مجله دانشکده پزشکی اصفهان
پیاپی 506 (هفته دوم بهمن 1397)

In the world, cardiovascular diseases are the major cause of death, as 31% of global mortality is from them. Due to problems such as the lack of technologies such as echocardiography, and limited access to cardiologists in deprived areas, automatic methods for detecting heart abnormalities in phonocardiogram (PCG) are used. In this study, to distinguish between normal and abnormal cases, three categories of features in PCG were estimated and evaluated. First, the extraction of the heart rate and heart rate variability; second, some of the features used in speech analysis and pattern recognition; and third, the time center, the frequency center, and the frequency variance of the signal. Some methods were proposed for extracting desired features, and the data were analyzed using t-test. The results of evaluation of the 10 proposed features, with the p-value of less than 0.010, showed that 8 features had significant distinction to detect abnormal cases from the normal ones. Regarding the patterns of the extracted features, the distinction between normal and abnormal signals was observed, which can be used to classify PCGs. Moreover, in the future, new features can be extracted from these patterns using some other analysis such as correlation.

Radiographers must be aware of the physical principles and capabilities of digital radiography systems in order to reduce radiation doses, and improve image quality. The aim of this study was to evaluate the knowledge of radiographers in occupied radiology centers in Isfahan City, Iran, regarding digital radiography systems. This descriptive-analytic study was carried out using a researcher-made valid and reliable questionnaire. The questionnaire included questions about demographic characteristics (age, gender, educational, and work experience), as well as questions about knowledge about radiation protection and physical principles of digital radiography systems. The questionnaires were distributed among 400 radiographers. The participation rate of radiographers was 57.5%. The average score of the general level of awareness among the radiographers was 40.29 ± 11.88 from 100, and in terms of radiation protection and physical principles of digital radiography systems, were 36.04 ± 16.88 and 44.54 ± 14.52 from 100, respectively. The level of general awareness as well as the level of knowledge about the physical principles had an inverse and weak relationship with the age and work experience of the radiographers (P < 0.05). More than 77 percent of the radiographers expressed their desire to participate in digital radiography courses. Awareness of radiographers about radiation protection and physical principles of digital radiography systems was at a low level. Therefore, with the development and deployment of digital radiology systems, the radiographers should be trained about these systems. Conducting such training classes can reduce radiation dose to patients, and reduce the risks of ionizing radiation.

Infertility and resulting stigma are of the challenges in reproductive health. This study was conducted with the aim of psychometric evaluation of the perceived stigma scale in infertile women. The present methodological research with cross-sectional design was carried out on 200 women who refer to Isfahan Fertility and Infertility Center, Iran, in 2018. The original English version of the stigma consciousness questionnaire (SCQ) was translated into Persian version using the back translation method. Exploratory and confirmatory factor analysis methods were used to determine the construct validity, as well as Cronbach's alpha and intraclass correlation coefficient to determine the reliability of the questionnaire. Exploratory and confirmatory factor analysis determined three factors that explained 57.09% of the total variance. The goodness of fit of the three factors model was confirmed based on standard indices. Moreover, the reliability of the SCQ was confirmed with Cronbach's alpha coefficient of 0.72 and intra-cluster correlation of 0.97 [Confidence interval (CI) of 95%: 0.68-0.99]. Based on appropriate psychometric properties, the SCQ could be used in future studies in infertile people as a valid and reliable scale.

Occupational exposure to body fluids, and consequently the blood-borne infections, is an important risk to healthcare workers. Needle-stick injury (NSI) causes occupational injuries, and imposes heavy health, as well as psychological and economic burdens on the individual, health system and community. In this study, we evaluated the risk factors of NSI in Alzahra hospital, the largest hospital of Isfahan City, Iran. This case-control study was carried out on 200 healthcare workers of Alzahra hospital affiliated to Isfahan University of Medical Sciences (100 cases and 100 controls). A total of 100 employees with NSIs were selected as cases and compared with 100 of those who had not NSIs as controls. Job content questionnaire (JCQ), job factors (job title, work experience, shift work, employment status, and department of activity), and NSIs characteristics (exposure severity, type of procedure, type and characteristics of tools) were asked and compared between the groups. There was a significant association between left dominant hand (P = 0.020), and history of participation in educational classes (P = 0.010) with NSIs. Highest rate of needle-stick was among nurses (72% in controls vs. 65% in cases), those with rotational shifts (80% in controls vs. 72% in cases), and those with less than 15 years of work experience (52% in controls vs. 46% in cases); but the differences were not statistically significance (P > 0.050 for all). Logistic regression analysis showed that social support [odds ratio (OR) = 0.85, P < 0.001)], psychosocial demand (OR = 1.07, P = 0.001), gender (OR = 0.44, P = 0.010), the dominant hand (OR = 0.52, P = 0.040), and participation in educational classes (OR = 0.24; P = 0.005) were risk factors of NSIs. Participating in training classes by healthcare worker can play a crucial role in preventing NSIs. Attitude to skill, decision-making power, physical activity, and social support have a significant relationship with NSIs, and should be planned comprehensively in health care centers.

Acute kidney injury (AKI) and rhabdomyolysis are among the prevalent etiologies of intensive care unit (ICU) admission that can be accompanied with different outcomes. In the current study, prerenal AKI and rhabdomyolysis etiology were assessed in patients admitted to ICU. This was a cross-sectional study conducted on 480 patients in ICU. Prerenal AKI, based on the Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease (RIFLE) criteria, and rhabdomyolysis were assessed among the patients. Demographic etiologies, Acute Physiology and Chronic Health Evaluation (APACHE), and Sequential Organ Failure Assessment (SOFA) criteria were assessed among the patients as well. 20.08% of patients were affected by prerenal AKI, rhabdomyolysis, or both. The most common underlying reason of prerenal azotemia was internal disease (52.9%), and for rhabdomyolysis was trauma (88.1%). Prerenal azotemia was significantly in association with male gender (P = 0.002), higher age (P < 0.001), diabetes mellitus (P = 0.006), hypertension (P = 0.018), and heart failure (P = 0.03). APACHE [P = 0.001, odds ratio (OR) = 1.13, confidence interval (CI) of 95%: 1.05-1.22] and SOFA (P = 0.005, OR = 1.10, CI95%: 1.03-1.18) were predicting factors of mortality; APACHE was significantly stronger predicting factor (P < 0.001). Internal diseases were the main cause of prerenal AKI in patients in ICU, and most cases doomed to die. Male gender, higher age, and underlying diseases were significantly associated with prerenal azotemia. Regarding rhabdomyolysis, the main cause was surgery due to trauma. Most of the cases were young, and finally discharged with complete health.