Masih Daneshvari Hospital Research Articles

Comparative Analysis of Ticagrelor and Clopidogrel Effects on Medication Adherence, Adverse Events, and Laboratory Parameters in Iranian Acute Coronary Syndrome Patients Post-PCI

Background: Acute coronary syndrome (ACS) remains a critical health concern, with patient outcomes significantly influenced by the selection of antiplatelet therapy post-percutaneous coronary intervention (PCI). Existing research suggests potential benefits of ticagrelor over clopidogrel in reducing cardiovascular events. However, there is limited comparative data within the Iranian population post-angiography. Objectives: This research aimed to compare laboratory findings, adherence rates, and side effects following the administration of ticagrelor and clopidogrel in ACS patients post-PCI. Methods: A case-control study was conducted to assess the impacts of antiplatelet therapy in 200 ACS patients undergoing PCI at Masih Daneshvari Hospital, Tehran, Iran. Patients were stratified into two groups, matched by age, gender, and type of cardiac disease. One group received clopidogrel, and the other received ticagrelor. Laboratory parameters, including HDL, LDL, and CRP, were evaluated at baseline and two months after treatment initiation. Additionally, adverse effects and medication adherence were assessed to evaluate the safety and efficacy of the two antiplatelet agents. Results: The study enrolled 200 ACS patients post-PCI, with 54% male and 46% female. The age range was 38 to 84 years, with a mean age of 63.07 ± 12.54 years. Of the patients, 76% had non-ST-elevation myocardial infarction (NSTEMI), while 24% had ST-elevation myocardial infarction (STEMI). Among STEMI patients, 56.25% were treated with fibrinolytics, and 43.75% underwent primary PCI. Common adverse events included dyspnea, bleeding, and gastrointestinal symptoms. Both the ticagrelor and clopidogrel groups showed reductions in LDL levels from baseline to the two-month follow-up. Conclusions: Ticagrelor and clopidogrel were both effective in reducing LDL levels after two months of treatment. However, ticagrelor demonstrated a more pronounced decrease in CRP levels, indicating potential anti-inflammatory benefits. These findings provide insight into antiplatelet therapy's role in managing ACS patients post-PCI.

The Lived Experiences of Patients with Coronavirus Disease 2019 in Masih Daneshvari Hospital: A Phenomenological Study

Abstract OBJECTIVE: The coronavirus disease 2019 (COVID-19) pandemic has had a profound impact on the lives of people around the world. This study aimed to investigate the lived experiences of COVID-19 patients during their illness, including hospitalization, referrals to treatment centers, and their physical and mental experiences, at the Masih Daneshvari Educational and Research Center in Tehran. METHODS: This was a phenomenological study using a conventional content analysis approach. Data collection and analysis were conducted based on the steps proposed by Graneheim and Lundman. The study population consisted of 52 COVID-19 patients (28 females and 24 males) hospitalized at Masih Daneshvari Hospital. Semi-structured, face-to-face interviews were conducted until data saturation was reached. RESULTS: A total of 957 primary codes were extracted from the data, which were subsequently reduced to 52 codes after reviewing and consolidating similar codes. The findings revealed that the challenges faced by COVID-19 patients could be categorized into 5 main themes and 15 subcategories: Patients’ perceptions of how they were infected (disease characteristics, cultural-religious issues, and vulnerable patients), communication with treatment staff (satisfaction, respect, and empathy), physical and mental health (psychological effects, symptom exacerbation, and disease complications), ambiguity experiences (training, awareness, risk perception, and multiple treatments), and emotional experiences from hospitalization (social stigma, fear of death, and disease suffering). CONCLUSION: This study provides valuable insights into the challenges faced by COVID-19 patients, which can inform future policymaking and planning for managing epidemics and similar public health crises.

Assessing the Sensitivity of Nested PCR Followed by Direct Sequencing on Exosomal DNA for EGFR Mutation Detection in NSCL

Early and minimally invasive detection of epidermal growth factor receptor (EGFR) mutations in non-small cell lung cancer (NSCLC) patients is a promising tool to select patients for targeted therapy in order to improve their prognosis. This study aimed to identify a sensitive, cost-effective, and easily accessible noninvasive method for detecting the EGFR-targetable mutations in the plasma exosomal DNA (exoDNA)+ of patients with NSCLC. This retrospective observational study was conducted over 10 months, from December 2022 to October 2023, at Masih Daneshvari Hospital in Tehran, Iran. A total of 30 patients with stage II-IV NSCLC and targetable mutation in the EGFR gene were included in the study. Nested PCR and Sanger sequencing were used to evaluate EGFR mutations in the DNA extracted from circulating exosomes. The study found a sensitivity of 76.6% for EGFR mutation detection on exoDNA compared to tissue results. No significant impact was observed based on tumor staging, histology, mutation type, smoking status, gender, or age. Therapeutically targetable driver mutations in the EGFR gene can be accurately detected using nested PCR followed by direct sequencing of plasma exoDNA from patients with NSCLC. This approach facilitates timely and more personalized treatment for NSCLC patients, ultimately improving patient prognosis. Additionally, this method reduces the reliance on invasive tissue biopsies and their associated complications.

Clinical and genomic evaluations of a persistent fatal SARS-CoV-2 infection in a goods syndrome patient: a case report

The coronavirus disease of 2019 (COVID-19) resulted from an infection by severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) which is the main cause of acute respiratory distress syndrome (ARDS) in global population from 2019 on. It may contribute to higher rate of death among the patients with immunodeficiency based on recent reports. In addition, Good syndrome (GS) as a result of thymoma removal might cause in some long-lasting microbial infections. We described clinical aspects and viral mutations on a case of GS suffering from COVID-19. A 46-year-old man with fever, common respiratory disease symptoms and positive COVID-19 polymerase chain reaction (PCR) test, with the history of thymoma removal surgery was admitted to Masih Daneshvari Hospital, Tehran, Iran. Lung radiographs and oxygen saturation measurement disclosed considerable implication resulted in application of several anti-microbial medication. The delta variant (B.1.617.2 (21 J Clade)) was the strain isolated from the patient by sequencing methods done by the COVID-19 National Reference Laboratory (CNRL), Pasteur Institute of Iran, while the dominant strain circulated mostly among population was Omicron (B.1.1.529) at the time of sampling. Unfortunately, the patient had passed away a month later by sudden respiratory failure progressed in refractory septic shock. Despite the fact that opportunistic infections may lead the GS patients to a major health problematic condition, unusual persistent of infections such as non-dominant variant of SARS-Cov-2 could be observed through the disease timeline. Therefore, a fully screening of thymoma plus intra-host evolution monitoring of SARS-CoV-2 is highly recommended in immunocompromised patients.

The effects of combination-therapy of tocilizumab and baricitinib on the management of severe COVID-19 cases: a randomized open-label clinical trial.

Background: Tocilizumab and baricitinib are considered standard treatments for hospitalized COVID-19 patients with an inflammatory status. However, the effects of co-administering these medications aiming for more rapid patient recovery are controversial among practitioners. The potential benefits include the rapid improvement of patients and regulation of the immune system, and the potential risks include the increased chance of serious adverse events, including infections. This study aimed to investigate the effects of co-administering these two medications on the 28-day mortality rate, other efficacy parameters, and safety issues. Methods: In this randomized open-label trial, 68 patients were recruited. The study was conducted at Dr. Masih Daneshvari Hospital during 6months (from 21 March 2022 to 23 August 2022). Severely ill patients aged between 18 and 100years old with confirmed COVID-19 were enrolled. The primary outcomes included the need for invasive mechanical ventilation and a 28-day mortality rate. Secondary outcomes included the need for non-invasive mechanical ventilation, the need for admission to the intensive care unit (ICU), the length of hospital stay, and the need for a second dose of tocilizumab. Safety assessments were also performed for 28days. The data were collected from the patients' medical records, which included age, gender, and comorbidities. Results: The 28-day mortality rate or the need for mechanical ventilation was not statistically different among the two groups (p-value = 0.49 for both outcomes). The need for non-invasive mechanical ventilation, the need for admission to the ICU, or the need for a second dose of tocilizumab and the length of hospital stay was not affected either (p-value = 1; 0.1; 0.49 and 0.9, respectively). One patient developed thrombosis in the combination group. No adverse events related to infectious complications were recorded in any groups. Conclusion: This study showed no beneficial effects of combining tocilizumab and baricitinib in managing severe COVID-19 cases. However, the need for ICU admission was meaningfully lower in the combination group. Studies with larger sample sizes are needed to confirm these results. Clinical Trial Registration: Identifier: RCT20151227025726N30M.

Safety and feasibility study of ex vivo expanded allogeneic-NK cells infusion in patients with acute pneumonia caused by COVID-19

BackgroundNK cells are the most active innate immune cells in antiviral immunity, which are impaired by SARS-COV2 infection. Infusion of allogeneic NK cells might be a complementary treatment to boost immune system function in COVID-19 patients. In this project, we focused on COVID-19 patients with low inspiratory capacity (LIC). This project aims to evaluate the feasibility and safety of allogeneic NK cell infusion as an intervention for respiratory viral disease.MethodsA non-blind two arms pilot study was designed and conducted after signing the consent form. Ten matched patients, in terms of vital signs and clinical features, were enrolled in the control and intervention groups. Approximately 2 × 10^6 cells/kg of NK cells were prepared under GCP (good clinical practice) conditions for each patient in the intervention group. The control group was under the same conditions and drug regimen except for the treatment with the prepared cells. Then, infused intravenously during 20 min in the ICU ward of Masih Daneshvari Hospital. The clinical signs, serological parameters, and CTCAE (Common Terminology Criteria for Adverse Events) were recorded for safety evaluation and the feasibility of project management were evaluated via designed checklist based on CONSORT.ResultsThere were no symptoms of anaphylaxis, hypersensitivity, significant changes in blood pressure, cardiovascular complications, and fever from injection time up to 48 h after cell infusion. The mean hospitalization period in the control and intervention groups was 10 and 8 days, respectively. The blood O2 saturation level was raised after cell infusion, and a significantly lower mean level of inflammatory enzymes was observed in the intervention group following discharge compared to the control group (p < 0.05). The inflammatory parameters differences at the discharge date in cell therapy group were highly negative.ConclusionIntravenous infusion of ex vivo-expanded allogeneic NK cells was safe and feasible. However, the efficacy of this approach to reducing the severity of disease in COVID-19 patients with LIC could not be determined.Trial registrationName of the registry: NKCTC. IRCT20200621047859N2. December 29, 2020. URL of trial registry record: https://www.irct.ir/trial/49382

Serial SOFA-score trends in ICU-admitted COVID-19 patients as predictor of 28-day mortality: A prospective cohort study.

The efficacy of Sequential Organ Failure Assessment (SOFA)score as predictor of clinical outcomes among ICU-admitted COVID-19 patients is still controversial. We aimed to assess whether SOFA-score in different time intervals could predict 28-day mortality compared with other well-acknowledged risk factors of COVID-19 mortality. This observational prospective cohort was conducted on 1057 patients from March 2020 to March 2022 at Masih Daneshvari Hospital, Iran. The univariate and multivariate Cox proportional analysis were performed to assess the hazards of SOFA-score models. Receiver operating characteristic (ROC)curves weredesigned to estimate the predictive values. Mean SOFA-score during first 96 h(HR: 3.82 [CI: 2.75-5.31]), highest SOFA-score (HR: 2.70 [CI: 1.93-3.78]), and initial SOFA-score (HR: 1.65 [CI: 1.30-2.11]) hadstrongest association with 28-daymortality (p < .0001). In contrast, SOFA scoresat 48and 96 has well as Δ-SOFA: 48-0 hand Δ-SOFA: 96-0 hdid not show significant correlations. Amongthem, merely mean SOFA-score (HR: 2.28 [CI: 2.21-3.51]; p < .001) remained as independent prognosticator on multivariate regression analysis; though having less odds of predicting value compared with age (HR: 3.81 [CI: 1.98-5.21]), hypertension (HR: 3.11 [CI: 1.26-3.81]), coronary artery disease [CAD] (HR: 2.82 [CI: 1.51-4.8]), and diabetes mellitus (HR: 2.45 [CI: 1.36-2.99]). The area under ROC (AUROC) for mean SOFA-score (0.77) and highest SOFA-score (0.71) were larger than other SOFA intervals. Calculating the first 96 hof SOFA trends, it was obtained that fatality rate was <12.3% if the score dropped, between 28.8%and 46.29% if the score remained unchanged, and >50.45% if the score increased. To predict the 28-day mortality among ICU-admitted COVID-19 patients, mean SOFA upon first 96 hof ICU stay is reliable; while having inadequate accuracy comparing with well-acknowledged COVID-19 mortality predictors (age, diabetes mellitus, hypertension, CAD). Notably, increased SOFA levels in the course of first 96 hof ICU-admission, prognosticate at least 50%fatality regardless of initial SOFA score.

The Effectiveness of Cognitive-Behavioral Stress Management Training on Anxiety and Depression in the COVID-19 Patients of Masih Daneshvari Hospital

Background: COVID-19 is not just a severe threat to the human body but can also jeopardize mental health. Thus, the prevalence of anxiety and depression has increased during the COVID-19 pandemic. Objectives: The present study aimed to evaluate the effectiveness of cognitive-behavioral stress management training on the anxiety and stress of COVID-19 patients in Masih Daneshvari Hospital, Tehran, Iran. Methods: The present study used a quasi-experimental pretest-posttest design with a control group. The population included all COVID-19 patients in Masih Daneshvari Hospital in April-May 2021, of whom 120 patients were selected using the convenience sampling method and randomly divided into an experimental group (60 participants) and a control group (60 participants). The data were collected using the Corona Disease Anxiety Scale (CDAS) by Alipour et al. (2020) and Beck’s Depression Inventory. The collected data were analyzed using the COVARIANCE analysis in SPSS24. Results: The results showed that cognitive-behavioral stress management training significantly affected the COVID-19 patients of Masih Daneshvari Hospital. Conclusions: There was a significant implication for counselors and psychologists. Cognitive-behavioral stress management training reduced anxiety and depression in COVID-19 patients and improved mental health.

Evaluating Preoperative Intravenous Iron and Erythropoietin Treatment and Outcomes in Cardiac Surgery Patients.

Anemia is more common in cardiac surgery patients than in other people. Severe anemia before cardiac surgery strongly predicts blood transfusion. This study aimed to evaluate the outcomes of Intravenous (IV) iron and erythropoietin (EPO) injection preoperatively in anemic patients waiting for coronary artery bypass graft (CABG) surgery. This cross-sectional study was performed between May to December 2020 at Masih Daneshvari hospital in Tehran, Iran. Anemia was described according to the WHO definition (Hb < 130 g/L in men). The study was designed in two groups of men CABG patients. Hematocrit level, platelet count, partial thromboplastin time, international normalized ratio, prothrombin time before surgery, red blood cells (RBCs) transfusion, as well as plasma and platelet units' transfusion during surgery and at the time of hospitalization were obtained from patient's files. The length of stay in the hospital and the consequences, including infection, stroke and heart attack, and mortality, were also obtained from the patient's files and recorded in the checklists. Pearson's chi-squared test, Fisher's exact test, independent samples t-test, univariate logistic regression, and odds ratio (OR) were used. All statistical analyses were performed by the SPSS software version 21. The significance level in this study was considered 0.05. In this study, the data of 64 patients were gathered, among whom 16 (25%) were injected with IV iron and EPO, and the remaining 48 (75%) did not receive any medications for stimulating erythropoiesis. The mean age of patients was 64.05 ± 8.21 years, with an age range of 51 - 91 years. Infection (P = 0.258) and mortality rate (P = 0.440) in the two groups of injection and non-injection did not show a statistically significant difference. The duration of the clamp at the time of surgery (r = 0.699, P = 0.001) and the duration of hospitalization (r = 0.399, P = 0.023) had statistically significant positive relationships with the pump duration. Red blood cell consumption in the injection and non-injection groups was 2.50 ± 2.07 and 2.90 ± 1.80 (P = 0.469), respectively. Infection (P = 0.258), mortality rate (P = 0.440), and RBC utilization (P = 0.469) in the two groups of injection and non-injection were not significantly different.

Determination of factors related to emergency re-referral in patients with heart failure a hospital in Tehran — Iran: a cross-sectional study

INTRODUCTION: The re-referral of heart failure patients to the hospital is a significant health problem today and is one of the most costly and preventable events for these patients. The present study aimed to investigate the factors affecting the re-referral of patients with heart failure to the emergency department of Shahid Beheshti University of Medical Sciences in Tehran in 2021. Identifying these factors can lead to the recognition of patients at high risk for re-hospitalization and the design of preventive and effective interventions. MATERIAL AND METHODS: This descriptive-correlational research was performed cross-sectionally. Ninety patients with heart failure who were re-referred to the emergency department of Masih Daneshvari Hospital entered the study. Sampling was done for 6 months from December 2020 to May 2021. Data collection tools included a researcher-made questionnaire and a European self-care questionnaire for heart failure patients, and the New York Heart Association Classification (NYHA) standard for classifying heart failure class. After completing the questionnaires, the collected data were analyzed by SPSS23 software. RESULTS: the results showed that age (the mean age of the participants in the study was 69.9 years), duration of disease (77.8% was six months to four years), body mass index (the mean body mass index was 27.2) (demographic characteristics) dyspnea (78.9%), organs edema (47.8%), shortness of breath (pathological factors), high blood pressure (54.4%), diabetes (25%), chronic obstructive pulmonary disease (11.1%), and ischemic heart disease (3.3%), (background diseases), high creatinine (the mean 1.98), (laboratory findings), not using beta-blockers (18.4%) and not taking angiotensin receptor blockers (18.8%) (pharmacological agents), NYHA criteria (89% were in NYHA class 3 and 4) and self-care levels of heart failure patients (the mean self-care score was 37.4) have a statistically significant association to re-referrals to emergency (p-value &lt; 0.05). CONCLUSIONS: Identify patients with a high risk of hospital re-referral and decrease additional costs imposed on care centers by recognizing the factors influencing the re-referral of patients with heart failure and design preventive and effective interventions. So, it is possible to increase the patient’s self-care level while reducing the number of re-referrals.

Evaluation of Elevated Liver Enzymes and their Association with Increased Risk of Perioperative Mortality in Heart Transplant Patients

Background: Cardiovascular disease, which itself can lead to liver disorders, is known as the most common cause of death in many countries, including Iran. Elevated liver enzymes can increase mortality risk after transplantation in most heart surgeries. This study aimed to investigate the effect of elevated liver enzymes before and after transplantation on the risk of perioperative mortality in heart transplant patients.&#x0D; Methods: The information of this historical cohort study was prepared using patients’ hospital records from 2014 to 2019. The data belonged to demographic information, medical history, and laboratory data of 203 patients admitted to Dr. Masih Daneshvari Hospital. More than three times normal institutional ranges defined elevated liver enzymes. Also, the number of deaths within 30 days after transplantation was considered to determine perioperative mortality. The Chi-square test and regression method were used to analyze the data using SPSS software.&#x0D; Results: Mortality of patients with elevated liver enzymes before and on the first, second, and third days after heart transplantation was 4.08, 3.95, 3.75, and 4.89 times higher than those with normal liver enzymes, respectively. Increasing the Model for End-Stage Liver Disease (MELD) score was associated with a significantly increased risk of death (p&lt;0.001).&#x0D; Conclusion: Elevated liver enzymes before or three days after heart transplantation are significantly associated with perioperative transplant death. Optimization of liver function before transplantation can play an important role in preventing mortality.

Evaluation of noscapine-licorice combination effects on cough relieving in COVID-19 outpatients: A randomized controlled trial.

Background: As February 2023, SARS-CoV-2 is still infecting people and children worldwide. Cough and dyspnea are annoying symptoms almost present in a large proportion of COVID-19 outpatients, and the duration of these symptoms might be long enough to affect the patients' quality of life. Studies have shown positive effects for noscapine plus licorice in the previous COVID-19 trials. This study aimed to assess the effects of the combination of noscapine and licorice-for relieving cough in outpatients with COVID-19. Methods: This randomized controlled trial was conducted on 124 patients at the Dr. Masih Daneshvari Hospital. Participants over 18years of age with confirmed COVID-19 and cough were allowed to enter the study if the onset of symptoms was less than 5days. The primary outcome was to assess the response to treatment over 5days using the visual analogue scale. Secondary outcomes included the assessment of cough severity after 5days using Cough Symptom Score, as well as the cough-related quality of life and dyspnea relieving. Patients in the noscapine plus licorice group received Noscough® syrup 20mL every 6h for 5days. The control group received diphenhydramine elixir 7mL every 8h. Results: By day five, 53 (85.48%) patients in the Noscough® group and 49 (79.03%) patients in the diphenhydramine group had response to treatment. This difference was not statistically significant (p-value = 0.34). The presence of dyspnea was significantly lower in the Noscough® group versus diphenhydramine at day five (1.61% in the Noscough® group vs. 12.9% in the diphenhydramine group; p-value = 0.03). The cough-related quality of life and severity also significantly favored Noscough® syrup (p-values <0.001). Conclusion: Noscapine plus licorice syrup was slightly superior to diphenhydramine in relieving cough symptoms and dyspnea in the COVID-19 outpatients. The severity of cough and cough-related quality of life were also significantly better in the noscapine plus licorice syrup. Noscapine plus licorice may be a valuable treatment in relieving cough in COVID-19 outpatients.

Etiology and Contributing Factors of Cavitary Pulmonary Lesions in HIV Infected Patients

Background: This study aimed to investigate the etiology and contributing factors of cavitary pulmonary lesions in HIV infected patients.&#x0D; Methods: In this study, 844 HIV infected patients with a total of 1000 admissions were investigated at Masih Daneshvari Hospital from Aug 2010 to Oct 2019. After excluding the missing data and distorted documentation, 746 cases and 878 admission episodes finally underwent statistical analysis. The CXRs were observed thoroughly and the cavitary lesions were identified. Eventually, demographic data, diagnostic information, and laboratory findings were extracted and analyzed.&#x0D; Results: Of the 878 episodes of hospitalization, cavitary pulmonary lesions were observed in 145 documents. The most prevalent etiology was TB with 105 cases (72.5%). After that, Pneumocystis jiroveci and septic embolism were responsible for a further 7.6% and 5.6% of the total lung cavities, respectively. 58.5% of the cavities were present in a single lobe, with men being affected in 90.2% of the cases. The upper lobes were the most common site of involvement in the lungs [42.9% for Left Upper Lobe (LUL) and 52.3% for Right Upper Lobe (RUL)]. The rate of definitive diagnosis was significantly higher in patients affected with cavitary lesions (82.8%) in comparison with the unaffected (74.8%) (p=0.001). No significant difference in demographics, HIV and ART status, CD4+ cell count, viral load, and mortality was evident between the two groups.&#x0D; Conclusion: The most common etiology of cavitary lesions in HIV positive patients was attributable to TB, PJP, and septic embolism respectively. Cavitary lesions were more prevalent in males and mainly tend to involve the upper zones of pulmonary parenchyma.

The Effect of Pirfenidone on Idiopathic Pulmonary Fibrosis Patients of Masih Daneshvari Hospital in Tehran, Iran

Background: Idiopathic Pulmonary Fibrosis (IPF) is the most common form of lung fibrosis. This chronic and lethal disease is characterized by the gradual progression of fibrosis in the lung and decreased lung oxygen exchange capacity. This study aimed to evaluate the effect of pirfenidone on pulmonary parameters such as TLC, FVC, DLCO, 6-Minute Walk Distance (6MWD), and SPO2 has been done.&#x0D; Methods: In this study, 40 patients with IPF participated in two groups. Pulmonary indicators such as TLC, FVC, VC, and DLCO by wind box and the SPO2 index were calculated by pulse oximetry. The variable of 6MWD is the distance traveled in meters in 6 min. Variables such as age, sex, height, weight, and hospitalization were obtained through interviews with patients. The indicators were reviewed in both groups at 3 and 6 months.&#x0D; Results: Data analysis showed that there was no significant difference (p&gt;0.05) between the two groups. The mean reduction in these indexes was lower in the pirfenidone group and the decrease was significant over time. Also, the mean increase in the percentage of distance traveled in the 6MWD in the group of patients receiving pirfenidone was 53.53 and in the placebo group, it was 20.3%, which had a significant difference between the group receiving the drug and placebo was observed.&#x0D; Conclusion: The results of this study demonstrated that pirfenidone is considered as a preferred drug in all phases of the treatment of IPF disease and it has more therapeutic effects than other medicines.

The Effectiveness of Multimedia Education on Patients' Knowledge and Behavior on Fall Prevention

BACKGROUND: Falls are considered a serious problem among hospital events. Patients in hospitals are at risk for falls due to unfamiliar and potentially high-risk environments, weak physical conditions, and medicines that may increase fall risk. AIM AND OBJECTIVE: There is some evidence that patient education is an important component of multifactorial interventions for falls prevention. Given that patient education has an effective role in falls preventions at hospitals, the purpose of this study was to evaluate multimedia education for preventing falls. MATERIALS AND METHODS: A quasi-experimental design was used to investigate the effectiveness of educational materials in fall prevention program at Masih Daneshvari hospital. The study was conducted in four models of a patient education program. Patients' knowledge and skill of fall prevention in the hospital were tested on admission (pretest) and day 7 (posttest). The intervention was delivered after admission in all groups. RESULTS: There were 204 patients in four intervention groups and 50 patients in the control group. The comparison of the intervention groups with the control group showed that the changes in knowledge and behavior in the group that used multimedia education were significantly higher compared to traditional education. CONCLUSION: The findings of the present study suggest that patient education can be considered one of the main strategies to prevent falls, especially in a hospital setting. Further, the use of multimedia education simultaneously with face-to-face training has a synergistic effect and increases the effectiveness of fall prevention education programs.

Comparison of Dexmedetomidine and Propofol on Serum Neutrophil Gelatinase-associated Lipocalin Levels of Patients after Thoracotomy

BACKGROUND: Acute kidney injury (AKI) is a well-known complication of surgery that increases the death rate and the side costs of postoperative care and treatment. Neutrophil gelatinase-associated lipocalin (NGAL) is a protein that is emerging as a new marker in the early detection of kidney damage. AIM AND OBJECTIVE: In this study, we try to compare the effect of propofol (Pro) and dexmedetomidine (Dex) on activity in patients undergoing thoracotomy by evaluating and measuring the amount of renal function evaluation factors similar to blood urea nitrogen (BUN), creatinine, and NGAL. MATERIALS AND METHODS: All patients who underwent thoracotomy (with two types of anesthetics Dex and Pro) in the first 6 months of 2019 (April–September) in Masih Daneshvari Hospital were included in this study and the information obtained from all of them was based on a questionnaire design. RESULTS: The BUN index in patients of the two groups was significantly different in three time periods before surgery, 2 h after surgery, and 24 h. Based on the available results, the NGAL index as a factor in assessing renal function was significantly different in the two groups of patients. However, the mean numerical values in all three intervals of NGAL levels were much lower in the patients of the Pro group. However, other indicators in the study did not show significant changes in terms of mean values in the two groups of patients. CONCLUSION: Pro significantly reduced NGAL compared with Dex for thoracotomy surgery.

Primary Spontaneous Pneumothorax: Open Thoracotomy vs. Video-assisted Thoracoscopic Surgery: A Single-center Retrospective Cohort Study.

Primary spontaneous pneumothorax (PSP) is a spontaneous pneumothorax without underlying lung disease. The main goals of this study were to compare the outcomes of video-assisted thoracoscopic surgery (VATS) and open thoracotomy in patients with PSP. The current study is a retrospective cohort study of patients who were admitted to the emergency department or general surgery ward at Dr. Masih Daneshvari Hospital (Tehran, Iran) with the diagnosis of PSP and underwent surgery by open or VATS approach from 2006 to 2012. The groups were compared in terms of the length of operation, the length of hospitalization, recurrence, and postoperative complications. Data were analyzed using SPSS version 18.0, and Student's t test, analysis of variance (ANOVA), Chi square, and Fisher's exact test were employed. P values less than 0.05 were considered statistically significant. PSP was diagnosed in 90 patients who underwent surgery. Open thoracotomy and VATS procedures were performed in 65 (72.2%) and 25 (27.8%) patients, respectively. VATS was converted to open in seven cases (7.7%). Recurrent pneumothorax was the most common surgical indication for PSP. There was no significant difference between the two groups in terms of mean age, sex, smoking, side of the involved lung, previous pneumothorax history, mean length of hospitalization for recurrence, post-operation bleeding, and failure of lung expansion. However, the length of surgery (P=0.011) and air leakage (P=0.048) significantly differed between the two groups. When compared to open thoracotomy, VATS could be the primary treatment option in the surgical treatment of PSP due to the shorter length of surgery and decreased complications such as air leakage.

Total Antioxidant Capacity and Total Oxidant Status and Disease Severity in a Cohort Study of COVID-19 Patients.

Previous reports have suggested the role of oxidative stress in progression of COVID-19 infection, but there is limited information regarding the effect of antioxidant capacity and total oxidant status of patients with COVID-19 on disease severity. In the present study, we aimed to investigate the relationship between total antioxidant capacity (TAC), total oxidant status (TOS), TAC/TOS levels, and disease severity in hospitalized patients with COVID-19. This cohort study was carried out at Masih Daneshvari Hospital in Tehran, Iran, from September 2020 to October 2020. Clinical data of 331 patients with COVID-19 admitted to the hospital were analyzed and divided into mild, moderate, and severe groups (needed oxygen, intubation, and mechanical ventilation). The patients' TAC, TOS, and TAC/TOS levels were assessed using the serum samples by colorimetric assay kit. We found no significant difference in serum levels of TAC, TOS, and TAC/TOS in terms of the disease severity. These results indicated that total antioxidant capacity and total oxidant status may not be the determining factor on the disease severity.

Effectiveness of emotion regulation strategies treatment on avoidance and arousal behavior in women with post-traumatic stress disorder due to COVID-19

Aim: The aim of this study was to investigate the effectiveness of treatment of emotion regulation strategies on avoidance and arousal behavior in patients with post-traumatic stress disorder due to COVID-19. Materials and Methods: The research method was semi-experimental with a single-subject multiline basic design. The statistical population consisted of people who were admitted to the intensive care unit of Masih Daneshvari Hospital in Tehran between 2020 and 2021 due to COVID-19 and had post-traumatic stress disorder. Three women were selected by available sampling method and assigned to emotion regulation strategies treatment group. Then, three subjects received an 8-session protocol for treatment of emotion regulation strategies (Gross-2008). Event-edited impact questionnaires (Garmer, 2003) were administered as research tools in four stages: baseline, third and sixth Chelsea and after treatment. Data were analyzed using SPSS software version 22 by repeated measurement analysis and data analysis using diagram drawing. The recovery percentage formula (Ogles, 2001) was used to judge the rate of recovery. Results: The results showed that the approach of emotion regulation strategies improved avoidance and arousal in patients with post-traumatic stress disorder due to COVID-19. The percentage of recovery of avoidance and arousal in patients with post-traumatic stress disorder caused by the disease was between 52% and 68%. Conclusion: It can be concluded that the approach of emotion regulation strategies improves avoidance and arousal in patients with post-traumatic stress disorder due to COVID-19 and this treatment can be used to reduce psychological problems in COVID-19 patients.

The role of angiotensin I converting enzyme insertion/deletion polymorphism in the severity and outcomes of COVID-19 patients.

The pandemic of coronavirus disease in 2019 has led to a global crisis. COVID-19 shows distinct clinical manifestations of the severity of symptoms. Numerous patients with no associated risk factors demonstrate acute respiratory distress syndrome (ARDS). The role of genetic factors in determining the severity and outcome of the disease remains unresolved. The purpose of this study was to see if a correlation exists between Angiotensin I Converting Enzyme (ACE) insertion/deletion (I/D) polymorphism and the severity of COVID-19 patients' symptoms. 120 COVID-19 patients admitted to Masih Daneshvari Hospital in Tehran with their consent to participate entered the study. Based on the World Health Organization classification, patients were divided into moderate and severe groups, which were primarily affected by O2 saturation levels. The effects of the patients' ACE insertion/deletion polymorphism, background disease, Angiotensin receptor blocker (ARB) drug consumption, and demographic parameters on the severity risk were calculated statistically. The ACE D allele was associated with an increased risk of disease severity (OR = 6.766, p = 0.012), but had no effect on mortality.