Imam Khomeini Hospital Research Articles

The Effect of Vitamin D Deficiency Treatment on Hemoglobin Levels in Hemodialysis Patients: A Double-blind, Randomized Controlled Trial

Background: The role of vitamin D deficiency and hemoglobin levels in renal anemia is well established. However, few studies with inconsistent findings have examined the relationship between vitamin D supplementation and the prevalence and severity of anemia in the chronic kidney disease. Objectives: The present study aimed to evaluate the effect of vitamin D deficiency treatment on hemoglobin levels in hemodialysis patients. Methods: The present study was a double-blind, randomized controlled trial on 60 hemodialysis patients aged 18 - 83 years, who were undergoing maintenance dialysis and receiving erythropoietin. All patients with vitamin D (< 30 ng/mL) referred to the dialysis wards of Imam Khomeini, Razi, and Sina hospitals in Ahvaz in 2019, were assigned into two groups. One group was treated with 500 mg oral calcium-D tablets three times a day, and another group was treated with 50,000 units of D-Pearls weekly. The two groups were treated for 12 weeks. Then they were re-evaluated in terms of response to treatment and the rate of improvement in hemoglobin levels and erythropoietin dose. Results: In each intervention group, vitamin D levels increased significantly (P < 0.001). D-Pearls improved vitamin D deficiency; however, the difference was not statistically significant. This study also showed a significant increase in hemoglobin (> 1 unit) in the calcium-D group; however, such a change was not observed in the D-Pearls group (P = 0.3824). Moreover, there was no difference between the two groups in terms of erythropoietin dose (P = 0.98), blood calcium level (P = 0.57), parathyroid level (P = 0.20), and phosphorus (P = 0.99). Conclusions: Despite its significant limitations,this study revealed vitamin D supplements improved vitamin D deficincy, and calcium-D tablets could improve hemoglobin levels in patient.

FOXA1, FOXA2, SOX10 and GAS2 Gene Expression in Oral Squamous Cell Carcinoma and Their Relationship with Clinicopathological Indices

Background: The use of molecular methods in cancer diagnosis has led to a better prognosis. One of the important gene families in the carcinogenic pathways of various cancers is the forkhead box (FOX) family genes. Moreover, developmental transcription factors and proapoptotic proteins play critical roles in cell function and carcinogenesis. Objectives: The current study aimed to evaluate the expression of A1 FOXA1, FOXA2, SOX10, and growth arrest specific 2 (GAS2) genes in oral squamous cell carcinoma (OSCC) tumors due to biomarker discovery and early diagnosis of cancer. Methods: To evaluate the expression of FOXA1, FOXA2, SOX10, and GAS2 genes, 30 OSCC samples and 30 normal specimens were obtained from Imam Khomeini Hospital Cancer Institute. RNA extraction and cDNA synthesis were done by relevant kits. After a specific primer design for FOXA1, FOXA2, SOX10, and GAS2 genes, real-time PCR was done to evaluate the genes’ expression for molecular biomarker discovery and validation. ANOVA and independent t-test were used to analyze the data. Results: Significant differences were observed in the expression of the studied genes in tumor and control tissues (P < 0.001). The results showed that FOXA1, GAS2, and SOX10 expressions in tumor and normal cells have significant differences (P < 0.001). Regardless of FOXA1, FOXA2 and SOX10, there was a significant difference in the expression of GAS2 genes in term patients’ age (P < 0.05) and overexpressed in patients over 55 years. SOX10 gene is upregulated in grade II OSCC tumors but there is no significant difference in expression of FOXA1, FOXA2, and GAS2 in different stages and grades. The ROC curve analysis, FOXA1, and FOXA2 showed AUC = 0.66 and AUC = 0.57 respectively. Meanwhile, SOX10 and GAS2 showed AUC = 0.9 and AUC = 1 respectively. Conclusions: In general, the expression of FOXA1, GAS2, and SOX10 genes in cancer and control tissues were different, and therefore the role of these genes in OSCC is confirmed. Also, in the present study, the biomarker potential of SOX10 and GAS2 genes for OSCC diagnosis was demonstrated. In the current study, the important role of the studied genes in OSCC diagnosis was shown. However, further studies are needed to confirm this.

Neutrophil to Lymphocyte Ratio (NLR) and Derived NLR Combination: A Cost-effective Predictor of Moderate to Severe COVID-19 Progression.

Inflammation is an essential contributor to Coronavirus disease 2019 (COVID-19). In this regard, finding a prognostic indicator is valuable because the treatment will be more effective if critical patients with high inflammation are diagnosed earlier. We aimed to evaluate some hematologic markers for COVID-19 and assess their association with the severity of the disease. A total of 154 COVID-19 patients were laboratory-confirmed and admitted to Imam Khomeini Hospital Complex, Tehran, Iran, from February 12, 2020, to April 4, 2020, and 55 healthy individuals were enrolled in the study. The severity of the patients' illnesses was classified into three subgroups according to the types of oxygen therapies (moderate (61), severe (28), and critical (43)) and examined the different ratios of total white blood cell (WBC) count, neutrophil to lymphocyte ratio (NLR), platelet to monocyte ratio (PLR), macrophage to lymphocyte ratio (MLR), derived NLR ratio (dNLR), and some biochemical tests. COVID-19 patients had higher levels of NLR, MLR, PLR, and dNLR than healthy subjects. receiver operating characteristic (ROC) analysis of the curve revealed that NLR and dNLR had a high diagnostic value to differentiate COVID-19 patients from healthy subjects (area under the curve [AUC]=0.923 and 0.910, respectively) and predict mortality (AUC=0.726 and 0.735, respectively). NLR and dNLR may be reliable markers to evaluate the severity of COVID-19. NLR and dNLR had a high diagnostic value for differentiating COVID-19 patients from healthy subjects, and they could predict the severity and outcome of the disease.

Deciding When to Intubate a COVID-19 Patient.

The SARS-CoV-2 pandemic is one of the most significant challenges for healthcare providers, particularly in the critical care setting. The timing of intubation in COVID-19 patients seems to be challenging. Therefore, we aimed to investigate how it may have a survival benefit, and we determined which clinical characteristics were associated with outcomes. This cross-sectional study was conducted in the Imam Khomeini Hospital Complex. We randomly selected patients admitted to intensive care units and, based on intubation status, categorized them into three subgroups (early, late, and not intubated). Early intubation is defined as intubation within 48 hours of ICU admission, and late intubation is defined as intubation after 48 hours of ICU admission. Early-intubated patients were more likely to have dyspnea than late-intubated patients, and late-intubated patients had a higher mean heart rate than early-intubated patients. The neutrophil/lymphocyte ratio was significantly (P < 0.05) lower in not-intubated patients than in other patients. There was no difference in NLR between early- and late-intubated patients. Mean serum creatine phosphokinase and troponin I levels were higher in late-intubated patients than in early- and not-intubated patients. Early-intubated patients had a lower ROX index than late-intubated patients. Patients with higher scores of APACHE 2, respiratory rates, and neutrophil to lymphocyte ratio were more likely to be intubated. Increasing APACHE and SOFA scores were associated with decreased odds of survival. There were no statistically significant differences in total mortality between early- and late-intubated patients. APACHE 2 scores, NLR, RR, and history of ischemic heart disease are some of the appropriate predictors of intubation. Higher respiratory rates (tachypnea) can be an indicator of early intubation. The ROX index is one of the most sensitive and capable tools for predicting intubation. Intubation status is a potent predictor of in-hospital mortality.

Platelet counts and C-reactive protein in preterm infants with patent ductus arteriosus

Introduction: Patent ductus arteriosus (PDA) is a common disorder in premature infants which causes heart failure. Platelets and C-reactive protein (CRP) play an important role in closure. Objectives: The purpose of this study was to evaluate serum CRP and plasma platelet count in preterm infants with PDA compared to infants without PDA. Patients and Methods: This case-control study was conducted on premature infants with PDA admitted to Imam Khomeini hospital in Ahvaz, Iran (2020-2021). A group of 120 infants with inclusion criteria was selected and divided into two groups of 60 subjects. The preterm infant with PDA and without PDA was defined as the case and control group, respectively. Platelet count, serum CRP, and an echocardiogram were assessed in all infants. The subjects were matched by gender, gestational age, and birth weight. Results: The mean platelet count was 194.67±74.03 (×103 /mm3 ) in the neonate with PDA, and it was significantly lower than in neonate without PDA (P=0.04). The mean of serum CRP was significantly different in neonates with PDA (11.62±5.96 mg/L) compared to neonates with closed arterial ducts (8.52±3.97 mg/L; P=0.002). Additionally, PDA was associated with high platelet distribution width (PDW). Conclusion: The findings of this study revealed that PDA is associated with a low-number of platelets and high serum levels of CRP in preterm neonates. It is suggested that further studies with a higher sample size on platelet count and/or function be performed in PDA patients to understanding more about the cause of PDA and to discover novel and beneficial aims in these cases

High Incidence of Acute Kidney Injury in Kidney Transplant Recipients with COVID-19: A Single-Center Case Series from Tehran

Background: Kidney transplant recipients are among vulnerable individuals with increased risk of developing COVID-19. Long-term immunosuppression and multiple co-morbidities might affect clinical characteristics of COVID-19 in such patients. In this study, we describe clinical presentations and the incidence of Acute Kidney Injury (AKI) in 9 kidney transplant patients with COVID-19.&#x0D; Methods: This retrospective case series was conducted on 9 kidney transplant recipients with COVID-19 who were admitted in Imam Khomeini Hospital Complex during the first wave of the disease in Iran from February 20 to 20th April 2020. The diagnosis of COVID-19 infection was confirmed by either positive results of quantitative RT-PCR on nasopharyngeal swabs or typical findings in chest CT scanning.&#x0D; Results: The median age of patients was 51 years and the graft was functional in all cases before COVID-19 infection. Most patients complained of fever (8 cases), followed by cough (7 cases) and shortness of breath (5 cases). Eight cases had lymphopenia, and leukopenia was reported in 4 cases. AKI occurred in 8 cases. The increase in serum creatinine level resolved partially in most cases, but those who required renal replacement therapy had worse prognosis. Those who survived the acute illness are still alive after more than 16 months with functioning graft.&#x0D; Conclusion: It was shown in our study that similar to general population, fever and respiratory symptoms are presenting features of COVID-19 in kidney transplant recipients. Lymphopenia is more prominent and the course of COVID-19 infection is more likely to be complicated by AKI in such patients.

Neuroprotective Effects of Vitamin D on Patients With Traumatic Brain Injury: A Clinical Trial

Background and Aim: Traumatic brain injury (TBI) is a globally-critical socioeconomic and public health problem. Introducing medications and strategies to treat and improve the prognosis of TBI is crucial. Current literature not only supports the key role of vitamin D on normal brain function, but also helps recovering from a myriad of pathologies. The present research was conducted to evaluate the neuroprotective effects of vitamin D on patients with TBI presenting to Imam Khomeini Hospital, Sari, Iran. Methods and Materials/Patients: This randomized clinical trial assigned patients with vitamin D levels of over30 ng/ml to an intervention group (n=42) and a control group (n=42), who respectively received a single dose (150,000 units) of vitamin D and a placebo upon admission. The Glasgow Coma Score (GCS) and mortality were recorded at the beginning of the study and three months after the final prescription. Results: The mean GCS score upon admission was obtained as 8.64±2.29 in the vitamin D group and 8.42±2.93 in the placebo group. This score was respectively obtained as 13.50±1.85 and 10.97±2.37 upon discharge, suggesting a significant difference as per the t-test (P=0.04).The mean Glasgow Outcome Score (GOS) upon discharge was obtained as 4.24±1.51 in the intervention group and 4.10±1.40in the controls. The t-test suggested insignificant differences in the GOS between the two groups upon admission (P=0.823). After three months, the GOS respectively reaching desirable levels in 49.7% and 62.8% of cases in the placebo and intervention groups revealed statistically significant differences among the two groups (P=0.03). Conclusion: The present results showed the improving effects of vitamin D on level of consciousness and outcomes in patients with acute TBI. More studies are suggested to be performed to investigate the effects of other medications, including amantadine and methylphenidate with a larger sample size.

Patient safety friendly hospital standards and customer orientation among Iranian nurses during the COVID-19 pandemic

BackgroundThe quality of health services is determined on the basis of meeting customers’ needs and expectations. Due to the COVID-19 pandemic, health systems have faced high degrees of uncertainty as...

Effect of Nurses’ Autonomy on the Quality of Patient Care Based on Kramer and Schmalenberg’s Model

Background and Aim This study aims to investigate the effect of nurses’ autonomy on the quality of patient care based on Kramer and Schmalenberg’s model Methods &amp; Materials This is a causal-comparative study. Participants were 101 nurses of Imam Khomeini Hospital in Arak, Iran from the intensive care unit and internal medicine, surgery, pediatrics, gynecology, orthopedics, and emergency departments. The data collection tools were Moghimi and Ramazan’s patent care quality questionnaire and an autonomy assessment questionnaire based on Kramer and Schmalenberg’s autonomy model. The data were analyzed in SPSS software. Ethical Considerations This study was approved by the ethics committee of Islamic Azad University of Arak Branch (Code: IR.IAU.ARAK.REC.1397.66). Results The mean autonomy score of nurses was 3.16 ±0.35, indicating a desirable level. Nurses of all departments had limited autonomy. In the internal department, nurses had unsanctioned autonomy, while in the surgical department, they had autonomous nursing care action. The regression models were significant for all departments except for the internal department. With an increase of one unit in limited autonomy in the intensive care unit, autonomous nursing care in the surgical department, and limited autonomy in pediatrics, gynecology, orthopedics, and emergency departments among the nurses, the quality of care can be increased by 0.253, 0.187, 0.522, 0.205, 0.466 and 0.129, respectively. Conclusion Nurses’ autonomy can increase the quality of patient care. The nursing managers need to empower nurses and provide an environment for them to apply their knowledge in practicing autonomy.

An evaluation of clinical and ultrasound results of Pavlik harness treatment for developmental dysplasia of the hip.

Developmental dysplasia of the hip (DDH) is the instability or dislocation of the hip joint at birth that may occur in utero, during infancy, and childhood. This condition was identified as an important challenge. This study aimed to determine the clinical and ultrasound results of Pavlik harness treatment for DDH in patients referred to the pediatric clinic of Imam Khomeini Hospital in Ahvaz. This is a descriptive cross-sectional study in which 100 newborns aged 15 to 30 days were included by the census method after obtaining parental consent. Follow-up of the infants was performed at 3 and 6 months after treatment. All analyzes were performed using SPSS version 22 at a significance level of 0.05. The results showed that the mean age of the infants was 23.46±2.12 days, of which 33 infants were boys and 67 girls. The involvement on the right and left sides was 39% and 50%, respectively, and 11% of the infants had bilateral involvement. The mean value of acetabular index before placement was 25.48±6.509 and 26.38±3.866 on the right and left sides, which after 3 months of placement, was reduced to 21.62±2.578 and 21.57±2.839, respectively. Pavlik harness treatment was associated with acceptable radiological results in infants. This technique seems to be a suitable and applicable attempt to treat this problem and prevent serious and irreversible complications of late diagnosis.

Relationship Between Post-traumatic Growth and Illness Perception and Emotion Regulation in Patients with Cancer

Background: Cancer diagnosis causes emotional problems and profound psychological helplessness in patients. We aimed to investigate the relationship between post-traumatic growth and disease perception and emotion regulation in patients with cancer. Methods: The statistical population of this correlation study was all patients aged 18-65 years with breast, leukemia, and gastrointestinal cancer going to the oncology ward of Omid and Imam Khomeini hospitals in Urmia in the first half of 2021. 250 people (121 women and 129 men) were selected by the purposeful sampling method. Data collection tools included a post-traumatic growth questionnaire, a modified illness perception questionnaire, and the emotion regulation process strategies questionnaire. Pearson’s correlation test and multiple regression analysis were used for data analysis. Results: The results showed that negative illness perception had a significant and negative relationship, and optimistic illness perception had a positive, meaningful relationship with post-traumatic growth (P&lt;0.05). Emotion regulation had a significant and positive association with post-traumatic growth (P&lt;0.05). Conclusion: How to perceive the disease and emotion regulation strategies in patients with cancer have an influential role in promoting post-traumatic growth.

Short-term outcomes following amniotic membrane and conventional dressing in skin graft donor site; a randomized clinical trial

Introduction: Burn injuries have been associated with a bad prognosis throughout history. Nowadays, the treatment of burn wounds is one of the problems in the country’s health care system. There are several treatments for localized burns, such as antimicrobial dressings (using topical antibiotic drugs) and biological dressings (using tissue from living organisms). Biologic dressing with an amniotic membrane is one of the treatments for burned tissues in these patients. Objectives: This study aimed to investigate the short-term outcomes of dressing with amniotic membrane and routine dressing in graft donor site. Patients and Methods: This clinical trial study was conducted in the burn ward of Imam Khomeini hospital, Urmia, Iran in 2019. The patients were treated with two amniotic membrane dressings (the patient’s left leg) and a local antimicrobial dressing (the patient’s right leg). The amniotic membrane was purchased from Sina Cell Company and used to dress the second-degree wound. Patients’ right foot was covered with gauze soaked in nitrofurazone dressing since 2 μg of ointment was used for each percent of graft site. The recovery and epithelialization time was assessed one month after the study. Results: The rate of infection in the two groups did not differ significantly. Furthermore, the rate of wound healing (epithelialization) and post-dressing pain was much better in the group of dressings with amniotic membrane than the group of routine dressings, which was significant (P&lt;0.01) and showed that amniotic membrane dressings are much more effective in healing wounds and reducing pain compared to the routine dressings. Conclusion: This study showed that the use of amniotic membrane for dressing second-degree burn wounds, compared to the routine dressings, has better results and benefits such as less pain, faster epithelialization, shorter length of stay at hospital and better patient acceptance. Trial Registration: Registration of trial protocol has been approved by the Iranian Registry of Clinical Trials (identifier: IRCT20181216041996N1, https://en.irct.ir/trial/35985, ethical code; IR.UMSU.REC.1397.245).

Study of intestinal microbial flora of local chickens to investigate the effect of probiotics Bacillus subtilis and Bacillus coagulans on the expression of ctxM and luxS pathogenic genes in isolates of Escherichia coli

Background and objective: Antibiotics are widely used worldwide. However, due to the emergence of antibiotic resistance in a wide range of microorganisms, their use worldwide has failed. Probiotics are suggested as complementary and alternative medicine. The present study aimed to investigate the effects of probiotics isolated from local chickens on the expression of luxS and ctxM genes in resistant Escherichia coli. Materials and methods: 300 fecal samples were taken from patients referring to Imam Khomeini Hospital in Tehran during May–September 2016 and Escherichia coli samples were isolated using specific culture media and biochemical tests and then the presence of luxS and ctxM genes were identified using PCR with specific primers. In order to extract the probiotics forming spores, the intestinal contents of 10 poultry that had not used any antibiotics and probiotics were cultured, isolated, and identified using biochemical and PCR methods. Commercial strains of Bacillus subtilis and Bacillus coagulans were purchased to compare their effects with native bacteria. These strains were then co-cultured with resistant Escherichia coli strains containing ctxM and luxS genes. Real-time PCR was used to evaluate the effect of these probiotics on gene expression Results: The results indicated that 40 isolates (7.5%) of Escherichia coli were obtained from the 300 fecal samples. Thirteen samples (32.5%) were outpatients and 27 (67.5%) were inpatients. All isolates were isolated from men and women aged 21–62. Four Escherichia coli strains were isolated from patients carrying ctxM and luxS genes. Isolation of Bacillus coagulans and Bacillus subtilis from samples was confirmed by biochemical and molecular experiments. The commercial and native strains of Bacillus coagulans reduced the expression of the luxS and ctxM genes by 3.60, 3.30, 1.58, and 2.70 times respectively. Also, the commercial and native strains of Bacillus subtilis decreased the expression of the luxS and ctxM genes by 1.37, 1.10, 2.20, and 2.80 times respectively. The results of statistical analysis showed a significant relationship between the presence of native and commercial probiotics in culture and reduced expression of ctxM and luxS genes. Conclusion: According to the results, supplements of Bacillus coagulans and Bacillus subtilis increase the effect of antibiotics resistance in Escherichia coli by reducing the expression of resistance genes.

Exploring the Association Between Latent Toxoplasma gondii Infection and COVID-19 in Hospitalized Patients: First Registry-Based Study.

PurposeThis study aimed to determine the possible association between Toxoplasma gondii infection and COVID-19 outcomes among 133 patients with an RT-PCR-positive test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), hospitalized at Imam Khomeini Hospital, Sari, Mazandaran Province, northern Iran, during August to November 2020.MethodsA questionnaire was used to collect baseline data from the patients who were registered to the Iranian National Registry Center for Toxoplasmosis (INRCT). Also, blood samples were taken from each patient for detecting anti-T. gondii antibodies and T. gondii DNA using enzyme-linked immunosorbent assay (ELISA) and conventional-PCR methods, respectively. Variables related to the COVID-19 severity and outcomes were indicated based on multiple multinomial logistic regression models.ResultsOf 133 patients enrolled in the INRCT with COVID-19 through RT-PCR, 50 (37.59%), 52 (39.1%), and 31 (23%) suffered from mild, moderate, and severe COVID-19, respectively. 57.1% of the patients who died had severe COVID-19, while among those with other outcomes, only 18.60% had severe COVID-19 (P < 0.05). Anti-T. gondii IgG was detected in 109/133 (81.95%) patients, which was not statistically significant (P > 0.05). Among those with negative and positive anti-T. gondii IgG, 2 (8.30%) and 29 (26.60%) had severe COVID-19, respectively (P > 0.05). T. gondii DNA and anti-T. gondii IgM were not found in any of the patients. Moreover, all deaths occurred in those with moderate or severe COVID-19 and a positive anti-T. gondii IgG.ConclusionTo our knowledge, this is the first registry-based study concerning T. gondii infection among patients with COVID-19. Our data show the high rate of latent T. gondii infection among COVID-19 with different severity. However, there is no significant relationship between latent T. gondii infection and COVID-19 severity and outcomes. Thus, conducting multicenter studies in different geographic regions of the world could offer a better understanding of this relationship.

The Referral Pattern in a Central Hospital in Iran During the First COVID-19 Peak: The Role of Media and Health Planning

Background: A better understanding of the pattern of epidemic-related referrals to healthcare centers might allow the identification of vulnerabilities and the required changes that the healthcare management system should undergo. Objectives: This study aimed to investigate the COVID-19 referral pattern and the role of media and health management planning in changing the trends. Methods: Data extracted from the electronic medical database of Imam Khomeini Hospital Complex (IKHC), located in Tehran, Iran, from February 20 to June 4, 2020 were examined. Individuals were divided into two groups, COVID-19 positive and negative. We used Google Trends to evaluate Google Internet search queries and also available policy documents, programs, and official news related to COVID-19 in Iran during the mentioned period. Results: In this study, 8647 individuals aged 46.05 ± 16.5 years were referred to IKHC. Approximately 57% were male, and 70% were COVID-19 positive. The most clinical symptoms were dyspnea, fever, cough, and myalgia. Chronic kidney disease (CKD) and type 2 diabetes mellitus were the most common underlying health conditions. In the first two weeks, the percentage of negative cases was higher than positive cases and then the pattern was reversed, when people searched for information about COVID-19 in media. Conclusions: Proper and timely information and education to people through the media and health management measures can be effective in reducing unnecessary visits to health centers, preventing the exhaustion of medical staff, and controlling the disease during epidemics.

Effect of end-of-life nursing education on the knowledge and performance of nurses in the intensive care unit: a quasi-experimental study

BackgroundEnd-of-life care education is required for nurses to acquire the clinical competence necessary for the improvement of the quality of end-of-life nursing care. The aim of this study was to determine the effect of nursing care education based on End-of-Life Nursing Education Consortium (ELNEC) on the knowledge and performance of nurses working in the intensive care unit (ICU).MethodsThis quasi-experimental study was conducted with a pretest–posttest design. From among nurses working in the ICU of Golestan and Imam Khomeini hospitals in Ahvaz, Iran, 80 nurses were selected based on the inclusion criteria. They were randomly assigned to the intervention and control groups (40 people in each group) using a table of random numbers. Data were collected using a demographic characteristics form, the ELNEC Knowledge Assessment Test (ELNEC-KAT), and the Program in Palliative Care Education and Practice Questionnaire (German Revised Version; PCEP-GR).ResultsA significant difference was observed between the intervention and control groups in terms of the average knowledge score in all 9 modules including nursing care, pain management and control, disease symptom management, ethical/legal issues, culture, communication with the patient and his/her family, loss and grief, death, and quality of life (QOL) (P < 0.001). Moreover, the average performance score of nurses in the fields of preparation for providing palliative care, self-assessment of ability to communicate with dying patients and their relatives, self-assessment of knowledge and skills in palliative care increased significantly in the intervention group compared to the control group (P < 0.001).ConclusionsEnd-of-life nursing education is recommended as an effective method for promoting knowledge, attitude, performance, and clinical competence among all nurses involved in end-of-life care.

Effect of Urinary Catheter Removal Time on Satisfaction of Patients After Lower Limb Fracture Surgery: A Clinical Trial

Background and Objectives The patients undergoing lower limb fracture surgery face with several complications and problems. One of these complications is related to use of urinary catheters and their indwelling which may affect the patients’ satisfaction. This study aims to determine the effect of urinary catheter removal time on the satisfaction of patients undergoing lower limb fracture surgery. Subjects and Methods This is a non-randomized clinical trial that was conducted during 2018-2019 in Tehran, Iran. By using a convenience sampling method, 84 patients undergoing lower limb fracture surgery in the orthopedic department of Imam Khomeini and Bank Melli hospitals were selected and divided into three groups of 28: Catheter removal after 24 hours, catheter removal after 48 hours, and catheter removal after 72 hours. The data were collected through self-reporting and interview. 72 hours after catheterization and voluntary urination, they completed a demographic form and a patient satisfaction questionnaire. The gathered data were analyzed by using descriptive and inferential statistics in SPSS software, version 16. Results All three groups showed high satisfaction with their urination and there was no significant difference among the groups (P=0.86). Regarding overall satisfaction, there was a significant difference among three groups (P=0.031), where the overall satisfaction was higher in patients with 24-hour catheterization. Conclusion Early removal of urinary catheters in patients undergoing lower limb fracture surgery is associated with their higher overall satisfaction.

Comparison of the prevalence of venous thromboembolism in patients treated with enoxaparin and heparin: A cross-sectional study in the intensive care unit of Imam Khomeini Hospital in Ahvaz

Comparison of the prevalence of venous thromboembolism in patients treated with enoxaparin and heparin: A cross-sectional study in the intensive care unit of Imam Khomeini Hospital in Ahvaz

Evaluation of bone density and its relation with radiographic stage in knee osteoarthritis, 2016-2017

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Osteoarthritis (OA) is the most common arthritis and its incidence is directly related to age. According to the related research in the last 30 years, a relationship is reported between severity of osteoarthritis and bone density. The aim of this study was to investigate the bone density and its relation with radiographic stage in knee OA.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; In this descriptive cross-sectional study, 123 patients with knee OA diagnosis who referred to rheumatology clinic at Imam Khomeini hospital in Ardabil, were selected to participate in our study. Age, sex, weight, height and other variables were collected and analyzed with SPSS version 21.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; A significant correlation was found between T-score and age of the patients (r=-0.38, p=0.001). A significant correlation was found between T-score and BMI. The correlation of T-score and radiographic stage of patients with osteoarthritis was indirect and non-significant (r=-0.22, p=0.06). Multivariate regression models showed that among variables, only two variables BMI and age had significant relation with T-score.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Results showed that the relation between radiographic stage and T-score was significant and BMI and age had a significant effect on T- score.&lt;/p&gt;

Why are breastfeeding rates declining in Iran? A qualitative study on three centers in Tehran

Background and objective: This qualitative study was conducted to identify obstacles to breastfeeding and provide strategies for promoting its practice in Tehran based on the experiences and perceptions of breastfeeding mothers. Methods: Data were first collected through focus group discussions with 51 breastfeeding mothers admitted to Vali Asr Hospital in the Imam Khomeini Hospital Complex and two health centers in Tehran. We held follow-up in-depth interviews with 26 mothers over a year postpartum or until breastfeeding was discontinued. Results: The most important barriers to breastfeeding were (1) Physical condition of the mother, including lack of vigor, physical weakness, weight loss, inappropriate nutrition, nipple-related problems, inadequate breast milk, changes in body shape, and maternal and neonatal diseases. (2) Health care system, including (a) Hospital-related problems included (i) Providing educational services related to breastfeeding, (ii) Problems related to the behaviors of hospital staff, and breastfeeding problems related to cesarean delivery. (3) Emotional and psychosocial aspects of breastfeeding, including emotional support from husband and family, dislike of breastfeeding in public places, stress and mental pressure, and maternal employment. Conclusion: Politicians in the field of health can exert a considerable effect on breastfeeding practice and its continuation by providing early intervention designed to increase awareness of breastfeeding among young girls, training health staff in offering breastfeeding support, and ensuring contact between mother and infant. Also, provide support services, such as extended maternity leaves, daycare facilities in the workplace, and breastfeeding counseling centers. Further research is needed to assess the effectiveness of the interventions currently proposed in the Iranian context.