zahra khazaeipour

 Diabetes is one of the main problems of health systems and a global threat to public health that has increased dramatically over the past two decades. Patients with diabetes are susceptible to multiple complications, such as diabetic foot ulcers. A diabetic foot ulcer is a common diabetes complication that has shown an increasing trend over the past decades. In treating diabetic foot ulcers, using ulcers with wound treatment is one of the critical challenges for therapists. So far, the dressing that meets all the requirements for the treatment of diabetic foot ulcers has not been produced, and the proper choice of sauce depends on the type and stage of the wound, the spread of the injury, the patient's condition, and the tissues involved.

 The present study was conducted using the one-blind clinical work method on 80 diabetic patients referred to the Alborz University of Medical Sciences supervised clinics; 40 patients with diabetic foot ulcers were treated and compared to algae, and 40 patients with alginate dressing. The information collected was analyzed using Chi-Square and T statistical tests.

There were no significant differences in gender, education level, marital condition, land disease, wound time, size, and secretion. In comparing the body mass index, there was no significant difference between the two groups in consequence of wound healing. The recovery percentage in the Alji Pad group was significantly better than in the alginate group. Also, the number of sessions for each patient in the Alji Pad group was considerably lower than in the alginate group. In reviewing the Push scoring process, we evaluated the fifth referral. Because in both groups, most people went to the fifth session. We used repeated measurement analysis. The results showed that the recovery process was good in the two groups (P <0.001), but the recovery in the Alji Pad group was significantly faster than in the alginate group.

 Algae Pad dressing in patients with diabetic foot ulcers is a simple and practical method that, according to the study of the cost of treatment, the duration of treatment is preferable to the conventional alginate dressing method.

Since the introduction of the Food and Drug Administration (FDA)-approved repetitive transcranial magnetic stimulation (rTMS) intervention in 2008, a breakthrough has been made in treating major depressive disorder (MDD). However, many sessions of treatment and its cost make it inconvenient for those who seek treatment, especially in large cities as well as in developing countries.

A total of 22 patients (out of initial 24 referrals) who met diagnostic and statistical manual of mental disorders, 4th edition (DSM IV) criteria for MDD were enrolled in the study. All subjects had to fail at least one prior treatment for depression. The patients received the FDA-approved protocol of high-frequency (10 Hz) rTMS over the left dorsolateral prefrontal cortex. 

Seventeen out of twenty-two cases showed significant improvements after two weeks of treatment. Only six patients continued their treatments for the next two to four weeks.

We have replicated other studies showing that the use of rTMS is effective for many patients with MDD without major side effects and their improvements are measurable mostly after two weeks. Our data highlight the importance of the application of more convenient protocols that require fewer sessions on fewer days to help with compliance and outcome, particularly in large populated cities and countries, such as Iran going through economic hardship.

Propofol is an advantageous agent for anesthesia induction. It can cause dose-related hemodynamic adverse effects. The bispectral index (BIS) is a brain function monitor utilized to assess the depth of anesthesia. This study aimed to compare the adverse hemodynamic effects of BIS-guided response dosing with conventional weight-based dosing of Propofol.In this clinical trial, patients were anesthetized with propofol in two different orthopedic operating rooms. In one operating room, patients received propofol with dose-response method (group A), and the other received weight-based dosing (group B). For both groups, BIS was used as an index of anesthesia depth. Hemodynamic parameters were recorded at baseline, during induction, and at different time points.A total of 73 patients were included in the final analysis. The meandose of propofol for induction was higher in the control group than in the response-guided group (1.94±1.65 vs. 1.09±0.32, respectively, P=0.006). There wereno reported significant adverse hemodynamic effects in patients of the two groups.Response-guided propofol dosing can be used to decrease propofol dose during anesthesia induction. Further studies are needed to investigate the clinical benefit of this dosing strategy.

There is still controversy on the importance of soft markers on the fetus and neonatal outcomes. This study aimed to determine the mentioned outcomes in the fetuses with soft markers detected by ultrasound screening.

This prospective study was conducted on 461 pregnant women who were referred to the prenatal clinics of hospitals affiliated with the Tehran University of Medical Sciences, Tehran, Iran, in 2021. The study outcomes included incidence of abortion, preterm birth (PTB), cesarean section (CS), low birth weight (LBW), neonatal admission rates, and neonatal mortality.

The most frequent soft marker in the present study was echogenic intra-cardiac foci (EIF) (32.5%), followed by choroid plexus cyst (CPC) (30.6%), pyelectasis (25.2%), and echogenic bowel (EB) (15.8%), respectively. Spontaneous abortion, PTB, CS, LBW, neonatal department admission, neonatal intensive care unit (NICU) admission, stillbirth, and fetal distress, and death occurred in 10 (2.1%), 52 (12.5%),  316 (76%), 35 (7.6%), 28 (6.7%),  42 (10.1%), 13 (3.1%),  26 (5.6%), and one (0.24%) cases, respectively.Poor neonatal outcomes were significantly associated with EIF (P=0.007), CPC (P=0.045), echogenic bowel (P=0.031), pyelectasis (P=0.026), and single umbilical artery (P=0.010). In addition, the fetuses with synchronous CPC and IEF and also synchronous pyelectasis and IEF were at significantly higher risk of poor neonatal outcomes (P=0.037).

The study results showed that although poor neonatal outcomes were associated with some soft markers, most fetuses with soft markers had desired outcomes in the absence of structural or chromosomal abnormality.

A better understanding of the pattern of epidemic-related referrals to healthcare centers might allow the identification of vulnerabilities and the required changes that the healthcare management system should undergo.

This study aimed to investigate the COVID-19 referral pattern and the role of media and health management planning in changing the trends.

Data extracted from the electronic medical database of Imam Khomeini Hospital Complex (IKHC), located in Tehran, Iran, from February 20 to June 4, 2020 were examined. Individuals were divided into two groups, COVID-19 positive and negative. We used Google Trends to evaluate Google Internet search queries and also available policy documents, programs, and official news related to COVID-19 in Iran during the mentioned period.

In this study, 8647 individuals aged 46.05 ± 16.5 years were referred to IKHC. Approximately 57% were male, and 70% were COVID-19 positive. The most clinical symptoms were dyspnea, fever, cough, and myalgia. Chronic kidney disease (CKD) and type 2 diabetes mellitus were the most common underlying health conditions. In the first two weeks, the percentage of negative cases was higher than positive cases and then the pattern was reversed, when people searched for information about COVID-19 in media.

Proper and timely information and education to people through the media and health management measures can be effective in reducing unnecessary visits to health centers, preventing the exhaustion of medical staff, and controlling the disease during epidemics.

The coronavirus disease 2019 (COVID-19) epidemic is a great challenge among  healthcare workers, especially nurses,duet othei rmoref requent and closer contact with patients.

This study aimed to evaluate anxiety, depression, and their causes among nurses with COVID-19 infection in different wards of a hospital.

This cross-sectionalstudy was carried out between February 1stto October 30th, 2020, among all nurses with COVID-19 infection in different wards of Imam Khomeini Hospital (university hospital), Tehran, Iran. The nurses were contacted by phone, and data were collected using a self-administered, valid, structured questionnaireconsisting ofsociodemographic characteristics and clinical symptoms. Psychological complications, including anxiety and depression levels, were assessed and their association with other sociodemographic variables was also evaluated.

A total of 158 nurses were entered into the study, out of which 112 (70.2%) cases were females. Among all participants, 72.8%and 42.4% of the subjects reported anxiety and depression, respectively. The frequency of moderate to severe anxiety was significantly greater in women than in men (P<0.001). The infected nurses who worked in low-risk departments experienced a greater proportion of moderate to severe depression (P=0.004). In addition, the most prevalent reason for anxiety and depression was found to be the fear of infecting family members.

Nurses bear a significant psychological burden during the COVID-19 pandemic, markedly when they get infected and experience clinical symptoms. Therefore, the government and other staff should provide some facilities and supportive administrative work for reducing anxiety and depressionand improving nurses' psychological health.

Implementation of a program to support physicians’ working long in deprived areas is one of the most important programs of the Health System Transformation Plan in response to the challenge of the shortage of expert staff, particularly physicians. Numerous factors affect the persistence of physicians in different regions, especially in deprived ones. This study aims to explain the experiences of physicians in relation to the challenges of working long in deprived areas.

The present research is a qualitative study that was conducted in 2020 in Tehran, Iran. To achieve information saturation, 16 physicians and specialists were chosen using purposive sampling method. Then, for data collection, semi-structured interviews were used. Moreover, data analysis was performed using Graneheim and Lundman contractual content analysis method, and data management was done with MAXQDA software version 12. Furthermore, Lincoln and Guba reliability criteria were applied to achieve data accuracy and reliability.

Three female and 13 male physicians with a mean work experience of 45.4±7.8 years and an average work experience in deprived areas of 8±6.3 years participated in the study. Six participants were native to the region and the rest were non-native. Twelve participants in the study were the faculty members of the university. When the data were analyzed, 286 initial codes were extracted. The information was divided into four main categories and eleven subcategories. Welfare, motivation, justice and security were the main categories of this study.

Providing individual and social welfare for physicians, and fair treatment in financial payments and educational justice along with establishing security provide the necessary motivation for physicians to stay in a deprived area. Besides by combining several solutions at the same time, the presence of doctors in deprived areas can be guaranteed.

To compare the ketamine efficacy at a sub-dissociative morphine dose to reduce pain in isolated limb traumatic injuries. A double-blind randomized clinical trial study was carried out on patients referred to emergency departments (EDs) due to isolated limb traumatic injuries. Eligible patients were divided into two groups which one group received 0.1 mg/kg ketamine and the other group received 0.05 mg/kg morphine, intravenously. An observed side effect includes pain scores and vital signs were recorded at baseline of every 5 minutes for 30 minutes. Totally, 73 patients with the mean age of 32.9±10.4 were enrolled of whom 59 (80.8%) individuals were men. The baseline characteristics difference of the two study groups was not statistically significant. The results showed that the change of mean pain score was -6.2 (95% CI: -5.72 to -6.69) points in the group receiving ketamine compared to -5.8 (95%CI: -5.15 to – 6.48) in the group who were administered morphine. At all assessed checkpoints, the pain mean score was lower in the ketamine group than in the morphine group (p <0.05); the mean of total pain reduction was greater in the ketamine group during the observation period compared with patients who received morphine (p=0.002). The study findings suggest that the sub-dissociative ketamine efficacy in controlling of the acute pain is not lower than morphine sulfate in patients with isolated limb trauma in ED’s. Thus, it can be considered as a safe and effective alternative approach.

Muscle energy technique (MET) is one of the alternatives for the treatment of joint dysfunctions. Previous studies investigated this technique without considering the kind of dysfunctions. Therefore, the aim of this study was to evaluate the therapeutic effects of MET by considering the type of dysfunction and the direction of the corrective maneuver in women with iliosacral joint dysfunctions.

This randomized controlled clinical trial included 60 women with anterior innominate or posterior innominate dysfunctions and were randomly divided into the treatment group (n=30) receiving a session of MET and the control group (n=30). The range of flexion and extension of the lumbar, visual analogue scale (VAS), active straight leg raising (ASLR), and pressure pain threshold (PPT) at five points were measured before, after, and 24 hours after MET.

Before, after, and 24 hours after the intervention, the mean change of the range of lumbar flexion and extension showed an increase. However, the mean change of the level of VAS and ASLR decreased significantly (P<0.05) in the treatment group with corresponding 95% confidence intervals.

According to the results of this study, using MET by considering the kind of dysfunction may more efficiently improve a patient’s symptoms.

Several studies have demonstrated an association between chronic pain and impairment of cognitive capabilities. Since the number sense is one of the cognitive ability involved in the evaluation of pain intensity using some pain measurement tools, impairment of number sense may impact pain assessment. Therefore, the validity of number-based pain assessment tools should be re-evaluated.

This study aimed to determine whether number sense is altered in chronic and acute pain patients compared to healthy subjects.

Overall, 150 participants were recruited and divided into the three groups of controls, chronic and acute pain patients. Pain intensity was evaluated using numeric and verbal rating scales as pain assessment tools. Number sense was assessed using number naming, number marking, and line bisection tasks. Deviation from correct answers was measured for each task.

Patients with chronic pain (migraine headache) had higher pain intensity scores than acute pain subjects. Chronic pain patients showed significant deviation from the expected responses compared to controls in the line bisection task.

Chronic pain patients may have impaired number sense and may differently use number-based pain assessment tools in comparison with healthy individuals.

The National Traumatic Spinal Cord Injury Registry in Iran (NSCIR-IR), was implemented initially in three hospitals as a pilot phase from 11 Oct 2015 to 19 Jun 2016 and has been active in eight centers from 19 Jun 2016. Poursina Hospital, a trauma care referral center in Rasht, Guilan Province of Iran is one of the registry sites, and has been involved in registering eligible patients since 1 Jan 2016. This study aimed to identify the challenges and solutions for sustaining the NSCIR-IR in a regional center.

This was a mixed-methods study. For the quantitative analysis, a retrospective observational design was used to measure case capture or case identification rate, mapping cases in the registry against those eligible for registry inclusion amongst the register of hospital admissions. For the qualitative component, data was collected using focus group discussions and semi-structured interviews, followed by thematic analysis.

From 19 Jun 2016 to 24 Jan 2018, the proportion of case capture (case identification rate) was 17%. The median time between case identification and data entry to the system was 30.5 d (range: 2 to 193 d). Thematic analysis identified a lack of trained human resources as the most important cause of low case identification rate and delay in data completion.

Recruitment and education to increase trained human resources are needed to improve case capture, the timeliness of data input and registry sustainability in a regional participating site.

Chronic pain is the third main problem of global health and the most common cause of long-term disabilities. The duration that patients suffer from chronic pain is directly proportional to the extent of the suffering and to the amount of health care resources allocated to this problem. There is no research that has studied the risk factors associated with the long pain duration in chronic pain patients.

We investigated the potential risk factors associated with long pain duration in a population with diverse pain conditions in a cross-sectional study. We used a questionnaire that included a number of potential risk factors including sex, age, marital status, household condition, number of children, employment, education, body mass index (BMI), pain intensity, and the level of anxiety/depression. The data were analyzed by univariable and multivariable linear regression models.

We recruited 780 patients. The analyses showed that age and abnormal BMI had a positive correlation with pain duration.

The risk factors that might be associated with longer pain duration include older age and abnormal BMI.

Lumbar stiffness is a common complaint of patients with low back pain. The Muscle Energy Technique (MET) is a common intervention to treat the spine and sacroiliac joint dysfunctions and their resulting disability in daily activities. This research aimed to evaluate the effects of MET on pain, functional disability, and lumbar stiffness of patients with sacroiliac joint dysfunctions by considering the type of dysfunction and the orientation of the correcting maneuver.

Fifty women with ant innominate or post innominate dysfunctions were recruited for the research and randomly divided into two groups (n=25). One group received one session of MET, and the other group received the sham position. Visual Analogue Scale (VAS), lumbar Stiffness Disability Index (SDI) and Oswestry Disability Index (ODI) were used for the evaluation of the participants before, 24 hours after and one week after the intervention.

According to the results, MET significantly decreased the mean range of VAS and ODI, 24 hours, and a week after the intervention (P<0.01). We did not see any significant difference in SDI values before, 24 hours, and one week after MET in the patients (P>0.01).

Applying MET regarding the kind of dysfunction may reduce the patient’s pain and disability.

Flexibility is considered as one of the most significant components of rehabilitation protocols including two definitions: static flexibility measured by the Range of Motion, and dynamic flexibility measured by stiffness. Generally, a normal flexibility is necessary for an appropriate posture and flawless activity in daily life. With regard to various methods that contribute to increasing flexibility of hamstring muscles, the current study aimed at investigating immediate effects of Muscle Energy Technique (MET) on hamstring flexibility and stiffness in healthy young females Ten healthy young females with the mean age of 22.5±2.67 years old participated in the study. Flexibility was measured via active knee extension and modified sit-and-reach test, and stiffness was measured based on the ratio of torque to angular changes via Biodex System 3 before and after MET interventions by post-isometric relaxation method. The amounts of active knee extension and modified sit-and-reach tests significantly increased after MET intervention; the amounts of active knee extension and modified sit-and-reach increased significantly (P<0.001). Moreover, the estimated hamstring stiffness decreased significantly in comparison with its values before treatment (P<0.001) The results of this study indicated that MET may improve hamstring flexibility as well as its stiffness.

This study is aimed to evaluate the effects of opium dependency on testicular tissue in a rat model.

Thirty-two Wistar male rats (aged 30 days and weighing 200-250 grams) were randomized into two groups. Group A, consisting of 16 rats, received dissolved oral opium tablets in drinking water for 45 days, whereas group B (control group) consisted of 16 rats that received opium-free water. After 45 days vertical and horizontal diameters of testis, number of seminiferous tubules, mean seminiferous tubule diameter, number of germ cells, height of germinal epithelium, percentage of degenerating Leydig and germ cells and glutathione density of testicular tissue (µmol/g of tissue) were compared between study groups.

Morphological evaluation of testicular tissue revealed a significantly higher percentage of degenerating Leydig and germ cells in the treated group compared to control group. (10.08 ± 0.351 vs. 1.83 ± 0.88, 4.50 ± 0.769 vs. 0.607 ± 0.118, respectively) (P-value<0.001 for each) Interestingly, vertical and horizontal diameter of testis, the average number of germ cells, height of germinal epithelium and number of seminiferous tubules, were significantly higher in the treated group compared to control group. Seminiferous tubule diameter and glutathione density of testicular tissue were not statistically significantly different between the groups.

Applying a rat model, we noted that opium has a substantial effect on testicular structure and function. A significantly higher proportion of Leydig and germ cells were degenerated in treated rats despite an increase in the average number of seminiferous tubules and germ cells. These findings support the hypothesis that opium consumption adversely affects male fertility.

All the trauma scoring systems (TSSs) have some limitations, and none is useful for patient monitoring. Recently, investigators have tried to modify the TSSs to improve their use.

This study was conducted to determine whether any correlation exists between dysoxia metabolism markers (DMMs), including venous base deficit (BD) and HCO3 level with different TSSs.

In this cross‑sectional study, all multiple trauma patients admitted to the emergency department were eligible. Blood samples for venous blood gas analysis were taken at the onset of resuscitation process. TSSs, including trauma index (TI), abbreviated injury score (AIS), Injury Severity Score (ISS), Revised Trauma Score (RTS), and Trauma Score‑ISS (TRISS), were calculated for the patients. Spearman’s rank correlation coefficient test was applied to find the association between the independent variables.

A total of 285 patients with a mean age of 33.37 ± 15.29 fulfilled the inclusion criteria, of which, 211 cases (74.0%) were male. Statistical analysis revealed that there was a correlation between TI and HCO3 level (P = 0.0001, r = −0.37) and also TI and BD (P = 0.0001, r = −0.47). Furthermore, there was an indirect correlation between AIS and ISS with HCO3 and BD levels and the direct correlation between RTS and TRISS with HCO3 and BD levels.

It is likely that there is a statistical correlation, although weak, between TSSs with DMMs, including HCO3 and BD level.

 Endotracheal intubation is an important procedure in critical care and emergency medicine settings. Optimal depth of the tube placement has been a serious concern because of several complications associated with its malposition. The aim of the current study was to find a new formula to estimate the proper endotracheal tube depth when using ultrasonography or lighted stylet device in order to increase the accuracy of determining Endotracheal tube (ETT) depth and decrease the side effects of ETT misplacement. Patients older than 18 years of age admitted to Imam emergency department who needed tracheal intubation were included. Tube’s length at the angle of the mouth while the tube passed the suprasternal notch, ETT depth after insertion and the distance from ETT’s tip to carina were recorded. Ultrasonography and portable chest x-ray were used as tools for measuring these lengths. A total number of 91 patients including 55 men and 36 women were eligible for inclusion in the study. Not placing the tube at proper depth was considered as failure of intubation. This failure rate was 9.9% in the standard method which would have been 1.1% if our proposed formula was used. The findings of this study suggest that the use of this new formula may help in predicting the proper intubation tube placement. Further studies are warranted to confirm these findings.

The present study aims at determining the proportion of clinical information known by the patients with cancer and their families about diagnosis of their disease as well as investigating the different attitudes of patients and their families towards informing the patients of the malignant nature of the disease.
We designed a structured questionnaire which was completed by patients with cancer who were under follow up in Cancer Institute of Tehran University of Medical Sciences, and one member of their families who accompanied them while being treated. Patients, physicians, and patients’ family members were interviewed separately.
A total of 250 cancer outpatients and 250 patients’ family members were interviewed. Overall, 227 patients (90.8%) desired to be informed of their diagnosis, and 98 patients (38.8%) declared that physicians informed them completely. One hundred fifty-three family members (61.2%) believed that patients are entitled to know the truth. Stepwise multiple logistic regression analysis indicated that patients’ educational grade (odds ratio: 6.08; 95% CI, 1.27 to 29.07) and patients’ age (odds ratio: 7.97; 95% CI, 1.25 to 50.59) were predictable factors for requesting to know the truth.
Findings of the present research indicated that most patients and family members wanted to be informed of the diagnosis; The present study suggests that physicians respect the patient's rights to know the truth and inform them accordingly. This can help them adapt themselves to new condition and manage their own life.

We investigated the effects of cigarette smoking in non-per os (NPO) period on volume and pH of gastric contents in smoker male patients.
In a prospective cohort study, 86 male smoker patients undergoing elective non-abdominal surgery under general anesthesia, were surveyed. They were NPO for at least 8-12 hrs. prior to surgery without direction to smoking. Then they were divided in two groups in the operation room based on smoking during NPO period. The study was continued until 43 patients entered in each group. After induction of anesthesia, gastric contents were aspirated by NG tube then volume and pH of gastric contents were measured. There were no significant differences in basic characteristics of patients such as age and weight between two groups.
The pH of gastric content was significantly lower in the smokers group (1.57±0.74 vs 3.12±1.90 p=0.001). The mean volume was significantly higher in the smokers’ group (34.60±20.90 vs 19.86±14.72 ml, p=0.001).
Smoking during NPO period in habitual smokers before elective surgery increases the volume and acidity of gastric contents and probably increases risk of acid pulmonary aspiration.

The Emergency Severity Index (ESI) is a five-level triage system that has shown promising reliability and validity. According to ESI algorithm, in the presence of danger zone respiratory rate (RR), heart rate (HR) or Oxygen (O2) saturation, patients should be up-triaged from ESI level 3 to 2 Hence, the current study aimed to investigate the value of the measurement of vital signs in predicting the up-triage of patients from ESI level 3 to 2. Patients who visited the emergency department at Imam Khomeini Hospital Complex, Tehran, Iran, and were categorized into ESI level 3 were investigated. RR, HR, and O2 saturation were recorded by the triage nurse, and the rates of abnormalities in these three variables were evaluated. Out of 551 cases who were up-triaged from ESI level 3 to 2,489 (88.7%) had an increased RR, and 539 (97.8%) had an increased RR or HR. Only 12 cases (2.2%) had normal RR and HR, who were up-triaged only due to abnormal O2 saturation. Out of these 12 cases, 10 had O2 saturations

Recently, extensive efforts have been made to understand the rate of energy expenditure and the weight gain associated with atypical antipsychotic treatment, including identification of markers of obesity risk. In recent years, leptin, an adipocyte hormone, has gained significant interest in psychiatric disorders. S100B has been considered as a surrogate marker for astrocyte-specific damage in neurologic disorders. Also, S100B has been detected in adipose with concentration as high as nervous tissue as a second release source. In this study we evaluated the relationship between S100B and leptin in schizophrenic patients under treatment with clozapine and risperidone.This study included 19 patients meeting the DSM-IV-TR criteria for schizophrenia, having body mass index (BMI) of 16- 25 kg/m2 and suffering schizophrenia for more than 3 years and from this study. Twenty five healthy controls were group matched for age and gender whose BMI was 16-25 kg/m2. Serum S100B and leptin levels and positive and negative symptom scale (PANSS) were assessed at admission and after six weeks. During the study, S100B showed a strong and negative correlation with leptin (r = -0.5, P = 0.01). Also, there were negative correlation between serum S100B level and PANSS negative subscale after 6 weeks of treatment (r = -0.048, P = 0.8).
Positive correlation between leptin level and PANSS suggested a potential role for leptin which can mediate the link between antipsychotic induced weight gain and therapeutic response in schizophrenia.

The objective of the study was to evaluate the position of patient education measuring knowledge, attitude, and practice (KAP) among health care workers (HCWs). It is also aimed to emphasize the need for a real position for patient education. This survey was performed among a group of HCWs in Iran. The scores had an acceptable level. However, nurses, females and younger people received higher scores. The staff was already aware of patient education necessity and considered it as the duty of all medical team. Often HCWs cannot include patient education in their routine due to time shortage, lack of staff’s financial motivation, fatigue, and loads of work, etc. There is still need for a real training in the educational curriculum. Additionally, the various HCWs–related obstacles should be taken into account.

Spinal cord injury (SCI) causes multiple complications, which can be prevented or minimized, through patient education (PE). Individuals with SCI are different, according to culture, socioeconomic status, level of education, access to educational facilities, and geographic region. Therefore, different teaching strategies should be used to increase effectiveness of education. The aim of this study is to evaluate the perspectives of individuals with SCI, about their preferred methods of PE.Patients and This was a descriptive cross-sectional study undertaken at the brain and spinal cord injury research center (BASIR), Tehran university of medical sciences, Tehran, Iran. The participants comprised of 119 SCI persons (81 men and 38 women), with mean age of 32 ± 10.5 years, referred to BASIR clinic to receive outpatient rehabilitation, in 2012. The patients were asked about their views, concerning preferred methods of PE. Most participants (94%) appreciated to be informed concerning their illness. The two most preferred education methods were educational movies by CD or DVD (44%) and lectures or face classes (36%), followed by educational TV programs (30%), brochures (24%), education via internet or computer-aided (14.3%), and, finally, educational books (2%). Health care providers should take into account the differences between individuals with SCI, to use effective teaching strategies. Also, they should apply appropriate teaching methods and more than one teaching strategy, in relation to the different time and situation. Effective PE, in individuals with SCI, can increase their knowledge and motivation in self-care, improve satisfaction, prevent complications and make the PE more effective.

Seroma formation is a common complication after breast cancer surgery. Several techniques such as tube drainage, fibrin sealant and suturing methods have been employed to prevent or reduce seroma formation. Capitonnage, a suturing method widely used following hydatid cyst removal, has been used after breast surgery in limited studies. Our aim was to compare the effectiveness of tube drainage, fibrin sealant and capitonnage to prevent early complications. Eligible patients with breast cancer who were candidate for breast conserving surgery were enrolled and randomized into three different groups (tube drainage, capitonnage, capitonnage plus fibrin sealant). Patients were visited on 5th,12th and 19th days after surgery and were assessed for any probable complications. A total of 90 patients were enrolled. One patient developed seroma in tube drainage and capitonnage group, while no participant from capitonnage plus fibrin sealant group experienced the mentioned complication. Three patients developed skin necrosis, all of them were treated with capitonnage plus fibrin sealant protocol. Based on our observations, it seems that capitonnage alone or in combination with fibrin sealant do not lead to significant differences in frequency of complications after breast cancer surgery such as hematoma, seroma and surgical site infection.

Oxidative stress processes play an important role in the pathogenesis of secondary brain injury after traumatic brain injury (TBI). Hypertonic saline (HTS) has advantages as being preferred osmotic agent, but few studies investigated oxidant and antioxidant effects of HTS in TBI. This study was designed to compare two different regimens of HTS 5% with mannitol on TBI‑induced oxidative stress. Thirty‑three adult patients with TBI were recruited and have randomly received one of the three protocols: 125 cc of HTS 5% every 6 h as bolus, 500 cc of HTS 5%as infusion for 24 h or 1 g/kg mannitol of 20% as a bolus, repeated with a dose of 0.25-0.5 g/kg every 6 h based on patient’s response for 3 days. Serum total antioxidant power (TAP), reactive oxygen species (ROS) and nitric oxide (NO) were measured at baseline and daily for 3 days. Initial serum ROS and NO levels in patients were higher than control (6.86± [3.2] vs. 1.57± [0.5] picoM, P = 0.001, 14.6± [1.6] vs. 7.8± [3.9] mM, P = 0.001, respectively). Levels of ROS have decreased for all patients, but reduction was significantly after HTS infusion and mannitol (3. 08 [±3.1] to 1.07 [±1.6], P = 0.001, 5.6 [±3.4] to 2.5 [±1.8], P = 0.003 respectively). During study, NO levels significantly decreased in HTS infusion but significantly increased in mannitol. TAP Levels had decreased in all patients during study especially in mannitol (P = 0.004). Hypertonic saline 5% has significant effects on the oxidant responses compared to mannitol following TBI that makes HTS as a perfect therapeutic intervention for reducing unfavorable outcomes in TBI patients.