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فهرست مطالب نویسنده:

masoumeh abedzadeh-kalahroudi

  • Khadijeh Kalan Farmanfarma, Esmaeil Fakharian *, Robbert J Gobbens, Soudabeh Yarmohammadi, Mehrdad Mahdian, Masoumeh Abedzadeh- Kalahroudi, Reza Fadaie Vatan, Gholamreza Reza Khosravi, Mohammad Reza Fazel, Mojtaba Sehat
    Introduction

    Hip fractures in patients are often accompanied by mortality and considerable complications. Accordingly, the aim of this study has dealt with a systematic review of mortality predictors following hip fracture.

    Methods

    The study collected and examined all systematic review and meta-analysis studies published in English between 2000 and 2023, obtained from international databases such as the Cochrane Library, PubMed, and Web of Science. The search strategy involved using MeSH terms matching the keywords (predictor AND mortality AND hip fractures AND systematic review). The inclusion criteria were systematic and meta-analysis studies, while the exclusion criteria consisted of observational studies, letters to the editor, conference abstracts, commentaries, and case series.

    Results

    In the studies that were examined, risk factors, body organs, and certain diseases were found to have a significant correlation with mortality. On the other hand, depression and low serum albumin had no significant association with mortality. In the examined studies, the relationship between other post hip fracture mortality predictors had not been reported.

    Conclusion

    It is crucial to focus on the most significant predictors of mortality following hip fractures in this study. This knowledge can potentially contribute to a reduction in post-hip-fracture mortality rates, and it underscores the importance of long-term collaboration among experienced multidisciplinary medical professionals and specialized healthcare providers to improve survival outcomes after hip fracture.

    Keywords: Predictors, Mortality, Hip Fracture, Overview
  • Khadijeh Kalan Farmanfarma, Soudabeh Yarmohammadi, Esmaeil Fakharian, Robbert J. Gobbens, Mehrdad Mahdian, Zahra Batooli, Mohammad‑Sajjad Lotfi, Masoumeh Abedzadeh Kalahroudi, Reza Fadaei Vatan, Reza Khosravi, Mohammad Reza Fazel, Mojtaba Sehat

    The hip fracture causes significant disabilities in many elderly people. Many studies around the world have identified various risk factors for the hip fracture. The aim of this study was to systematically investigate the risk factors of hip fractures. This study is a systematic review of risk factors for hip fractures. All published papers in English and Persian languages on patients in Iran and other countries between 2002 - 2022 were examined. The search strategy used keywords matching the mesh, including : predictors, hip fracture, and disability. Articles were selected from international databases (PubMed, Proquest ,Web of Sience, Scopus, Google scholar and Persian(Sid,Magiran), and the Newcastle Ottawa Scale was used to assess the risk of bias. The study has identified several factors that were significantly correlated with the risk of hip fracture, including age, cigarette and alcohol consumption, visual and hearing problems, low BMI levels, history of falling, weakness, and diseases such as stroke, cardiovascular disease, high blood pressure, arthritis, diabetes, dementia, Alzheimer's, Parkinson's, liver and kidney diseases, bone density, osteoporosis, vertebral fracture, and hyperthyroidism. However, the study did not find any significant correlations between the consumption of calcium and vitamin D, history of fractures, cognitive disorders, schizophrenia, and household income, and the risk of hip fracture. The results of this study reveal the determining role of some risk factors in hip fracture in older persons. Therefore, it is recommended that health policy makers provide the possibility of early intervention for some changeable factors.

    Keywords: Prognostic Factors, Hip Fracture, Elderly, Systematic Review
  • Hamidreza Talari, Masoumeh Abedzadeh-Kalahroudi *, Javid Azadbakht, Habibollah Rahimi, Zahra Dehghani, Abdollah Omidi, Esmaeil Fakharian, Nushin Mousavi-Bioki
    Background
    The relationship between neurometabolic changes after mild traumatic brain injury (mTBI) and psychological disorders is not well defined.
    Objectives
    The aim of this study was to compare the relationship between the neurometabolic state of the brain and cognitive tests in mTBI patients and healthy individuals.
    Methods
    This cohort study included 21 mTBI patients (exposed group) and 21 individuals without trauma (non-exposed group).The demographic and trauma information of patients including age, sex, the mechanism of trauma and the GCS score were recorded. Then, the psychological status of the two groups were evaluated by Wechsler, Stroop, and Wisconsin test. Moreover, the levels of neurometabolites were measured by magnetic resonance spectroscopy (MRS). Data were analyzed by SPSS software and P<0.05 was considered statistically significant.
    Results
    The amount of brain metabolites (NAA, choline, creatine, Chol/Cr ratio and NAA/Cr ratio) in the white matter of bilateral frontal lobe in the two exposer and non-exposer groups had no significant difference (P>0.05). Additionally, there was a significant difference between the two groups regarding the correct answers of the Wisconsin test (p=0.027), and the time to complete the Stroop test (p=0.009). No significant difference was observed in the Wechsler memory test score between the two groups (p>0.05).
    Conclusion
    Mild TBI does not lead to changes in brain metabolites in the acute phase after trauma. However, the scores of psychological tests of Stroop and Wisconsin in mTBI patients had a statistically significant difference with healthy individual.
    Keywords: Traumatic Brain Injury, Magnetic Resonance Spectroscopy, Brain Metabolites, Psychological Status
  • الهه مصداقی نیا، معصومه عابدزاده کلهرودی*، مجتبی صحت، منصوره نورمندی پور
    سابقه و هدف

     زایمان زودرس یکی از علل عمده ی مرگ ومیر و ناتوانی در نوزادان است. در سال های اخیر از پروژستین ها برای پیشگیری از زایمان زودرس استفاده شده است. هدف از این مطالعه مقایسه ی اثرات پروژسترون میکرونیزه (یوتروژستان) و هیدروکسی پروژسترون کاپرووات (پرولوتون) بر گردش خون مادر و جنین در زنان در معرض خطر زایمان زودرس بود.

    مواد و روش ها

     این کارآزمایی بالینی تصادفی شده ی یک سوکور درباره ی 80 زن باردار 20 تا 34 هفته که در معرض خطر زایمان زودرس بودند، انجام شد. در ابتدا، سونوگرافی داپلر از شریان های رحمی، نافی و مغزی - میانی جنین انجام شد. سپس بیماران به طور تصادفی، به دو گروه دریافت کننده ی پروژسترون خوراکی (200 میلی گرم یوتروژستان، دو بار در روز) به مدت 48 ساعت و پروژسترون عضلانی (500 میلی گرم پرولوتون) تقسیم شدند. یک هفته پس از تجویز داروها، سونوگرافی در هر دو گروه تکرار شد و شاخص ضربانی (PI)، شاخص مقاومت (RI)، حداکثر سرعت سیستولیک (PSV) و نسبت سیستولیک به دیاستولیک (S/D) در این شریان ها اندازه گیری شد.

    یافته ها

     دو گروه از نظر سن، BMI، سن حاملگی، تعداد بارداری، سابقه ی زایمان زودرس، طول سرویکس و دیلاتاسیون اولیه ی سرویکس مشابه بودند. پس از تجویز پرولوتون، میزان کاهش RI و  S/Dشریان رحمی بیشتر از یوتروژستان بود (0.05<p). در گروه پرولوتون، شاخص S/D شریان نافی پس از مداخله به طور قابل توجهی کاهش یافت (0.021=P)، اما در گروه یوتروژستان، افت این شاخص معنی دار نبود. میانگین شاخص های S/D و PSV شریان مغزی - میانی بین دو گروه تفاوت داشت (0.05<p).

    نتیجه گیری

     دو دارو اثرهای مشابهی بر گردش خون رحمی و نافی داشتند. پرولوتون تاثیر بهتری بر گردش خون مغزی جنین داشت؛ بنابراین، می توان بر اساس ترجیحات بیمار و امکانات دردسترس از هریک از داروهای فوق استفاده کرد.

    کلید واژگان: پروژسترون میکرونیزه, زایمان زودرس, گردش خون مادر و جنین, هیدروکسی پروژسترون کاپرووات
    Elaheh Mesdaghinia, Masoumeh Abedzadeh-Kalahroudi*, Mojtaba Sehat, Mansooreh Noormandipour
    Background and Objective

    Preterm birth is one of the leading causes of death and disability in neonates. In recent years, progestins have been used to prevent preterm labor. This study aimed to compare the effects of micronized progesterone (Utrogestan) and hydroxyprogesterone caproate (Proloton) on maternal and fetal blood circulation in women at risk of premature delivery.

    Materials and Methods

    This randomized, single-blind clinical trial study was conducted on 80 pregnant women at 20-34 weeks who were at risk of preterm labor. At first, Doppler ultrasound of the uterine, umbilical, and mid-cerebral arteries was performed. Subsequently, patients were randomly allocated in two groups receiving oral progesterone (200 mg of Utrogestan twice daily) for 48 hours and intramuscular progesterone (500 mg of Proluton). After one week, ultrasonography was repeated in both groups, and pulsatile index (PI), resistance index (RI), peak systolic velocity (PSV), and systolic to diastolic ratio (S/D) were measured.

    Results

    The two groups were similar in terms of age, body mass index, gestational age, gravida, history of preterm labor, cervical length, and initial cervical dilatation. The decrease in uterine artery RI and S/D was greater after Proloton administration than Utrogestan (P<0.05). In the Proloton group, the S/D index of the umbilical artery decreased significantly (P=0.021); however, this difference was not significant in the Utrogestan group. The mean S/D and PSV indexes of the middle cerebral artery were significantly different between the two groups (P<0.05).

    Conclusion

    The two medications had similar effects on uterine and umbilical circulation. Proluton had a better effect on fetal cerebral circulation. Therefore, any of the above medications can be used based on the patient's preferences and available facilities.

    Keywords: Hydroxyprogesterone Caproate, Maternal, Fetal Blood Circulation, Micronized Progesterone, Preterm Labor
  • Majid Khakbaz Niasar, Nooshin Moosavi Buki, Leila Ghafor, Masoumeh Abedzadeh Kalahroudi, Mojtaba Sehat, Soroush Khojasteh-Kaffash*
    Introduction

    Trauma is the most common cause of death under the age of 50, and one of the three main causes of death. The role of microscopic hematuria in the diagnosis of abdominal injuries is not clear. This study aimed to investigate the predictive role of microscopic hematuria in the assessment of abdominal organ damage in blunt trauma.

    Methods

    This cross-sectional study was conducted on all blunt trauma patients, who were admitted to the surgery department of Shahid Beheshti Hospital in Kashan in 2016 and 2017. Patients with blunt abdominal trauma aged 18 to 65 years were included, and patients with macroscopic hematuria, unstable hemodynamic status, and a history of kidney diseases were excluded. Spiral CT scan of the abdomen and pelvis was performed with intravenous injection of contrast material with delayed nephrogram phase as the gold standard. Data analysis was performed using the SPSS software. The Chi-square test, and McNemar's test were used. (P<0.05) was considered significant.

    Results

    In this study, 400 patients with blunt trauma participated. The frequency of microscopic hematuria in patients with intra-abdominal organ damage was significantly higher than in other patients (71.4% versus. 38.9%, P<0.001). The sensitivity and specificity of microscopic hematuria in diagnosing damage to intra-abdominal organs were 53.84% and 77.14%, respectively. The overall accuracy of the test was 62.0% (Kappa coefficient=0.22, P<0.001).

    Conclusion

    Due to the low accuracy of microscopic hematuria in diagnosing damage to intra-abdominal organs, it is not suitable as the main diagnostic method, but it can be used as an auxiliary method.

    Keywords: Abdominal Injuries, Blunt Trauma, Evaluation, Hematuria
  • Esmail Abdorrahim-Kashi, MohammadJavad Azadchehr, Mohammadreza Aminipour, Hamidreza Talari, Leila Ghafoor, Masoumeh Abedzadeh-Kalahroudi, Nushin Moussavi
    Background and Objectives

    During the COVID‑19 pandemic, hospitals were overwhelmed and non‑COVID admissions were restricted due to national guidelines and decreased references. The aim of this study was to evaluate the collateral effect of the pandemic on general surgery admissions, operations, and patient outcomes. Patients and

    Methods

    After the ethics committee approval for this retrospective descriptive study, all general surgery patients from February 23 to May 21, 2020, were compared with a similar timeframe in 2019. Time from symptom onset to admission, final diagnosis, and type of surgery was documented. Morbidity and mortality rate, intensive care unit (ICU) admission time, and total admission time were compared.

    Results

    During the first COVID‑19 surge, a 64% decrease in admissions was observed. The mean time from symptom onset to admission showed a significant delay of 1.2 days. Fewer patients were admitted to the ICU, but ICU admission time was longer. Total admission time and postoperative surgical and nonsurgical complications showed no significant difference. The rate of complicated appendicitis increased from 2.8% to 12.3% of total surgeries. A decrease in total trauma admissions was observed, but trauma operations remained unchanged, and penetrating trauma admissions had doubled.

    Conclusion

    Although morbidity and mortality were not increased during the pandemic, increased time to admission, under triage of trauma patients, shortage of ICU beds, and a higher rate of complicated appendicitis portray the collateral effects of the pandemic on general surgery patient care. The increased number of penetrating injuries demands psychological support during home confinement. Efforts should be made to maintain maximal surgical care during pandemics.

    Keywords: Admissions, COVID‑19, general surgery, operations, outcome, pandemic
  • Esmaeil Fakharian, Masoumeh Abedzadeh-Kalahroudi, Fatemeh Atoof, Voorya Nooranipour, Javid Azadbakht
    Background and Objectives

    Traumatic brain injuries (TBIs) are among leading causes of debility and death at a global scale. The current study aimed at investigating the possible advantage of administrating tranexamic acid (TXA) in patients with post‑TBI brain contusion and intraparenchymal hemorrhage (IPH).

    Materials and Methods

    This double‑blind randomized clinical trial was conducted on patients who had brain contusion/IPH according to their on‑admission brain computed tomography (CT) scan, referring to Shahid Beheshti Hospital, Kashan University of Medical Sciences, during 2018-2021. The patients were randomly allocated to either the intervention group (receiving TXA through an antecubital vein access) or the control group (receiving Normal Saline via a similar route). TBI severity, ICH volume, and compressive effects of hemorrhagic mass on admission, 24 h, and 72 h after treatment were assessed. Then 3‑month outcome estimated by Glasgow Outcome Scale (GOS).

    Results

    There was no significant difference between patients’ age, gender, TBI etiology (traffic collision or fall from height), and skull fracture between the study groups. Compressive effects of hemorrhagic mass, new bleeding and brain edema during 24 and 72 hours after intervention were not significantly different between the TXA and placebo groups. The alterations in ICH volume from preintervention to 24/72 h postintervention were similar between the intervention and placebo subgroups (P > 0.05). Majority of participants (82.5%) showed a good 3‑month neurological outcome according to GOS, but that was not significantly different between the study groups. One case of death occurred in each subgroup, and both of them died after hospital discharge.

    Conclusion

    TXA neither has a preventive effect against in‑hospital post‑TBI hemorrhage enlargement nor on neurological outcomes three months after hospital discharge.

    Keywords: Contusion, intraparenchymal hemorrhage, tranexamic acid, traumatic brain injury
  • Hamid Reza Talari, Noushin Mousavi, Masoumeh Abedzadeh Kalahroudi *, Hossein Akbari, Seyed MohammadHossein Tabatabai, Niloofar Ashtari
    Introduction

    Hemothorax is one of the most prevalent complications after thoracic trauma. Extended Focused Assessment with Sonography for Trauma (e-FAST) is one of the diagnostic methods for hemothorax assessment. This study aimed to assess the diagnostic value of e-FAST in detecting hemothorax and its size in patients with blunt thoracic trauma.

    Methods

    This cross-sectional diagnostic assessment was conducted on 400 adult patients with blunt trauma who needed a chest CT scan. Chest X-ray (CXR), sonography, and chest CT scans were performed and hemothorax size was assessed with sonography and CT-scan. Sensitivity, specificity, and positive or negative predictive values of sonography and CXR were calculated. Hemothorax size on sonography was compared with the results of CT-scan as the gold standard.

    Results

    The mean age of participants was 43.67±22.03. Based on CT scan findings, 176 participants (44%) had a hemothorax. The sensitivity, specificity, positive and negative predictive values, and correct classification rate of sonography were 79%, 99.1%, 98.6%, 85.7%, and 90.2%, respectively. The accuracy of sonography was 97.1% for small hemothorax, 46.9% for medium hemothorax, and 33.3% for large hemothorax.

    Conclusion

    Sonography is a sensitive diagnostic modality for the detection of hemothorax in multiple trauma patients but tends to underestimate moderate to large-sized hemothorax. Chest sonography can be an acceptable imaging modality if a CT scan is not available or desired.

    Keywords: hemothorax, Sonography, Trauma, e-FAST
  • راضیه اقتصادی، معصومه عابدزاده کلهرودی*، اسماعیل فخاریان، حسین اکبری، قاسم پهلوان زاده
    سابقه و هدف

    شکستگی لگن می تواند با خونریزی، شوک و افزایش مرگ و میر همراه باشد و تشخیص صحیح آن ضروری است. رادیولوژی نقش مهمی در ارزیابی اولیه بیماران با ترومای لگن ایفا می کند. هدف از این مطالعه، بررسی اندیکاسیون ها و یافته های رادیوگرافی لگن در بیماران ترومای غیرنافذ مراجعه کننده به بیمارستان شهید بهشتی کاشان بود.

    مواد و روش ها

    در این مطالعه توصیفی گذشته نگر پرونده 292 بیمار دچار ترومای غیرنافذ که در سال 1398 به اورژانس بیمارستان شهید بهشتی کاشان مراجعه کرده بودند، به منظور دستیابی به اطلاعات مربوط به اقدامات رادیولوژیک شامل تعداد گرافی های انجام شده، اندیکاسیون های انجام گرافی لگن و سی تی اسکن، یافته های گرافی لگن و سرویس درخواست کننده گرافی مورد بررسی قرار گرفت. داده ها توسط SPSS نسخه 22 مورد تجزیه و تحلیل قرار گرفت.

    نتایج

    اکثریت بیماران (6/58%) مرد بودند. سقوط (61%)، شایع ترین عامل بروز تروما بود. در حدود 88% از بیماران بیش از دو گرافی ساده لگن درخواست شده بود. شایع ترین اندیکاسیون درخواست گرافی، تندرنس لگنی و شایع ترین نوع شکستگی، شکستگی اینترتروکانتریک (38%) بود. در 26% از بیماران علاوه بر گرافی، سی تی اسکن لگن نیز انجام شده بود که در این بیماران بین یافته های گرافی و سی تی اسکن توافق وجود داشت (769/0=Kappa).

    نتیجه گیری

    سقوط، شایع ترین عامل بروز ترومای لگن و تندرنس، شایع ترین اندیکاسیون برای درخواست گرافی بودند. با توجه به درخواست گرافی های متعدد توسط سرویس های تخصصی مختلف، طراحی و اتخاذ یک پروتکل واحد برای درخواست های تصویربرداری به منظور کاهش هزینه های درمانی و پرهیز از دوز بالای اشعه و همچنین اصلاح روند موجود در اورژانس، ضروری به نظر می رسد.

    کلید واژگان: رادیوگرافی لگن, سی تی اسکن, ترومای غیرنافذ
    Razieh Eqtesadi, Masoumeh Abedzadeh- Kalahroudi*, Esmaeil Fakharian, Hosein Akbari, Ghasem Pahlevanzadeh
    Background

    Pelvic fractures may be associated with bleeding, shock, and increased mortality and its correct diagnosis is necessary. Radiology plays an important role in the initial evaluation of trauma patients. This study aimed to evaluate the indications and findings of pelvic radiography in patients with blunt trauma referred to the Shahid Beheshti Hospital in Kashan.

    Materials and Methods

    In this descriptive retrospective study, radiologic information of 292 Patients with blunt trauma who referred to the Shahid Beheshti Hospital in Kashan during 2020, including number of pelvic radiographies, indications for pelvic radiography and CT Scanning, and service that requesting radiography were collected. Data were analyzed using SPSS - 22.

    Results

    The majority of (58.6%) patients were men. The most common cause of trauma was falling (61.0%). About 88% of patients had two or more pelvic radiography. Pelvic tenderness was the most prevalent indication for radiography and intertrochanteric fracture was the most common type of pelvic fracture (38%). 26% of patients had additional CT Scan besides their radiography, in which there was an agreement between the radiographic and CT scan findings (Kappa = 0.769).

    Conclusions

    Falling is the most common cause of pelvic trauma and tenderness is the most prevalent indication for pelvic radiography. According to the request of multiple radiographies by various specialized services, it is necessary to designate and implement a single protocol for imaging requests in trauma patients in order to reduce the treatment costs and avoid high doses of radiation, as well as modifying the recent disorganized process in the emergency room.

    Keywords: Pelvic radiography, CT, Scan, Blunt trauma
  • معصومه عابدزاده کلهرودی، زهرا کریمیان، سعیده نصیری*، ملیکا سادات خورشیدی فرد
    مقدمه

    وضعیت فعلی و هشدار دهنده پاندمی کووید-19 ممکن است باعث ایجاد استرس، اضطراب در زنان باردار شود. با توجه به شیوع بالای بیماری در شهر کاشان، مطالعه حاضر با هدف تعیین میزان اضطراب و استرس درک شده زنان باردار نسبت به بیماری کووید-19 و عوامل مرتبط با آن انجام شد.

    روش کار

    این پژوهش توصیفی مقطعی در سال 1399 بر روی 360 زن باردار توسط پرسشنامه الکترونیکی در شهر کاشان انجام شد. ابزار گردآوری داده ها در این مطالعه، پرسشنامه اطلاعات دموگرافیک- باروری، سوالات مربوط به بیماری کووید-19، مقیاس اضطراب کرونا ویروس (محدوده نمره 54-0) و پرسشنامه استرس درک شده کوهن (محدوده نمره 56-0) بود. تجزیه و تحلیل داده ها با استفاده از نرم افزار آماری SPSS (نسخه 16) و آزمون های آماری تی، آنووا، رگرسیون خطی و ضریب همبستگی پیرسون انجام گرفت. میزان p کمتر از 05/0 معنی دار در نظر گرفته شد.

    یافته ها

    نمره کل اضطراب زنان باردار در رابطه با بیماری کرونا 48/12±71/18 و نمره استرس ادراک شده 00/7±57/24 بود. بر اساس نتایج آزمون رگرسیون خطی، شغل فرد، مشکلات حین بارداری، سابقه زایمان، ابتلاء اعضای خانواده به کرونا و نگرانی جهت پیامدهای بیماری برای خود و نوزاد، متغیرهای پیش بینی کننده نمره استرس درک شده و متغیرهای ابتلاء خانواده به کرونا و وجود نگرانی در مورد ابتلاء خود و نوزاد، نگرانی برای دریافت مراقبت های بارداری و وجود مشکلات حین بارداری، پیش بینی کننده نمره اضطراب در زنان باردار بودند.

    نتیجه گیری

    میزان اضطراب و استرس زنان باردار در دوران پاندمی کووید-19 بالا بود و زنان نگرانی های زیادی در رابطه با ابتلاء خود و نوزاد و یا مراجعه جهت دریافت مراقبت های دوران بارداری داشتند.

    کلید واژگان: استرس درک شده, اضطراب, بارداری, کووید-19
    Masoumeh Abedzadeh-Kalahroudi, Zahra Karimian, Saeideh Nasiri *, Melika Sadat Khorshidifard
    Introduction

    The current and alarming condition of Covid-19 pandemic may cause stress and anxiety in pregnant women. Due to the high prevalence of the disease in Kashan, this study was performed with aim to determine the anxiety and perceived stress of pregnant women toward Covid-19 and its related factors.

    Methods

    This cross-sectional descriptive study was performed in 2020 on 360 pregnant women by electronic questionnaire in Kashan. Data collection tools were demographic-fertility information questionnaire, the questions related to Covid-19 disease, coronavirus anxiety scale (score range: 0-54) and Cohen perceived stress questionnaire (score range: 0-56). Data were analyzed by SPSS software (version 16) and statistical tests of t-test, ANOVA, linear regression and Pearson correlation coefficient. P

    Results

    The total anxiety score of pregnant women in relation to Covid-19 disease was 18.71 ±12.48 and the perceived stress score was 24.57±7.00. Linear regression test showed that person's job, problems during pregnancy, delivery history, family members infection with coronavirus and concern about the consequences of the disease for themselves and the infant were the predictive variables of perceived stress score; and the variables of family members infection with coronavirus, concerns about infection of themselves and the infant, concern about receiving prenatal care, and the presence of problems during pregnancy were the predictors of anxiety scores in pregnant women.

    Conclusion

    The level of anxiety and stress of pregnant women was high during the Covid-19 pandemic and women had many concerns about infecting themselves and the infant or referring to receive prenatal care.

    Keywords: Anxiety, COVID-19, Perceived stress, pregnancy
  • زهره طبسی، الهه مصداقی نیا، معصومه عابدزاده کلهرودی*، حسین اکبری، مهسا بندگی مطلق
    سابقه و هدف

     پره اکلامپسی یکی از مهم ترین عوارض بارداری بوده و در 8-2 درصد از کل بارداری ها مشاهده می شود. پره اکلامپسی شدید عوارض مادری و نوزادی بسیاری را به همراه دارد که در نوع زودرس، بیشتر می باشد. در این راستا، مطالعه حاضر با هدف تعیین فراوانی پیامدهای مادری و نوزادی درمان انتظاری در پره اکلامپسی شدید قبل از 34 هفته انجام شد.

    مواد و روش ها: 

    در این مطالعه توصیفی گذشته نگر، پرونده 55 مادر مبتلا به پره اکلامپسی شدید قبل از 34 هفته تحت درمان انتظاری و نوزادان آن ها طی سال های 98-1393 در کاشان مورد بررسی قرار گرفت. اطلاعات استخراج شده از پرونده ها شامل: متغیرهای جمعیت شناختی مادر و نوزاد، پیامدهای مادری و پیامدهای نوزادی بود. داده های جمع آوری شده از طریق نرم افزار SPSS 16 و با استفاده از آمار توصیفی و استنباطی تجزیه و تحلیل گردیدند. سطح معناداری معادل 05/0 در نظر گرفته شد.

    یافته ها: 

    میزان ابتلا به تشنج، خونریزی پس از زایمان، بستری در ICU و افت پلاکت به ترتیب 5/5، 1/8، 6/3 و 3/7 درصد بود. 9/10 درصد از مادران دچار نارسایی کلیوی و به همین میزان دچار افزایش آنزیم های کبدی و همولیز شده بودند. میزان ابتلا به سندروم زجر تنفسی و آپگار پایین در نوزادان به ترتیب 7/44 و 7/12 درصد بود. 4/6 درصد از نوزادان دچار تشنچ و پنوموتوراکس شده بودند و مورتالیته نوزادی در 4/6 درصد از موارد مشاهده گردید. یافته ها حاکی از آن بودند که پیامدهای مادری با سن بارداری و پیامدهای نوزادی با تعداد زایمان ارتباط معناداری ندارند (05/0>p)؛ اما پیامد نارسایی کلیه با تعداد زایمان ارتباط معناداری داشت (023/0=P)؛ به طوری که تمام مادرانی که نارسایی کلیه داشتند، در بین نولی پارها بودند. علاوه براین پیامدهای مرگ نوزادی، سندروم زجر تنفسی، وزن کم هنگام تولد، آپگار پایین دقیقه 5 و پنوموتوراکس، ارتباط معناداری با سن بارداری داشتند (05/0<p)؛ به طوری که هرچه سن بارداری هنگام زایمان کمتر بود، پیامدهای ذکر شده بیشتر می شد.

    نتیجه گیری: 

    درمان انتظاری در پره اکلامپسی با شروع زودرس برای نوزادان مفید می باشد و در صورت پایش های دقیق و منظم در مراکز مجهز، عوارض مادری افزایش نخواهد یافت

    کلید واژگان: پره اکلامپسی, پیامد آبستنی, درمان انتظاری
    Zohreh Tabasi, Elahe Mesdaghinia, Masoumeh Abedzadeh Kalahroudi*, Hossein Akbari, Mahsa Bandagi-Motlagh
    Background and Objective

    Preeclampsia is one of the most critical complications of pregnancy observed in 2%-8% of all pregnancies. Severe preeclampsia has many maternal and neonatal complications that are more prevalent in early-onset preeclampsia. The present study aimed to determine the prevalence of maternal and neonatal outcomes of expectant management of severe preeclampsia before 34 weeks of gestation.

    Materials and Methods

    In this retrospective descriptive study, the medical records of 55 mothers who had severe preeclampsia before 34 weeks of gestation and underwent expectant management and those of their neonates within 2014-2019 in Kashan, Iran, were reviewed. The information extracted from the medical records included maternal and neonatal demographic variables and outcomes. All data were analyzed in SPSS software (version 16) using descriptive and inferential statistics. The p-values of less than 0.05 were considered significant.

    Results

    In this study, the rates of seizure, post-partum hemorrhage, intensive care unit admission, and platelet decline were 5.5%, 1.8%, 3.6%, and 7.3%, respectively. Moreover, 10.9% of mothers had renal failure, and therefore, elevated liver enzymes and hemolysis. Among the neonates, 44.7% and 12.7% of the cases had respiratory distress syndrome (RDS) and low Apgar scores, respectively. It was also revealed that 6.4% of the neonates had convulsions and pneumothorax (PTX), and neonatal mortality was observed in 6.4% of them. No significant relationship was observed between maternal outcomes and gestational age and between neonatal outcomes and the number of deliveries (P>0.05). However, renal failure outcomes had a significant relationship with the number of deliveries (P=0.023), meaning that all mothers with renal failure were nulliparous. It was found that gestational age had a  significant relationship with the outcomes of neonatal death, low 5-minute Apgar score, low birth weight, RDS, and PTX (P<0.05); in other words, lower gestational age led to higher mentioned neonatal outcomes.

    Conclusion

    Expectant management of early-onset preeclampsia was beneficial for neonates, and the implementation of regular and close monitoring in equipped centers would prevent the increase of maternal complications.

    Keywords: Expectant Management, Preeclampsia, Pregnancy Outcome
  • Hamid Reza Talari, Nooshin Mousavi, Masoumeh Abedzadeh-Kalahroudi*, Hossein Akbari, Abolfazl Kargar
    Background

    Thoracolumbar fracture (TLF) is one of the common problems associated with trauma. This study evaluated the diagnostic value of chest and abdominopelvic computed tomography (CT) in detecting TLFs among patients with blunt trauma.

    Methods

    This prospective diagnostic assessment study was conducted during 2016-2017. Participants were 256 patients above 18 years with blunt multiple trauma who had undergone chest and abdominopelvic CT at their admission to the emergency department and were subjected to thoracolumbar CT (TL CT) for the further assessment of TLFs. The sensitivity, specificity, and positive and negative predictive values of chest and abdominopelvic CT were calculated based on TL CT findings.

    Results

    The total sensitivity, specificity, and positive and negative predictive values of chest and abdominopelvic CT in detecting TLFs were 89.55%, 100%, 100%, and 89.71%, respectively. These values were, respectively, 95.56%, 100%, 100%, and 98.39% in detecting transverse process fractures; 50%, 100%, 100%, and 91.04% in detecting vertebral body fractures; and 80%, 100%, 100%, and 65.24% in detecting vertebral body and posterior element fractures. Chest and abdominopelvic CT sensitivity and specificity were, respectively, 97.5% and 100% among patients younger than 40 years and 77.4% and 100% among patients older than 40 years. There was a significant agreement between chest and abdominopelvic CT and TL CT findings (kappa coefficient = 0.896; P < 0.001).

    Conclusion

    Chest and abdominopelvic CT has acceptable sensitivity and specificity in detecting TLFs. However, due to low sensitivity and specificity in detecting vertebral body fractures without posterior element involvement and clinical importance of these fractures, image reformatting is suggested. Of course, TL CT can be used in case of suspicious fractures or older patients.

    Keywords: Blunt trauma, chest, abdominopelvic, thoracolumbar, computed tomography, spinal fracture
  • Tayebeh Hashemi Dermaneh, Negin Masoudi Alavi*, Masoumeh Abedzadeh Kalahroudi
    Background

    Nurses are at a high risk of workplace violence (WPV). This phenomenon is largely dependent on the sociocultural conditions.

    Objectives

    This study explained the experiences of nurses about the WPV in medical, surgical, and emergency departments of a general hospital in Kashan, Iran, in 2017.

    Methods

    In a qualitative content analysis, 13 nurses who had the experience of WPV were invited to participate in semi‑structured interviews. The interviews were analyzed through conventional qualitative content analysis using the method suggested by Graneheim and Lundman.

    Results

    Four themes were extracted from the interviews. The themes were: “violent behaviors,” “antecedents of violence,” “violence management,” and “violence outcomes”.

    Conclusion

    WPV had many forms, antecedents, and consequences. Training the personnel and developing a committee for evaluating the incidents can prevent the occurrence of the violence

    Keywords: Workplace Violence, Nurses, Qualitative research
  • Fereshteh Jalili, Negin Masoudi Alavi *, Masoumeh Abedzadeh Kalahroudi
    Introduction
    Patients with cancer under chemotherapy usually manifest a wide range of symptoms. The frequency of these symptoms is reported differently. The current study aimed at addressing the common symptoms of cancer, according to gender and primary site of cancer in patients receiving chemotherapy in Kashan, Iran, in 2017.
    Methods
    The current cross-sectional study was conducted on 186 patients with cancer. The frequency of 14 common symptoms in cancer was evaluated with interviewing the patients. The data were analyzed with SPSS version 13 using descriptive statistics, chi-square, the Mann-Whitney U, and the Kruskal-Wallis tests.
    Results
    About half of the subjects were female, and 58.1% aged above 50 years. The common primary sites of cancer were breast (23.1%), colon (21%), bone (11.3%), and lung (7%). The most common symptoms were fatigue (86.6%), followed by dry mouth, insomnia, anorexia, and pain. The subjects reported 6.672.63± symptoms in average. The patients with the history of surgery reported significantly more symptoms. The symptoms of insomnia, nausea, and diarrhea were significantly higher in female patients, while anorexia was significantly higher in male ones. Dry mouth, diarrhea, and total number of symptoms were significantly associated with the primary site of the cancer.
    Conclusions
    Patients with cancer experience various symptoms that are different based on the primary site of the cancer and the gender of patients. Any effective actions in palliative care should be based on the accurate assessment of the symptoms.
    Keywords: Neoplasms, Drug Therapy, Symptom Assessment
  • Ehsan Azami, Masoumeh Abedzadeh-Kalahroudi*, Mansour Dianati, Zohreh Sadat
    Background
    Deep Vein Thrombosis (DVT) is a common complication in patients with hemorrhagic stroke. Prophylaxis and treatment of DVT in these patients is very difficult because there are some limitations regarding the use of anticoagulant drugs..
    Objectives
    The purpose of this study was to compare the effectiveness of knee-high and thigh-high graduated compression stockings in preventing DVT in patients with hemorrhagic stroke..
    Methods
    In this clinical trial, 88 patients with hemorrhagic stroke were randomly assigned to two groups to receive either thigh-high or knee-high graduated compression stockings as prophylaxis for DVT. The prevalence of DVT was studied using clinical symptoms and Doppler ultrasound. Chi-square and Mann Whitney U tests were used to analyze the data..
    Results
    In the thigh-high stockings group, 11 patients (26.8%) and in the knee-high stockings group, 18 patients (38.3%) were affected by DVT during the study. However, no significant difference was observed between the two groups (P = 0.25)..
    Conclusions
    There was no significant difference between the two groups in the incidence of DVT. Therefore, either knee-high or thigh-high stockings can be used as prophylaxis, depending on patients’ will, cost and ease of use..
    Keywords: Stroke, Deep Vein Thrombosis, Graduated Compression Stockings
  • Azade Safa, Masoumeh Abedzadeh-Kalahroudi, Negin Masoudi Alavi*
    Background

    Traumatic injuries in the elderly often lead to permanent disabilities and long-term treatments that can adversely influence their activities of daily of living (ADL). The effect on ADL is an important outcome in elderly trauma.

    Objectives

    The present study was designed to evaluate the predictive factors of dependency in ADL following limb trauma in elderly referred to Shahid Beheshti Hospital, Kashan, Iran, in 2013. Patients and

    Methods

    This descriptive study was conducted on 200 traumatic patients admitted to the trauma emergency ward of Shahid Beheshti hospital in 2013. The questionnaire used in this study had three parts: demographic data, information related to trauma, and an independence scale of ADL (ISADL). The ISADL was completed in the emergency ward to declare pre-traumatic status; it was also completed one and three months after trauma. Statistical analysis was conducted by the t-test and analysis of variance (ANOVA). The repeated measure was used to study the trend of the ISADL and other demographic variables. The multiple regression analysis was also used to declare the predictive variables related to the ISADL.

    Results

    The study population consisted of 81 males (40.5%) and 119 females (59.5%). The participants’ average age was 70.57 ± 9.05 years. In total, 80.5% of the elderly were completely independent in ADL before trauma; this decreased to 13.5% one month after trauma. The repeated measure analysis showed a significant improvement in the ISADL three months after trauma. Gender, age, and education had significant interaction with the ISADL. The multiple regression analysis showed that type of trauma and location of injured organ had predictive values related to the ISADL, one and three months after trauma. The place and cause of trauma, and having surgery showed a significant relationship with the ISADL three months after trauma.

    Conclusions

    Many factors, such as gender, age, education, type of trauma, and location of injured organ,may predict ADL following limb trauma

    Keywords: Trauma, Elderly, activities of daily living
  • Zohreh Sadat, Masoumeh Abedzadeh Kalahroudi, Mahboobeh Kafaei Atrian *, Zahra Karimian, Zahra Sooki
    Background

    Postpartum depression (PPD) is a common problem after child''s birth and may influence the quality of life (QOL). Investigation of postpartum QOL and depression can be useful for better care for mothers and improvement of their well-being..

    Objectives

    The objective of this study was to assess the life quality in mothers with and without PPD..Patients and

    Methods

    In a prospective study, women who had experienced child''s birth with and without PPD were recruited in Kashan-Iran. PPD was measured using the Edinburgh Postnatal Depression Scale (EPDS) and QOL was measured by SF-36 questionnaire. Data collection was conducted at two assessment points: second month (n = 321) and fourth month (n = 300) postpartum. Based on EPDS, a score of 13 or more was defined as PPD. Mean scores of SF-36 questionnaire were compared between women with and without PPD at two assessment points and within each group from the first to the second assessments. Moreover, correlation between scores of EPDS and scores of life quality dimensions were evaluated. Data were analyzed by using the Student’s t-test, Mann–Whitney U-test, ANOVA, Kruskal-Wallis, Chi-square test, Pair t test, Wilcoxon, Pearson and Spearman Correlation Coefficient..

    Results

    Differences in seven out of eight mean scores of QOL dimensions (except role-physical) between depressed and non-depressed women at the first and the second assessments were significant. Results of changes in mean scores of QOL dimensions from the first to the second assessments in each group showed that non-depressed women scored higher in all of eight dimensions with significant differences in two dimensions (bodily pain and role-emotional as well as mental health component). In depressed women, scores of life quality decreased in some of QOL dimensions but differences were not significant. There were significant negative correlations between EPDS scores and scores of seven out of eight SF-36 sub-scales (except role-physical) in addition to physical and mental health components at two assessments. The highest correlation was found between EPDS scores and emotional well-being and total scores of SF-36 dimension at the first and the second assessments (r = -o.489, r = -0.381), respectively..

    Conclusions

    The findings demonstrated that postpartum depression leads to a lower life quality at second and fourth months postpartum. Integration of PPD screening into routine postnatal care is recommended..

    Keywords: Depression Postpartum, Health, Mental Health
  • Mansoureh Samimi, Azam Imani-Harsini, Masoumeh Abedzadeh-Kalahroudi
    Background
    Postpartum hemorrhage is a significant cause of maternal mortality and morbidity, worldwide..
    Objectives
    The aim of this study was to compare the efficacy between carbetocin and syntometrine in prevention of postpartum hemorrhage..
    Materials And Methods
    This study was a double blind randomized clinical trial that carried out on 200 pregnant women referred to Shabiehkhani maternity center of Kashan, during 2011. The first group received intramuscular syntometrine and the second group received intramuscular carbetocin after placental delivery. All of the participants were followed for 24 hours and blood pressure, pulse rate, uterine tone, hemoglobin concentration at first and 24 hours after delivery, and the need for additional uterotonic drugs and drug side effects were evaluated. Finally all data were analyzed using t-test, chi square tests and logistic regression..
    Results
    The mean fall in hemoglobin level in the carbetocin group was significantly lower than the syntometrine group (P < 0.001). Also there were significant differences between the two groups, regarding additional uterotonic drug requirements (P = 0.002). Moreover systolic blood pressure and uterine tone immediately and 30 minutes after drug administration were significantly different (P < 0.001). Incidence rate of tachycardia in the carbetocin group was 13%, in contrast to 5% in the syntometrine group (P = 0.04)..
    Conclusions
    This study revealed that carbetocin is more effective than syntometrine in prevention of postpartum hemorrhages. Thus it can be used as a good alternative of syntometrine for low-risk women..
    Keywords: Carbetocin, Postpartum Hemorrhage, Prevention, Control, Syntometrine
  • Zohreh Tabasi, Mehrdad Mahdian, Masoumeh Abedzadeh Kalahroudi
    Background
    Cesarean section (CS) is one of the most frequently performed surgical procedures worldwide. The complications following a CS include fever, wound infection, post-operative pain and bleeding which are not usually found in a normal vaginal delivery. Traditionally, suturing of peritoneal layers for CS patients has been done, but in some studies it has been shown that this procedure could be eliminated without affecting the rate of morbidity.
    Objectives
    The objective of this study was to assess the short-term outcomes of two different cesarean delivery techniques.Patients and
    Methods
    A total of 100 cases who underwent cesarean section were randomly assigned equally to either closure of both the visceral and parietal peritoneum or no peritoneum closure. Duration of operation, pain scores, analgesic requirements, alterations in hemoglobin levels and febrile morbidity were assessed accordingly.
    Results
    Pain scores, analgesic requirements assessed at 24 hours and operation duration were significantly lower in the non-closure group as compared to the closure group. Febrile conditions and changes in hemoglobin levels were similar in both groups.
    Conclusions
    Non-closure of both visceral and the parietal peritoneum when performing a cesarean section produces a significant reduction in pain, fewer analgesic requirements and a shorter operation duration without increasing the febrile morbidity and changes in hemoglobin levels as compared to the standard methods.
    Keywords: Cesarean Delivery, Diagnostic Techniques, Surgical, Pain
  • Mahboubeh Taebi, Masoumeh Abedzadeh Kalahroudi, Zohreh Sadat, Farzaneh Saberi
    Background
    Third stage of labor has been defined as the most dangerous stage. Due to the importance of the third stage, this study was performed in order to determine its length and related factors.
    Methods
    This research is a cross sectional study which was carried out on 1000 deliveries in Shabihkhani Hospital (Kashan-Iran). Inclusion criteria consist of gestational age of higher than20 weeks, singleton pregnancy, and vaginal delivery without any instrument.
    Results
    The mean, median and standard deviation of the third stage of labor were 6.03, 5 and 5.15 minutes respectively. The finding also showed that there was a significant association between Para, Induction of labor, use of analgesic drugs during labor (pethidin), and umbilical drainage for third stage management (p < 0.05). There was no significant association between a history of Abortion, Gestational age and Third stage management (Oxytosine).
    Conclusions
    The use of Induction, analgesic drugs during labor and umbilical drainage prolonged the third stage of labor, but multiparity decreased the duration of this stage. The diagnosis of these factors is recommended in order to predict and prevent the occurrence of the third stage dangers.
    Keywords: Labor stage, third stage, placenta delivery, normal vaginal delivery, postpartum hemorrhage
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