Shahid Modarres Hospital Research Articles

Magnetic resonance cholangiopancreatography in acute cholecystitis: Is it necessary for patients with normal common bile duct diameter?

AbstractAimInvestigating concurrent choledocholithiasis in patients with acute cholecystitis (AC) and normal common bile duct (CBD) diameter on ultrasound by performing magnetic resonance cholangiopancreatography (MRCP) can be challenging. This study aims to determine the conditions that necessitate MRCP before surgery and its potential impact on the course of treatment for these patients.Patients and methodsWe included 100 patients with AC and normal CBD diameter who were admitted to Shahid Modarres Hospital from September 2019 to September 2022. Patients with elevated levels of any liver serum markers above the upper limit of normal underwent MRCP.ResultsThe MRCP results were positive in 45.16% of cases and altered the type of treatment in 35.48% of them. The findings indicated that direct [area under the curve (AUC) = 0.782; 95% confidence interval (CI) 0.597–0.909] and total bilirubin (AUC = 0.697; 95% CI 0.507–0.849) were significantly effective in predicting the positive findings for concurrent CBD stone or Mirizzi's syndrome on MRCP. The optimal cutoff values for direct and total bilirubin were found to be above 1.02 and 2.19 mg/dL. Concerning the alteration of treatment approaches, direct bilirubin demonstrated predictive value (P = .014) at levels above 1.02 mg/dL.ConclusionsIn cases of AC with a normal CBD diameter on ultrasound and mild elevations in liver function parameters, including total and direct bilirubin, it is not routinely necessary to perform MRCP. However, if these laboratory values exceed a certain threshold, MRCP is recommended as it may reveal alternative diagnoses that could alter the clinical management.

The Effect of Guided Imagery and Progressive Muscle Relaxation on Sedation in Patients Undergoing Noninvasive Mechanical Ventilation

Mental imagery and relaxation are noninvasive methods and can easily be used by the patient. Accordingly, this study aimed to detect the effect of guided mental imagery (GI) and progressive muscle relaxation (PMR) on sedation in patients undergoing noninvasive mechanical ventilation (NIV). This clinical trial study was carried out in the Shahid Modarres Hospital in 2022 and encompassed 80 patients with COVID-19 undergoing NIV, who were assigned to two intervention and control groups. The sedation survey scale was used to collect the required data. Before the intervention, the two groups completed the questionnaires, and then the relaxation program was presented during four sessions for the intervention group. This study included 80 patients with a mean age (± SD) of 59.59 ± 9.27 years. The Quade nonparametric ANCOVA revealed the significant impact of intervention on the post values of Total score (p-value < 0.001), Tolerance (p-value < 0.001), Calmness (p-value < 0.001), Ventilator synchrony (p-value < 0.001), face relaxation (p-value < 0.001), Consciousness (p-value = 0.009) and Awakeness (p-value = 0.020). The study findings demonstrated the effectiveness of relaxation program in promoting sedation in patients undergoing NIV. Accordingly, intensive care unit (ICU) nurses at our institution are encouraged to use PMR and GI to sedation of patients under NIV.

Insulin-like growth factor (IGF) levels in pre-treatment plasma identifying breast cancer: A case control study.

Diabetes (primarily type 2) is linked to a higher risk of breast cancer. Insulin-like growth factor (IGF) is one of the most important factors that affects mitosis and thus inhibits apoptosis. The purpose of this study was to compare the pre-treatment insulin-like growth factor (IGF) levels in breast cancer against normal population. In this case-control study, 60 patients with breast cancer and 60 healthy controls were enrolled in 2017 and 2018 at Tehran's Shahid-Modarres Hospital. In this study, the blood sugar of the patients was examined before entering the study, and the age of the patients was also within the age limit of 18 to 70 years. They were studied to determine the relationship between insulin-like growth factor (ELISA method) and breast cancer. Both groups have similar IGF-1 levels (Ctrl and Case) (P= 0.188). But, IGF-2 levels were significantly higher in breast cancer patients (373.4 vs. 317.3 ng/ml), (P=0.0001). According to our study, IGF-2 may serve as a prognostic biomarker and potential therapeutic target for breast cancer. However, further investigation is needed to validate this claim.

Development and evaluation of a clinical decision support system for early diagnosis of acute appendicitis

The most frequent reason for individuals experiencing abdominal discomfort to be referred to emergency departments of hospitals is acute appendicitis, and the most frequent emergency surgery performed is an appendectomy. The purpose of this study was to design and develop an intelligent clinical decision support system for the timely and accurate diagnosis of acute appendicitis. The number of participants which is equal to 181 was chosen as the sample size for developing and evaluating neural networks. The information was gathered from the medical files of patients who underwent appendicectomies at Shahid Modarres Hospital as well as from the findings of their appendix samples' pathological tests. The diagnostic outcomes were then ascertained by the development and comparison of a Multilayer Perceptron network (MLP) and a Support Vector Machine (SVM) system in the MATLAB environment. The SVM algorithm functioned as the central processing unit in the Clinical Decision Support System (CDSS) that was built. The intelligent appendicitis diagnostic system was subsequently developed utilizing the Java programming language. Technical evaluation and system usability testing were both done as part of the software evaluation process. Comparing the output of the optimized artificial neural network of the SVM with the pathology result showed that the network's sensitivity, specificity, and accuracy were 91.7%, 96.2%, and 95%, respectively, in diagnosing acute appendicitis. Based on the existing standards and the opinions of general surgeons, and also comparing the results with the diagnostic accuracy of general surgeons, findings indicated the proper functioning of the network for the diagnosis of acute appendicitis. The use of this system in medical centers is useful for purposes such as timely diagnosis and prevention of negative appendectomy, reducing patient hospital stays and treatment costs, and improving the patient referral system.

Effects of Descurainia sophia on Oxidative Stress Markers and Thirst Alleviation in Hemodialysis Patients: A Randomized Double-Blinded Placebo-Controlled Cross-Over Clinical Trial.

Patients undergoing hemodialysis (HD) are regularly exposed to oxidative stress and inflammation and may suffer from thirst distress with no definitive treatment to address these complications. Descurainia sophia (DS) has been used to alleviate thirst in traditional Persian medicine. This study aimed to assess the effectiveness of DS on oxidation factors and thirst score in HD patients. This study was conducted on fifty-three HD patients referred to Tehran Shahid Modarres hospital. The patients were randomly divided into two groups: Group 1 received DS for six weeks, then underwent four weeks of washout period followed by six weeks of placebo treatment, while group 2 received placebo initially followed by treatment with DS. Biochemistry, malondialdehyde (MDA), and total antioxidant capacity (TAC) were measured in four phases: at the beginning, before washout, after washout, and at the end of the study. The patient's body weight was recorded at the start of each session to assess interdialytic weight gain. Thirst scores also were measured using a visual analog scale. A total of 53 patients, including 23 (43.4%) male and 30 (56.6%) female subjects, were included in the study. The results showed a reduction in thirst score (p=0.001), cholesterol levels (p=0.046), triglycerides (0.003), and MDA (p < 0.001) following the four-week administration of DS treatment in HD patients. The mean levels of TAC were increased (p < 0.001), and calcium, as well as Na+, remained unchanged (p > 0.05). Also, a significant decrease in the patient's weight was observed (p value <0.001). This effect persisted after shifting to a placebo. However, the two groups had no significant difference (p value = 0.539). DS powder-mixed syrup may benefit HD patients by facilitating free radical scavenging and alleviating thirst distress with minimal adverse effects. The seeds could therefore be utilized as a complementary therapy for hemodialysis patients.

Risk Factors of Recurrent Anal Abscess in Patients with Type 2 Diabetes Mellitus; a 4-Year Retrospective study.

Anal abscess is considered as a relatively common compilation in type 2 diabetes mellitus (T2DM) patients. This study aimed to determine the risk factors of recurrent anal abscess in T2DM patients. In this 4-year retrospective cross-sectional study, T2DM patients hospitalized due to anal abscess in Shahid Modarres Hospital, Tehran, Iran from December 2016 to December 2020 were studied. The independent risk factors of disease recurrence were determined among demographic factors, underlying diseases, diabetes-related factors, clinical factors, laboratory parameters, abscess type, and culture using multivariate stepwise logistic regression analysis. 203 patients were enrolled in the study. 58 (28.6%) patients had at least one re-occurrence of anal abscess during four years. The recurrent episodes had occurred more frequently in the first year after the initial treatment (55.2%). The prevalence of comorbidities such as metabolic syndrome, coronary artery disease, chronic kidney disease, end stage renal disease, and peripheral vascular disease was significantly higher amongst patients with abscess recurrence. The patients with recurrent anal abscess had statically significant poor glycemic control (HbA1C > 7.5), decreased levels of Estimated Glomerular Filtration Rate (e-GFR), and higher C-reactive Protein (CRP) upon the first admission. Presence of metabolic syndrome, HbA1c > 7.5%, WBC > 11.0 ×109/L, and CRP > 5 mg/l were amongst the independent risk factors of recurrence. HbA1c > 7.5% was the greatest independent risk factor of anal abscess recurrence (OR=2.68, 95% CI: 1.37-5.25; p < 0.001). The area under the receiver operating characteristic (ROC) curve (AUC) of HbA1C, CRP, and WBC in predicting the risk of abscess recurrence was 0.81, 0.71, and 0.64, respectively. Th recurrence rate of anal abscess in this series was 28.6 %. It seems that in T2DM patients with uncontrolled diabetes who have metabolic syndrome and increased CRP and WBC in their routine tests, the probability of anal abscess reoccurrence is high.

The effects of resilience training on self-efficacy, empowerment, and social adjustment of renal transplant patients

Context: Chronic kidney disease refers to one of the chronic diseases highly affecting the quality of life (QoL) of patients.Aim: The present study investigated the effectiveness of resilience training on self-efficacy, empowerment, and social adjustment of renal transplant patients. Setting and Design: This study was a quasi-experimental interventional pre-test-post-test research with control group conducted at Shahid Modarres Hospital in 2020.Materials and Methods: From all kidney transplant patients admitted to Shahid Modarres Hospital and Shohada Tajrish Hospital who underwent kidney transplant surgery in 1398, 30 people were selected and randomly divided into two experimental groups (15 kidney transplant patients in Shahid Modarres Hospital in Tehran) and Witnesses (15 kidney transplant patients were admitted to Shohada Tajrish Hospital in Tehran). The experimental group participated in 12 sessions of 45 minutes in the resilience training program. Both groups completed the Scherer and Maddox (1982) self-efficacy questionnaires, the Spritzer (1995) psychological empowerment questionnaire, and the Wissman and Pickel (1974) social adjustment questionnaires before and after the intervention.Statistical Analysis Used: Data were analyzed using Kolmogorov–Smirnov test, t-test, and paired t-test using SPSS software version 18. Results: Resilience training was effective on self-efficacy, social adjustment, as well as the empowerment of renal transplant patients. Conclusion: The findings showed that resilience training in renal transplant patients enhances self-efficacy, empowerment, and social adjustment, thus promoting their physical, general, and psychological health. Also, it seems that the designing andresilience training can facilitate the process of empowerment, accompanied by increasing self-efficacy and social adjustment of patients.

Prevalence and Clinical Outcomes of Vitamin D Deficiency in COVID-19 Hospitalized Patients: A Retrospective Single-Center Analysis.

Vitamin D attenuates inflammatory responses to viral respiratory infections. Hence, vitamin D deficiency may be a highly significant prognostic factor for severity and mortality in COVID-19 patients. To evaluate the complications and mortality in different vitamin D status groups in COVID-19 hospitalized patients, we conducted this retrospective study on 646 laboratory-confirmed COVID-19 patients who were hospitalized in Shahid Modarres Hospital, Tehran, Iran from 16th March 2020 until 25th February 2021. Overall, patients with vitamin D deficiency, insufficiency and sufficiency were 16.9%, 43.6% and 39.5%, respectively. The presence of comorbidity, length of hospitalization, ICU admission, and invasive mechanical ventilation requirement and overall complications were significantly more in patients with vitamin D deficiency (p-value < 0.001). 46.8% (51/109) of vitamin D deficient patients died due to the disease, whilst the mortality rate among insufficient and sufficient vitamin D groups was 29.4% (83/282) and 5.5% (14/255), respectively. In univariate analysis, age > 60 years (odds ratio (OR) = 6.1), presence of comorbidity (OR = 10.7), insufficient vitamin D status (OR = 7.2), and deficient vitamin D status (OR = 15.1) were associated with increase in COVID-19 mortality (p-value < 0.001). Finally, the multivariate analysis adjusted for age, sex, and comorbidities indicated vitamin D deficiency as an independent risk factor for mortality (OR = 3.3, p-value = 0.002). Vitamin D deficiency is a strong risk factor for mortality and severity of SARS-CoV-2 infection. Vitamin D supplementation may be able to prevent or improve the prognosis of COVID-19 during this pandemic.

The Relationship between Serum Levels of Cardiac Enzymes and Junctional Ectopic Tachycardia (JET) after Cardiac Surgery of Congenital Heart Disease

Background In this study, we aimed to survey the relationship between serum levels of cardiac enzymes and junctional ectopic‏ tachycardia (JET) after corrective surgery of congenital heart disease (CHD). Materials and Methods: In this cohort study, 140 children with CHD who were hospitalized in intensive care unit of Shahid Modarres hospital in Tehran, Iran, were divided into case group (the JET group including 37 patients), and control group including 103 patients. These two groups were compared based on the previous studies and collected data. Results: Based on the analysis of the area under the Receiver Operating Characteristic curve, the Creatine Kinase Myocardial Band (CK-MB) level assessment can predict the occurrence of JET after the surgery (area under the curve is 0.849, 95% confidence interval is 0.786- 0.911), and the best cut-off point for it is 95.5 to predict the occurrence of JET. So, CK-MB will diagnose the occurrence of JET with 97.3% sensitivity and 67% specificity‏. In the same analysis, the troponin level assessment can predict the occurrence of JET after the surgery (area under the curve is 0.877, 95% confidence interval is 0.821- 0.933). Accordingly, the best cut-off point for the troponin is 45 to predict the occurrence of junctional ectopic‏ tachycardia which will diagnose it with 97.3% sensitivity, and 72.8% specificity‏. Conclusion There is a positive correlation between the occurrence of JET after corrective surgery of CHD and an increase in the level of CK-MB and troponin enzymes. So that the level of CK-MB above 95.5 and the level of troponin above 45 might predict the occurrence of JET in these patients with high accuracy.

The impact of metabolic syndrome on morbidity and mortality among intensive care unit admitted COVID-19 patients

Background and aimsGiven the limited information describing the connection between metabolic syndrome (MetS) and Coronavirus Disease 2019 (COVID-19), we aimed to assess the impact of MetS on morbidity and mortality among COVID-19 patients. MethodsThis retrospective cohort study was performed from 1st April to May 3, 2020 on 157 ICU-admitted COVID-19 patients in Shahid Modarres Hospital in Tehran, Iran. Patients’ clinical, laboratory and radiological findings, and subsequent complications, were collected and compared between MetS and non-MetS groups. Results74 of all cases had MetS. Among the MetS components, waist circumference (p-value = 0.006 for men; p-value<0.0001 for women), Triglycerides (p-value = 0.002), and Fasting Blood Sugar (p-value = 0.007) were significantly higher in MetS group; with no statistical difference found in HDL levels (p-value = 0.21 for men; p-value = 0.13 for women), systolic blood pressure(p-value = 0.07), and diastolic blood pressure (p-value = 0.18) between two groups. Length of ICU admission (p-value = 0.009), the need for invasive mechanical ventilation (p-value = 0.0001), respiratory failure (p-value = 0.0008), and pressure ulcers (p-value = 0.02) were observed significantly more in MetS group. The Odds Ratio (OR) of mortality with 0(OR = 0.3660), 1(OR = 0.5155), 2(OR = 0.5397), 3(OR = 1.9511), 4(OR = 5.7018), and 5(OR = 8.3740) MetS components showed an increased mortality risk as the components’ count increased. The patient with BMI>40 (OR = 6.9368) had more odds of fatality comparing to those with BMI>35 (OR = 4.0690) and BMI>30 (OR = 2.5287). Furthermore, the waist circumference (OR = 8.31; p-value<0.0001) and fasting blood sugar (OR = 2.4588; p-value = 0.0245) were obtained by multivariate logistic regression as independent prognostic factors for mortality. ConclusionThe findings suggest a strong relationship between having MetS and increased risk of severe complications and mortality among COVID-19 ICU-admitted patients.

How Hospital Tours Affect Preoperative Anxiety in Mothers with Children Undergoing Open-Heart Surgery in Iran: A Quasi-Experimental Study.

ABSTRACTBackground: Parents tend to experience considerable amounts of anxiety before their children undergo open heart surgery. This study was conducted to assess the effects of taking a hospital tour on preoperative anxiety in the mothers of children undergoing open heart surgery.Methods: In this quasi-experimental study, 96 mothers from Shahid Modarres Hospital in Tehran, Iran, during April to December 2018, were selected through convenience sampling and were assigned to three groups using simple randomization. The oral instruction group (N=32) attended two oral instruction sessions; the hospital tour group (N=32) participated in tours of the operation room and intensive care unit; the control group (N=32) was prepared according to the ward’s routine. Preoperative anxiety was evaluated using the Amsterdam Preoperative Anxiety and Information Scale and the State Trait Anxiety Inventory. Data were analyzed in SPSS-20. The ANOVA, paired t-test and Tukey’s test were used for the data analysis. The level of statistical significance was set at P<0.05.Results: The mothers’ anxiety about surgery (F=30.99, P≤0.001) and their scores of state anxiety (F=6.02, P<0.001) differed significantly among the three groups after the intervention. A significant difference was observed between the oral instruction and control groups (P<0.001) and the hospital tour and control groups (P<0.001) regarding the surgery-related anxiety scores. A significant difference was also observed between the oral instruction and control groups (P=0.002) regarding the mothers’ state anxiety scores. Conclusions: The results suggest the greater efficiency of oral instructions versus hospital tours. Nurses can use oral instructions for reducing surgery-related anxiety and state anxiety of mothers before their toddlers’ open heart surgery.Trial Registration Number: IRCT20180904040944N1.

The Effect of Spiritual Self-Care Education on the Care Burden of Mothers With Children Hospitalized in Intensive Care Units for Open Heart Surgery

Objective: Spiritual health of caregivers has association with the patients’ health, but less attention has been paid to spiritual self-care education in health programs. This study aimed to assess the effect of spiritual self-care education on the care burden of mothers with children in hospitalized in Intensive Care Units (ICUs) for open heart surgery. Methods: This quasi-experimental study was conducted on 60 mothers of children hospitalized in ICUs of Shahid Modarres Hospital in Tehran, Iran. They were selected randomly from among those gave informed consent to participate in the study. The data collection tools were a demographic form and Zarit Burden Interview which were completed before and after intervention. The spiritual self-care education was presented using the teaching aids in four 45-min sessions, twice a week. Collected data were analyzed in SPSS V. 24 software using descriptive (frequency, percentage) and inferential (paired t-test) statistics at a significance level of P&lt;0.05. Results: Before the intervention, 72.3% of the samples had a severe care burden and 24.5% had a very severe care burden, which decreased after the intervention such that only 32.7% had a severe care burden. The mean and standard deviation of mothers’ care burden also decreased after the educational intervention (from 62.3±7.6 to 42.1±3.8). The results of paired t-test showed that this difference was statistically significant (P&lt;0.001). Conclusion: Spiritual self-care education can reduce the care burden of children’ caregivers; hence, planning and implementing appropriate programs to increase self-care knowledge of caregivers (especially the mothers of children with heart problems) and medical staff and paying more attention to mothers’ education are recommended.

Mortality Risk Factors among Hospitalized COVID-19 Patients in a Major Referral Center in Iran.

The Coronavirus Disease 2019 (COVID-19) pandemic has killed many people worldwide since December 2019, and Iran has been among the most affected countries. In this retrospective study, we aimed to determine the prognostic factors associated with mortality in COVID-19 patients by analyzing 396 survived and 63 non-survived patients in Shahid Modarres Hospital, Tehran, Iran, from January 30th until April 5th, 2020. As the results, the BMI > 35 (p = 0.0003), lung cancer (p = 0.007), chronic kidney disease (p = 0.002), Immunocompromised condition (p = 0.003), and diabetes (p = 0.018) were more frequently observed in the expired group. The history of statins use was more common in the discharged group (p = 0.002), while there was no significant difference in the drug history of angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, nonsteroidal anti-inflammatory drugs, aspirin, and/or steroids, and in the past-year influenza vaccination. Multivariable regression demonstrated rising odds of in-hospital death related with age (odds ratio (OR) = 1.055, p = 0.002), levels of C-reactive protein (CRP) (OR = 2.915, p < 0.001), creatinine (OR = 1.740, p = 0.023), lymphocyte count (OR = 0.999, p = 0.008), and magnesium level (OR = 0.032, p < 0.001) on admission. In conclusion, the patients with older age and higher BMI with lymphopenia, hypomagnesemia, elevated CRP and/or raised creatinine on admission are at higher risk of mortality due to the COVID-19 infection, which requires the physicians to use timely and strong therapeutic measures for such patients.

Continuous renal replacement therapy in Iran; current practice, indications and outcomes in hemodynamically unstable patients

Introduction: Continuous renal replacement therapy (CRRT) is the gold standard renal replacement therapy (RRT) for hemodynamically unstable patients. Objectives: To study the characteristics and survival of patients undergoing CRRT in Iran. Patients and Methods: This is a retrospective study conducted on 58 patients indicated for CRRT at the Shahid-Modarres hospital of Tehran during 2016-2017. Gender, age, underlying diseases, comorbidities, history of surgery, dialysis indication, and survival were gathered by reviewing patients’ medical records. The data was analyzed in SPSS version 21. Results: Sepsis constituted the most common underlying condition at admission. Overall, continuous venovenous hemodialysis (CVVHD) was performed in 72.4% of the patients. Diabetes and hypertension were the most common causes leading to RRT. The most common indication for CRRT was unstable hemodynamic condition. The patients were most frequently referred from ICU (34.5%), emergency department (20.7%), and CCU (15.5%). Conclusion: We here reviewed the characteristics of hemodynamically unstable patients undergoing CRRT. Our findings can help to understand the most important indications for CRRT and to standardize CRRT practice in Iran.

Catheter related blood stream infections; the incidence and risk factors in Iranian hemodialysis patients

Introduction: Patients with end-stage renal disease (ESRD) are routinely managed by hemodialysis. The catheter-related blood stream infections (CRBSIs) are important complications with high risk of mortality and morbidity in patients undergoing hemodialysis. Objectives: To determine the incidence of CRBSIs in patients undergoing hemodialysis in a single center in Iran. Patients and Methods: In this cross-sectional study, we evaluated the incidence of CRBSIs in 50 hemodialysis patients hospitalized at the Shahid-Modarres hospital of Tehran from March 2017 until March 2018. The data was collected from patients’ medical archives. The CRBSI was established by blood culture. Results: Of 50 hemodialysis patients enrolled in the study, 27 were males (54%). The mean age was 49.7 ±11. 8 years old. Positive blood culture was observed in 64% of patients. The most common causative organism was coagulase-negative staphylococci (24%). The most common comorbidity and systemic clinical symptom included hypertension (84%) and fever (92%) respectively. In most patients (74%), the length of catheter indwelling was less than one year. Echocardiography showed that 24% of the patients had vegetation. Conclusion: The coagulase-negative staphylococci were the most frequent organisms responsible for CRBSIs among hemodialysis patients. These findings might be helpful in early diagnosis and choose the best antibiotics for treatment.

Biliary Duct Injuries Due to Laparoscopic Cholecystectomy: 7-Year Experience at Shahid Modarres Hospital, Tehran, Iran

Background: Nowadays, cholecystectomy is the most prevalent elective abdominal surgery in the U.S., with over 750000 operations performed every year. However, laparoscopic cholecystectomy has been reported with 1% to 8% of major complications, including hemorrhage, wound infection, bile ducts and gallbladder damage. Methods: A total of 1970 medical records of patients undergone laparoscopically at Modarres Hospital between 2010 and 2017 were studied in this research. Of them 1185 were female (60.15%) and 785(39.85%) male. A total of 1003(50.9%) patients were presented with cholecystitis, 955(48.5%) with symptomatic cholelithiasis, and 12(0.6%) with polyp. Results: Biliary tract injury was reported in 11 cases, complete cut off of Common Bile Duct (CBD) in 4(0.2%) cases (3 males and 1 female), partial CBD injuries in 3 cases (2 males and 1 female), complete closure of CBD in 1 female case, and partially closure of CBD by clips in 3(0.1%) cases (1 male and 2 female). Conclusion: The laparoscopic method seems to be the ideal method of cholecystectomy, not just because of its cosmetic reasons, also due to its less invasive procedure.

Safety and efficacy of platelet-rich plasma in treatment of carpal tunnel syndrome; a randomized controlled trial

BackgroundCarpal tunnel syndrome is the most common peripheral entrapment neuropathy, for which conservative treatments are the first measures taken. However, these measures are not usually sufficient. Recently major attention has been drawn to platelet-rich plasma for its possible effects on axon regeneration and neurological recovery. Although few studies have evaluated the effects of this treatment in carpal tunnel syndrome, further investigation is required to reach concrete conclusion.MethodsIn this randomized controlled trial, women referring to the physical medicine and rehabilitation clinic at Shahid Modarres Hospital during 2016 with a diagnosis of mild and moderate idiopathic carpal tunnel syndrome were chosen. They were randomly assigned to two groups: (i) a control group using only a wrist splint, and (ii) a platelet-rich plasma group that received wrist splints along with a single local injection of platelet-rich plasma. The outcome measures were assessed via Visual Analogue Scale, the Boston Carpal Tunnel Syndrome Questionnaire and electrophysiological findings including the peak latency of sensory nerve action potential and the onset latency of the compound muscle action potential.ResultsA total of 41 women were included (20 wrists as control group) and (21 wrists as platelet-rich plasma group). Before treatment there were no significant differences between the two groups except for the median peak latency of sensory nerve action potential which was significantly higher among the patients in the platelet-rich plasma group (p = 0.03). All the measured variables significantly decreased in both groups after 10 weeks of treatment except for the median onset latency of the compound muscle action potential (p = 0.472). Finally, the changes in neither of the evaluated outcome measures were found to significantly differ between the two groups, even when the analyses were adjusted for age of the patients.ConclusionThe findings of this study showed that in a relatively short period of time after treatment, a single injection of platelet-rich plasma in the wrist does not significantly add to the effects of conservative treatment with wrist splints, in regards to the women pain and symptom severity, functional status and electrophysiological parameters.Trial registrationThe trial has been retrospectively registered with an ID: IRCT2017041513442N13 (Date of registration: 2017–06-19).

The Role of Work Ethics in Organizational Commitment of Nurses

Background and Aim: Moralities is an important factor in the regulation of human relationships. On the other hand, commitment is a psychological state that determines the relationship between individuals and their organization, and causes the emotional attachment of the employee to the organization. Therefore, the purpose of this study was to determine the role of work ethics in organizational commitment of nurses working in Shahid Modarres Hospital of Saveh city, Iran. Materials and Methods: This research is a descriptive-correlative study which conducted on 196 nurses working in Shahid Modarres Hospital of Saveh city, Iran, in 2018. Sampling was done by simple random method. For collecting data, standard questionnaires of professional ethics and organizational commitment were used. Regression and structural equation model were used to analyze the data through SPSS and AMOS soft wares. Findings: Findings indicate that professional ethics has a positive and significant relationship with organizational commitment of nurses (B=0.706). Using regression analysis, a positive correlation was seen between professional ethics and the components of organizational commitment (emotional commitment: β=0.368, continuous commitment: β=0.489, and normative commitment: β=0.543). Conclusion: According to the results, it can be claimed that managers should consider increase of the organizational commitment of nurses by improving the work ethics and their components. Please cite this article as: Bahmani Chobbasti A, Mousavi Davoudi SM, Khalilpoor MR. The Role of Work Ethics in Organizational Commitment of Nurses. Bioethics Journal 2018; 8(29): 77-85.

A survey of lower limb amputation rate in patients with diabetes at Shahid Modarres Hospital, Tehran, Iran, during 5 years

Introduction: Lower limb amputation in patients with diabetes is one of its major complications. Therefor understanding the prevalence and causes of this problem has great importance. The aim of this study was to evaluate lower limb amputation in patients with diabetes. Methods: During this observational cross-sectional study, 350 patients with diabetes mellitus admitted to Shahid Modarres Hospital, Tehran, Iran, from March 2012 to March 2017 were studied and incidence of lower limb amputation was observed. Results: About 64% of patients suffered from some degree of amputation. Important factors in these patients were delay in referral to surgeon, ineffective debridement and longtime impaired distal blood flow. Conclusion: The frequency of lower limb amputation in patients with diabetes is high and therefore there is a great need to find and reduce its underlying problems.

Three-Month and Three-Year Survival Rates and Complications of Transthoracic Surgery in Patients with Esophageal Cancer at Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences

Background: Nowadays, esophageal cancer is among the most malignant cancers with high mortality and morbidity. Although reasonable progress in radiotherapy and chemotherapy has been made, still esophagectomy is the main treatment for the disease. Using esophagectomy induces a durable palliation and provides possible cure. Objectives: This study aimed to assess the three-month and three-year survival rates and complications of transthoracic surgery in patients with esophageal cancer. Methods: In a longitudinal case series study was performed in three years, 34 patients with esophagus cancer, operated using trans-thoracic approach were assessed for short- and long-term survival rates and complications. Results: Immediately after the surgery, anastomotic leakage was seen in 17.6% and vocal cord paresis in 26.6% of cases; in next days, the vocal cord paresis decreased to 11.8%. Hospital mortality rate was 20.6% and the rate of malignancy recurrence in long-term follow-up was 8.8%. Long-term morality rate was 39.0%. There was microscopic residue in 20.5% and macroscopic residue in 6.0% of the patients. Three-month and three-year survival rates were 76% and 61%, respectively. Conclusions: The achieved three-month and three-year survival rate were reasonable in comparison to other studies. Although the rate of vocal cord paresis after the surgery was about two times more than previous studies, most of the cases were temporary paresis and resolved in coming days.