فهرست مطالب

  • Volume:6 Issue:4, 2018
  • تاریخ انتشار: 1397/10/01
  • تعداد عناوین: 9
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  • Mohammed Omar Galal * Pages 1-4
    Pulmonary hypertension (PHT) has classically been treated with expensive vasodilators. Through the treatment of hypoxia-induced PHT as well as postoperative hypoxia by proxy PHT, possible alternatives in treatment have been discovered. Results of the aforementioned treatments and patient interventions have been discussed in this paper. Medications discussed individually are MgSO4, ACE inhibitors, and alpha blockers as well as their implementation in therapeutic regimens. The conclusions drawn from those largely successful interventions lead to a proposal for the development of an alternative medication for the hypoxia-induced pulmonary hypertension that theoretically would prove to be as inexpensive as it would be effective. Bringing together the results of the aforementioned research, this medication would consist of MgSO4, ACE Inhibitors, and alpha blockers. It is inferred that a triple therapy of the three drugs would allow for synergistic effects and reduce the side effects to a minimum. The goal would be to develop a medication that can be used for all the communities where it is needed, regardless of their medical development or financial flexibility.
    Keywords: hypoxia induced pulmonary hypertension, high altitude pulmonary hypertension, MgSO4, alpha adrenoceptor blocker, ACE-I
  • Left atrial mass during angiography; myxoma or haemangioma? A case report
    Afsoon Fazlinezhad, Bentolhoda Panjalizadeh *, Ali Akbar Kamali Page 3
    Cardiac tumours are rare findings which can be manifested by different clinical features. Most of these tumours have similar imaging findings during the clinical work up of patients presenting with cardiac masses. Myxoma is a common tumour of the left atrium which also has less common differential diagnoses: haemangiomas and angiosarcomas. The final diagnosis of such a tumour is made by pathology studies. However, in some cases, surgery to reveal the exact nature of the mass is not possible. Imaging procedures, such as trans-oesophageal echocardiography and cardiac magnetic resonance imaging (MRI), are considered reliable methods for excluding differential diagnoses. In this report, we will discuss a case of a left atrial mass which was first diagnosed as myxoma in angiography. During further imaging work ups, a cardiac MRI assisted in determining the exact nature and location of the tumour. While myxoma is a common tumour of the left atrium, cardiologists should always consider haemangiomas as a differential diagnosis.
    Keywords: Heart Neoplasms, Magnetic Resonance Imaging, Angiography
  • Mohamad Abbasi Tashnizi, Seyed Hamid Hoseinikhah, Shadi Sarafan, Arash Akhavan Rezayat, Nahid Zirak * Pages 5-8
    Introduction
    Surgery in patients with severe calcification of the aorta, also known as “porcelain aorta”, is challenging for cardiac surgeons. In this study, we evaluated the efficacy of composite grafts in avoidance of aortic manipulation among patients with porcelain aorta undergoing coronary artery bypass grafting (CABG).
    Methods
    Ten patients among admitted ones for CABG over 3 years showed severe calcification of the aorta. We used a composite graft for revascularization of the target vessel without manipulation of the aorta. In patients with CAD and porcelain aorta, off-pump CABG was applied to avoid cannulation of the aorta. Moreover, a composite graft was used for internal mammary artery (unilateral/bilateral) to avoid partial clamping of the aorta.
    Results
    Among ten patients with the mean age of 72.5 years seven patients were male and 3 were female. The most common risk factors were diabetes (6 patients), hypertension (5 patients), smoking (5 patients), and hyperlipidemia. Four patients had the two-vessel disease, while the remaining had the six-vessel disease. In the intraoperative and postoperative periods, no hemodynamic instability was reported in any of the patients. Similarly, no ischemic complications due to femoral artery cannulation (lower limb ischemia) were reported. Based on the findings, no neurologic complications occurred in the early postoperative period and 12-month follow-up (causing no neurologic deficits). Postoperative evaluation of the grafts via computed tomography showed sufficient patency in all patients.
    Conclusion
    Coronary artery disease, concomitant with severe calcification of the aorta, is a challenging condition for cardiac surgeons, given the higher risk of atheroembolic events and serious morbidity. Although multiple techniques have been described for avoiding manipulation of the aorta in these patients, the composite graft technique may be a simple and safe procedure with reduced risk of cerebrovascular events due to atheroembolism.
    Keywords: Aortic disease, Porcelain aorta, Coronary artery bypass grafting (CABG)
  • Evaluating the Performance of Quality Improvement Team and their Effect on Service Efficacy Indices in Razavi Subspecialty Hospital
    Reza Saeidi *, Seyyed mojtaba Mirjalili , Morteza Shayeghi Rad , Seyyede Faeghe Mousavi Page 8
    Background
    Productivity is one of the main indices in development plans; therefore, the performance of quality improvement team in any hospital that is a step towards the Implementation of a comprehensive quality management may be considered as an appropriate management technique for development of human resources as well as promotion of the hospital efficacy.
    Objectives
    The current study is designed to evaluate the collaborative management method through the performance of quality improvement team in Razavi Hospital.
    Methods
    This study was carried out in Razavi Hospital, Mashhad during 2016 - 2018 focusing on establishment of a collaborative management system and its effect on the hospital service efficacy. It was an interventional and applied research. The target population included all the staff of Razavi Hospital who volunteered to participate the study, and took measures to promote the hospital efficiency after attending the related training workshops.
    Results
    According to the findings, the bed occupancy rate of Razavi Hospital increased from 59.5 percent in 2016 to 62 percent in 2017. Meanwhile, the patient's average length of stay decreased by 2 percent compared with the same period last year. The hospital bed turnover rate also increased from 86.3 times in 2016 to 121 times in 2017. Following the formation of quality improvement team and applying the optimal strategies and methods, especially in medical wards, it was revealed that the patient satisfaction had a significant increase in 2017 comparing to 2016. Furthermore, the job satisfaction (including job promotion, rules and regulations, colleagues, nature of the work, organizational communication and organizational goals) increased by 18.7 percent in 2017 in comparison with 2016 indicating the efficacy improvement at the hospital.
    Conclusion
    Formation of quality improvement team in Razavi Hospital and their activities have led to relative increase in the hospital management efficacy.
    Keywords: Collaborative management, Hospital management efficacy, Productivity
  • Nasrin Rafaee Saeedi, Ali Mashhadi *, Bahram, ali Ghanbari Hashemabad Pages 9-13
    Background
    Considering the importance of adolescence and in which identity formation occurs and effects of successful identity on adolescents Life expectancy, one common technique for reduction and resolving identity crisis is to use the reality therapy.
    Objectives
    The present study investigates the effectiveness of group reality therapy approach in reduction of personal identity crisis with emphasis on Life expectancy for the future.
    Materials & Methods
    This was a quasi-experimental study, which was carried out by pre-test and post-test with experimental and control group. The statistical population consisted of high school girl students of Mashhad in 2014-2015 educational years. Hefdahe-Shahrivar Girls’ High School was selected using convenience sampling method. From all grades of this high school, two first grades, one second grade and two third grades were randomly selected (totally 125 students). 22 students who answered the personal identity questionnaire and received the highest score, were divided into 2 groups of 11 (experimental and control) using random assignment. The experimental group received 10 sessions of 90-min group reality therapy, while the control group received no therapy. After the completion of therapy, both groups answered the personal identity questionnaire again.
    Results
    The results of ANCOVA test showed that group reality therapy led to reduction of identity crisis in the experimental group (01.0>p).
    Conclusion
    According to the findings, holding training workshops based on group reality therapy for high school students may reduce personal identity crisis with emphasis on Life expectancy for the future.
    Keywords: Reality therapy, Life expectancy, Group therapy, Identity crisis, control Group
  • Shabnam Mohammadi, Arya Hedjazi *, Maryam Sajjadian, Farhad Moghimian, Maryam Mohammadi Pages 14-18
    Background
    Kidneys play an important role in excertion of bodily waste and the regulation of water and electrolyte. Currently available sources and books are based on anthropometric characteristics from Western countries. Determining national anthropometric measurements is a research priority in Iran. Based on a recent search, no study has been done on the standard data of kidneys in the Iranian population. Therefore, the present study investigated the morphometrical characteristics of the kidney (length, width, thickness, index, and weight) in an Iranian population.
    Method
    This cross-sectional study was performed on 604 cadavers (122 females/ 482 males) with a mean age of 43.86 ± 19.09 years in Mashhad Forensic Medicine Center in 2015. After approval of the Ethical Committee, demographic characterizes of cadavers were recorded. Then, length, width, thickness, index and weight of kidney were measured using a vernier caliber. At the end, data were analyzed using SPSS software.
    Results
    The mean length of the kidney was 11.12 ± 1.73 cm, mean width was 5.09 ± 2.19 cm, mean thickness was 2.60 ± 1.39 cm, kidney index was 2.33 ± 1.62, and mean weight was 143.03 ± 52.97 g. No significant difference was seen in the morphometric values of the kidney between males and females (P>0.05), but a significant correlation was found between the age and body surface area of the cadavers and the length, width, thickness, index, and weight of the studied kidneys (P<0.05).
    Conclusions
    The investigation of the morphologic characteristics of kidney is useful for both surgeons and anatomists. Besides, it provides valuable data on standard kidney sizes in Iranian population.
    Keywords: kidney, cadaver, macroscopic anatomy, human, morphometry
  • Gholamhosein Zarifnejad, Mahbubeh Abdollahi, Fatemeh Zahra Karimi * Pages 19-23
    Backgrounds
    Due to the importance of empathy and its positive effect on the relationship between patient and health care providers, this study was conducted with aim to determine the level of empathy and its related factors among students of Nursing and Midwifery Faculty of Mashhad University of Medical Sciences in 2016.
    Methods
    In this cross-sectional study, 353 students from the Faculty of Nursing and Midwifery were selected by stratified random sampling. The data collection tool was the Persian version of Scale of Empathy- Health provider student version (SE-HPS) that the validity and reliability of the Persian version have been confirmed. Data was analyzed using SPSS software version 20.
    Results
    The mean total score of empathy among students was 102.76 ± 15.87. Among the 3 subscales of SE-HPS, the highest mean was related to the subscale of Perspective taking (53.41 ± 10.34). The mean scores of the subscales of Compassionate care and Standing in the patient’s shoes were 40.1 ± 7.71 and 9.24 ± 2.93, respectively. The results show that the mean score of empathy was in female students and those whose mothers had college education statistically significant higher. , The results of linear regression showed that gender, mother's education and field of study are the factors influencing empathy.
    Conclusion
    According to the results of the study about the amount of empathy among students and the role of empathy in improving the quality of service provider relationship with the patient, educational planning seems necessary to strengthen the empathy between students and patients.
    Keywords: Empathy, Caring, Compassion, Students, Patients
  • Mohammad Khajedaluee, Kolsum Deldar, Shahin Saeedinejat, Mohammad Saeid Sasan * Pages 24-29
    Background
    Influenza in infants and young children is a major medical problem which causes excess medical visits, antibiotic prescriptions and hospitalization even in otherwise healthy children. Many of the developed countries have recommended influenza vaccination for all children (>6month old), but the economic benefit of this strategy is not clear especially for developing countries.
    Objectives
    To find the difference in the incidence of influenza-like illness (ILI) and economic cost related to it between TIV vaccinated and non-vaccinated infants in Mashhad, Iran.
    Methods
    This was a community randomized controlled trial which was started in November 2005 and ended up at May 2006. Each of the study and control groups were composed of 500 infants between 6 month and 20 months old who were brought for routine vaccination. The study group was given two doses of TIV; the control group received routine care without any extra intervention. Both groups were followed by monthly telephone calls (up to six months after the vaccination) and were asked about signs and symptoms of flu like illnesses and any cost related to them. SPSS 11.5 was used for statistical analysis, P<0.05 is considered as statistically significant.
    Results
    There was no significant difference in the monthly occurrence of ILI between the vaccinated and non-vaccinated groups (P: 0.06- 0.97). The costs related to ILI were similar between vaccine and control groups, except for physicians visit cost in the third month, which was more in the control group (P<0.05).
    Conclusion
    In influenza season of 2005-06, TIV vaccination did not decrease the rate of influenza-like illnesses and was not cost saving in infants (6- 20 months old) in Mashhad.
    Keywords: Cost-effectiveness, Infants, Influenza, Iran, Vaccine
  • Kambiz Alizadeh, Masoomeh Tabari *, Zohreh Rouhandeh, Azra Izanloo Pages 35-37
    Background
    This paper intends to evaluate the effects of on-pump beating-heart coronary artery bypass graft (CABG) in patients with coronary artery disease. Studies have shown that this surgical procedure can have acceptable results.
    Methods
    We reported preliminary results related to mortality and morbidity in patients who underwent CABG in the period from 2015 to 2017 in Ghaem hospital, Mashhad, Iran.
    Results
    All patients underwent general anesthesia and on-pump beating-heart CABG surgery was done for them. The average number of grafts was 3.18± 0.474 and two patients died: one during surgery and one in ICU. There were no postoperative myocardial infarctions during the study. None of the patients reported kidney dysfunction. The average length of hospitalization was 4±1.11 days and the mean follow-up of the patients was 6 months. The average ejection fraction (EF) of patients was 43.38.28± 9.58.
    Conclusion
    In the period there was a big challenge between using off-pump CABG or on-pump CABG, on-pump beating method could present acceptable and effective results.
    Keywords: on-pump, off-pump, beating heart technique, high-risk, cardiovascular disease