can distinguish patients who will have best response to NAC is invaluable. In this study, we aimed to elucidate the factors influencing patient response to NAC. We retrospectively collected data of female patients with non-metastatic breast cancer that had received NAC followed by surgery, admitted to Imam Khomeini hospital between 2015-2019. We investigated the association between various tumor and patients' characteristics with pathologic complete response (PCR). Overall data of 205 female patients were collected. PCR was observed in 27.6% of cases. PCR rate in luminal A, luminal B, HER2 enriched, and TNB tumors was reported in 11.1%, 30.2%, 35.7%, and 36.4% of patients respectively (P=0.27). In patients with luminal B tumors, PCR was more prevalent in patients with positive HER2 only (P=0.006). In our study factors which was significantly associated with PCR were: tumor grade, progesterone receptor (PR) status, and HER2 status. In the multiple regression model, positive PR in the tumor lowered the odds of pathologic response 3.6 times (P=0.004). In our study, tumor grade, PR status, and HER2 status was associated with response to NAC. PCR was more prevalent in non-luminal tumors; however, PCR rate in luminal B patients-especially those with HER2 positive status- was slightly less than non-luminals.

Insomnia and its association with absenteeism: A cross-sectional study among Iranian nursing team.

ObjectiveGiven the potential impact of insomnia on nurses’ performance, it is assumed that insomnia is associated with their absence from work. The present study aimed to determine the insomnia status and its association with absenteeism among a selective group of Iranian healthcare providers.Material and MethodsThis cross-sectional study was conducted on 304 healthcare providers working at Imam-Khomeini hospital complex in Tehran. The study population were assessed by insomnia severity index for characterization of insomnia symptoms. The data of absenteeism was collected from the employees’ attendance system of hospital’s nursing and staff department. The multivariable linear regression model used for predicting determinants of insomnia and absenteeism in nursing team.ResultsDifferent degrees of insomnia was found in 79.9% of the study population, which 57.2% suffered from mild insomnia, 21.4% from moderate insomnia, and 1.3% from severe insomnia. The prevalence of insomnia was significantly higher in persons who were absent from their workplace frequently, or left because of illness. The mean days for total absenteeism in healthcare workers with moderate to severe insomnia was significantly higher than others with mild and no insomnia. In multivariate analysis, having night shifts and the severity of insomnia could predict absenteeism in studied population.DiscussionA majority of healthcare workers suffer from insomnia that may lead to their work absenteeism and decreased performance. Proper administrative and individuals for management of sleep problems is required to avoid long hours of absenteeism among nursing team.

The Effect of Schema Therapy on Psychological Capital and Vulnerable Attachmenin Women with Breast Cancer

Background: Cancer causes psychological problems, such as anxiety, depression, post-traumatic stress, feelings of sadness, and anger, and family problems. Objectives: This study aimed to evaluate the effect of schema therapy on psychological capital and vulnerable attachment in women with breast cancer. Methods: The research method was quasi-experimental with a pretest-posttest design and a control group. The statistical population included all women with breast cancer admitted to the Imam Khomeini Hospital, Tehran, Iran, from 23/07/2019 to 20/11/2019. The total number of the patients was 51, of whom 30 were purposefully selected and randomly assigned to an experimental and a control group (15 people in each group). The experimental group was exposed to schema therapy for 11 weekly 90-minute sessions, while the control group did not receive any training. The Luthans Psychological Capital Questionnaire and the Vulnerable Attachment Questionnaire were used to collect data. The collected data were analyzed using multivariate analysis of covariance in SPSS-21 software. Results: The results of paired t-test showed a significant difference between the mean scores of the components of psychological capital and vulnerable attachment in the two experimental and control groups. Therefore, it can be stated that the effectiveness of schema therapy was associated with increased self-efficacy (P = 0.013), hope (P = 0.001), resilience (P = 0.034), optimism (P = 0.001), and decreased vulnerable attachment (P = 0.029). Conclusions: Based on the findings of this study regarding the effect of schema therapy on improving psychological capital and reducing vulnerable attachment, it can be concluded that schema therapy can be used as an effective intervention along with other therapies to reduce the problems of women with breast cancer.

Acute Kidney Injury After Liver Transplant: Incidence, Risk Factors, and Impact on Patient Outcomes.

Acute kidney injury is a frequent complication of liver transplant. Here, we assessed the rate and contributing factors of acute kidney injury and need for renal replacement therapy in patients undergoing liver transplant at a transplant center in Tehran, Iran. We identified all patients who underwent liver transplant at the Imam Khomeini Hospital Complex from March 2018 to March 2019 and who were followed for 3 months after transplant. Acute kidney injury was defined based on the Acute Kidney Injury Network criteria. We collected demographic and pretransplant, intraoperative, and posttransplant data. Univariable and multivariable models were applied to explore independent risk factors for acute kidney injury incidence and need for renal replacement therapy. Our study included 173 deceased donor liver transplant recipients. Rates of incidence of acute kidney injury and need for renal replacement therapy were 68.2% and 14.5%, respectively. The 3-month mortality rate among those with severe and mild or moderate acute kidney injury was 44.0% (14/25) and 9.7% (9/ 93), respectively (P < .001). Multivariable analyses indicated that serum albumin (relative risk of 0.55; 95% confidence interval, 0.34-0.87; P = .021), baseline serum creatinine (relative risk of 2.11; 95% confidence interval, 1.56-2.90; P = .037), and intraoperative mean arterial pressure (relative risk of 0.76; 95% confidence interval, 0.63-0.82; P = .008) were independent factors for predicting posttransplant acute kidney injury. Independent risk factors for requiring renal replacement therapy were pretransplant serum creatinine (relative risk of 1.99; 95% confidence interval, 1.89-4.47; P = .044) and intraoperative vasopressor infusion (relative risk of 1.41; 95% confidence interval, 1.38-2.00; P = .021). We found a high incidence of acute kidney injury among liver transplant recipients in our center. There was a significant association between severity of acute kidney injury and 3-month and in-hospital mortality.

Comparing Single-locking and Double-locking Plate Fixation Methods in Patients With Proximal Tibial Fractures

Background: Proximal tibial fractures account for 1% of all fractures. Different treatments have been proposed for this fracture. Objectives: The present study aims to evaluate the clinical and radiological results of single-locking and double-locking plate fixation methods in patients with proximal tibial fractures. Methods: The present study was carried out on 40 patients with proximal tibial fractures referred to Imam Khomeini Hospital in Sari, Iran. They were divided into two groups of double-locking fixation with 3.5-mm Locking Compression Plate (LCP) and single-locking fixation with 4.5-mm LCP. They were followed up for at least 6 months after surgery. At the time of admission, they were assessed using Lysholm Knee Scoring Scale and Visual Analogue Scale. Radiographs were taken from all patients and the articular surface, and fracture healing,. Results: Of 40 patients, 17 and 23 were treated with 3.5-mm and 4.5-mm LCPs, respectively. The mean Lysholm score in the groups with 3.5-mm and 4.5-mm LCPs was 84±8.2 and 78.3±16.2, respectively. There was no statistically significant difference between the two groups (P&gt;0.5). Conclusion: The radiological and functional outcomes were almost the same for single-locking and double-locking plate fixation methods. Both methods can be used to treat the tibial plateau fracture. The treatment can be selected according to the surgeon and the patient’s request

Clinical Efficacy of Dexmedetomidine versus Ketamine in Shoulder Dislocation Reduction: A Randomized Clinical Trial Study.

Background :Shoulder joint dislocation and displacement is a common clinical condition. The present research aims to compare the clinical efficacy of ketamine versus dexmedetomidine during shoulder joint reduction. Methods : In this randomized clinical double-blind trial method, patients aged 18 to 65 years with shoulder dislocation referred to the Emergency Hospital of Imam Khomeini Hospital in Ahvaz, Iran, were enrolled. Patients were separated into two groups, patients in group A received 1mg/kg nebu-lized ketamine and patients in group B received 1 μg/kg nebulized dexmedetomidine. Pain score was recorded at 5 different time points: Zero (before intervention), 10 minutes, 20 minutes, 30 minutes, and 60 minutes after intervention., The pain score was evaluated using the visual analog scale (VAS) test. A linear regression test was carried out to compare the slopes. Also, ANOVA repeated measures test variables differences between groups. Then Tukey's multiple comparisons as post-hock were applied to compare the pains at different time points. Using IBM SPSS version 19.0 software, all analyzes were accomplished. Results : The pain score in both groups significantly decreased during different time points. The pain reduction slope in the group that received dexmedetomidine is meaningfully upper than that of ketamine (-0.08 vs. -0.06, p=0.012). The ketamine action onset time was 20 minutes after the in-tervention. In comparison, the effect of dexmedetomidine has an onset of 10 minutes after the in-tervention. Conclusion : Overall, the results of current research demonstrated that although nebulized dexme-detomidine and nebulized ketamine produce a significant decrease in pain score, dexmedetomidine provides a faster effect. Therefore, nebulized dexmedetomidine seems to be used as an appropriate choice to induce sedation during shoulder joint reduction in emergency departments.

The five-year survival of gastric cancer patients with a focus on its prognostic factors

Introduction: Despite extensive advances in the early diagnosis and treatment of gastric cancer, it is still one of the most common causes of death worldwide. In addition to stage and recurrence, the degree of tumor differentiation affects the survival of patients. Objectives: The current study was conducted to investigate the prognostic factors and survival rate of patients with gastric cancer. Patients and Methods: The current prospective study was conducted on patients with gastric cancer from 2010 to 2017 in Imam Khomeini and Apadana hospitals in Ahvaz, Southwest of Iran. For each patient, curative (total or subtotal gastrectomy with D2 lymphadenectomy) or palliative surgery (partial gastrectomy and gastrojejunostomy) were carried out based on clinical indications. Then Cox model was used to analyze factors affecting survival and the Kaplan-Meier test was also utilized to analyze the five-year survival of patients with SPSS version 21. Results: Around 154 patients with gastric cancer, including 101 males (65.6%), with a mean age of 62.21±13.76 years, were studied. The two- and five-year overall survival (OS) of patients were 57.7% and 28.5%, respectively (median OS=28 m). Lower stage, well-differentiated tumors, absence of metastasis, lack of recurrence, receiving adjuvant chemotherapy and curative surgery were significantly associated with greater OS (P&lt;0.05). Conclusion: OS rate of patients with gastric cancer undergoing surgery, especially in the ones with high-grade tumors, metastasis and recurrence, is relatively low, hence careful implementation of screening programs should be considered as the most important preventive strategy.

Psychometric evaluation of the nine-item heart failure self-care behavior scale (9-EHFScBS)

Background &amp; Aim: Self-care in patients with heart failure can improve multiple outcomes and reduce mortality. Measuring self-care requires valid and reliable tools. This study aimed to determine the psychometric properties of the 9-items European Heart Failure Self-Care Behavior Scale. Methods &amp; Materials: The present study is a psychometric evaluation. The original version of the tool was translated from English to Persian using the standard Backward-Forward method. The questionnaire's validity was assessed using face, content, criterion (the Self-Care of Heart Failure Index v.6 as a criterion), and construct validity. An exploratory factor analysis approach was used to construct validity with a sample of 216 patients with chronic heart failure referred to Dr. Shariati and Imam Khomeini Hospital's heart clinics in Tehran; and Ayatollah Mousavi Hospital in Zanjan. The reliability of the questionnaire was evaluated by internal consistency and stability methods. Results: After the validation process (validity and reliability), all 9 items of the questionnaire were approved and remained. The content validity index of the total content of the questionnaire was calculated to be 0.96. Based on factor analysis, only one factor was confirmed for the questionnaire. The correlation between the present questionnaire and the Self-Care of Heart Failure Index v.6 was positive and significant (p&lt;0.001, r=0.753). Internal consistency (α=0.728) and stability (0.897) of the questionnaire were also confirmed. Conclusion: The European Heart Failure Self-Care Behavior Scale is valid and reliable for measuring Iranian patients' self-care behaviors with heart failure.

Survival Analysis of Patients with Brain Stroke in the Presence of Competing Risks: A Weibull Parametric Model

Introduction: This study aimed to assess the association between the survival of patients and outcomes in Brain Stroke (BS) in the presence of competing risks utilizing a Weibull parametric model. Methods: In this longitudinal study, 332 patients with BS were attended from Imam Khomeini Hospital in Ardabil, Iran. The stroke was diagnosed according to the medical history, current symptoms, and brain imaging during June 2008 and 2018. The survival of the patients, as the primary outcome, was modeled utilizing the best-chosen Weibull model in the presence of competing risks, including stroke and other factors (heart disease, blood pressure, etc.). Results: Older age at diagnosis (59-68 years: hazard ratio [HR]=2.27; 90% confidence interval [CI]: 1.65 to 3.12; 69-75 years: HR=4.79; 95% CI: 3.56 to 6.44; ≥76 years: HR, 4.92; 95% CI: 3.55 to 6.80), being a male (HR, 1.39; 95% CI: 1.11 to 1.75), being unemployed (HR, 1.44; 95% CI: 1.39 to 1.82), having heart disease (HR, 1.68; 95% CI: 1.38 to 2.06), and hemorrhagic stroke (HR, 2.21; 95% CI: 1.378to 2.75) were directly related to death from BS. Older age at diagnosis (59-68 years: HR, 18.01; 90% CI, 5.33 to 64.92; 75-69 years: HR, 18.56; 95% CI: 6.97 to 86.57; ≥76 years: HR, 28.90; 95% CI: 15.77 to 218.49), and urban residence (HR, 0.46; 90% CI, 0.28 to 0.77) were directly related to death from other causes. Conclusion: The recognition of the influential factors on the mortality of BS patients can allow increasing their survival.

Effects of Admission Age and Gleason Score on the State Transition in Elderly Patients With Prostate Cancer Using a Multi-State Model

Objectives: Cancer is one of the leading causes of death among the elderly in the world. There are several factors involved in the development and progression of cancer. Therefore, knowing these factors and how they affect the cancer patient’s process can help in timely treatment of the disease. This study aims to evaluate the effects of admission age and Gleason score on the state transition in elderly patients with prostate cancer. Methods &amp; Materials: This is a historic cohort study conducted in 2018. The studied data are related to 125 elderly patients with prostate cancer (Mean±SD age= 72.12±7.32 years) who referred to the urology department of Imam Khomeini Hospital from 2004 to 2017 and underwent radical prostatectomy and were under different conditions (Radiation therapy, hormone therapy, or death) after surgery. The effect of admission age and Gleason score on the transition between states were tested using a multi-state model in R v.5.0 software. Results: Those who underwent surgery and treatment remained 4.5 years in the local recurrence state, 2 years in the distant recurrence state, and 6.5 years in the death state. People who had surgery were 17% more likely to metastasize and accept hormone therapy; 8.8% more likely to have a local recurrence and accept radiotherapy; and 8% more likely to experience death. The effect of Gleason score on the change of state was not significant, but the age variable was effective transition from surgical state to hormone therapy. Conclusion: In elderly patients who have undergone radical prostatectomy, the risk of metastasis increases with age.

Study on Early Onset Melanoma and Germ-Line Mutation in CDKN2A among Patients in Imam Khomeini Hospital Complex.

Objective:Malignant melanoma is a highly lethal melanocytic neoplasia with different predisposing factors. The genetic background in familial cases is an important issue in finding at risk family members. CDKN2A is one of these predisposing genes which have been estimated to be involved in germ line mutation in approximately 5-10% of familial melanoma cases. Materials and Methods:An inclusion criteria for familial melanoma was prepared according to the literature, and the age of onset was considered as a single criteria for selection. A total number of 322 melanoma cases were investigated regarding the criteria, among which 20 patients were chosen (<40 years). DNA was extracted from Formalin Fixed Paraffin Embed of normal tissues and DNA sequencing was performed for all coding sequences of CDKN2A (p16). Results:One of the cases showed a pathogenic mutation in codon 108, exon 2(322G >C; Asp108His). Further analysis of his offspring indicated no mutation in the next generation. Conclusion: As far as the authors of the present study are concerned, this was the first report on this germ-line mutation with mentioned amino acid alteration in the melanoma. Screening the CDKN2A gene for possible mutation could prevent the incidence of familial cases in at risk members.

The effect of Pregabalin on morphine consumption, sleep, mood and ability to change position after colorectal cancer surgery

Introduction Pregabalin is a co-analgesia to improve the pain control after colorectal cancer surgeries. But, the effect of Pregabalin on the sleep and ability to change position of patients in postoperative period is less well known. This study aimed to assess the effect of Pregabalin on postoperative morphine consumption, and effect of pain on sleep, mood and ability to change position after colorectal cancer surgery. Methods This double-blind, randomized, controlled, single-center clinical trial was conducted in Imam Khomeini hospital, Tehran, Iran from June 2017 to June 2018. Seventy patients were included for colorectal cancer surgery randomly divided into two groups. Group A received two doses of 150 mg Pregabalin preoperatively and postoperatively and group B placebo was administered at the same scheme. The two groups had same analgesia and anesthesia regimens otherwise. The pain score by a numerical rating scale (NRS); disturbance in sleep, mood and daily activity scores based on a scoring system like the BPI questionnaires; and, nausea- vomiting, fatigue headache, and morphine consumption were assessed 48 hours post-operatively. Results Morphine consumption was lower in the Pregabalin group 24 h postoperatively (P=0.01). The two groups were similar in terms of sleep interference scores and side effects (P>0.05). But, Mood and actions interference scores in the Pregabalin group showed a significant improvement in 48 h postoperative (P<0.05) (Table 3). Conclusion The results showed that Pregabalin could reduce postoperative morphine consumption and improve mood and actions interference scores after colorectal cancer surgery. However, there was no difference between Pregabalin and placebo in postoperative pain management and sleep interference scores after colorectal cancer surgery.