مجله سازمان نظام پزشکی جمهوری اسلامی ایران
سال سی و هشتم شماره 2 (پیاپی 150، تابستان 1399)

This study aimed to provide an evidence-based guideline for the clinical management of febrile neutropenia in children with cancer. In this narrative review, the most recently published sources of information on febrile neutropenia consisting of textbooks and articles, have been reviewed. We focused on the more recent data about diagnosis, treatment and management in children through the use of the MeSH-term words “pediatric patient”, “febrile neutropenia”, “hematologic malignancies”, in Google Scholar, PubMed, Ovid and Science Direct. Meanwhile, our search was not restricted to this particular strategy; we also tried to find all of the most recent available data in the field. Step-by-step recommendations including risk assessment, diagnostic approaches and therapeutic guidelines have been provided in this review. Although the incidence and severity of febrile neutropenia and its complications are inversely proportional to the absolute neutrophil count, it is still possible to determine the risk and categorize patients into high-risk and low-risk groups. Besides, even in high-risk patients, those who are more suspected of severe sepsis also could be identified by well-designed predictor models. This guideline has attempted to provide an evidence-based approach in children with cancer who had fever and neutropenia based on the latest validated reports to be used as a helpful strategy for better management of broad-spectrum antibiotics and resources. This study has provided useful diagnostic and therapeutic guidelines for the management of children with fever and neutropenia, although, in some situations, attention to local epidemiological and bacteriologic data and also further validation of suggested guidelines may still be required.

Severe acute respiratory syndrome coronavirus-2 has led to a widespread pandemic whose spread is astonishing, its treatment is uncertain, mortality is significant, and associated socioeconomic complications are uncontrollable. Although little is known about the pathogenesis of the disease, severe cases of COVID-19 are usually associated with cytokine release syndrome and high serum levels of inflammatory cytokines, which are thought to be the leading cause of death in these patients. Different pathways cause inflammation and the release of cytokines, one of which is the Bruton Tyrosine Kinase (BTK) pathway, which is important for the production of several anti-inflammatory cytokines. Theoretically, inhibition of BTK signaling could reduce cytokine levels and subsequent anti-inflammatory effects. The purpose of this review article is to investigate the role of BTK in the pathogenesis of COVID-19 disease and the possible effects of its inhibitory drugs in the treatment of this disease.

The efficacy of glutamine and Curcumin consumption and their synergistic effect on muscle damage recovery over five days is not clear yet. The purpose of this study was to compare the effect of these two supplements and their synergistic effect on serum markers of muscle damage and muscular pain perception after an eccentric exercise session.

Forty non-athlete young men were randomly divided into four groups. Each group received a supplement or placebo for five days, group 1: glutamine [Gln 0.1 gr⁄(Kg/day)], group 2: curcumin (Cur 1000  mg/day), Group 3: glutamine [Gln 0.1 gr⁄(Kg/day)] + curcumin (Cur 1000  mg/day) and group 4: maltodextrin [Pla 0.1  gr⁄(Kg/day)] as placebo. The last supplement was taken 8 hours before eccentric exercise. Measurements were taken before the resistance exercise and, 24 and 48 hours after. Serum Creatine Kinase (CK) and Lactate Dehydrogenase (LDH) were measured using photometric method and muscle pain measured using standard pain scale. The resistance exercise included leg press with 70% of 1RM.

There was a significant decrease in serum CK and LDH and muscle soreness in curcumin group and glutamine + curcumin group compared to the placebo group at all times (P<0.05). There was no significant difference in glutamine group compared to the placebo group, and glutamine + curcumin group had no significant difference compared to the curcumin group.

According to the results of this study, it seems that consumption of curcumin for five days can decrease some of the indices of muscle damage and also muscle pain after an eccentric exercise, but consumption of glutamine along with curcumin had no significant effect on muscle damage indices compared to the curcumin only. Therefore, these nutrients have no synergistic effect.

Labor pain causes severe maternal anxiety that ultimately leads to abnormal uterine contractions and interference with optimal delivery process. The purpose of the present study was to investigate the efficacy of “Pharmacological and Non-Pharmaceutical” pain reduction training and spouse training on labor anxiety in pregnant women.

The research method was quasi-experimental (pre-test and post-test) with control group. The study population included all pregnant women who were in late second trimester or early third trimester and had anxiety according to Hartmann labor anxiety questionnaire. Among study population referring to health centers in Tehran, 80 subjects were selected by convenient sampling and were randomly assigned into experimental and control groups. Research data were collected by Hartmann Labor Anxiety Inventory. The experimental group received 2 sessions of 90-minute of pain reduction training and spouse training during pregnancy. During the two training sessions, pregnant women`s husbands were physically present. However, the control group did not receive any training and continued to go through normal pregnancy and childbirth process. Data were analyzed by covariance analysis through SPSS software.

The results showed that pain reduction training and spouse training was effective in decreasing anxiety in pregnant women, encouraging them to attempt vaginal delivery. The mean score of labor anxiety in experimental group was lower than the control group after the intervention, and the difference was statistically significant (P >0.001).

Pain reduction training and spouse training during pregnancy can be used by specialists as an educational approach to reduce the anxiety of pregnant women, drive them to prefer vaginal delivery rather than cesarean section, and help the mothers create a suitable environment for development of children mental health services.

Cardiopulmonary exercise testing (CPET) is a widely applied clinical procedure. The aim of the present study was to acquire a comprehensive set of reference values for cardiopulmonary responses to exercise and to evaluate the possible associations with sex, age and body mass index (BMI).

From files of 3,992 CEPT performed in the hospital during six years, 102 files of healthy individuals were selected from our laboratory. Athletes, patients with any known pathology, users on continuous medication and obese patients were excluded. Peak VO2 was considered max VO2. Analysis of essential parameters like the anaerobic threshold VO2, maximum ventilation and oxygen pulse according to sex, age, sedentary and active patients were carried out.

For this study 102 participants were enrolled. 32% of participants were woman and 68% of them were man. The Mean ±SD of the age was 36±12. Mean±SD of HR, HRR, O2Pulse, VO2max, VO2/kg, VCO2 and AT were 90±6, 18±11, 12±3, 1.93±0.59, 24.84±7.15, 2.29±0.71 and 1.15±0.49, respectively.
Multiple linear regression analysis was done for height, weight and age and no difference was detected between males and females.

CPET in Iran is usually performed according to the standards of foreign countries and the results are interpreted mainly based on ATS reference values. Considering the ethnic, geographical and behavioral differences between Iranians and people of other nationalities, a new definition for normal values of CPET in Iran seems necessary.

Documenting medical records plays an important role in treatment and prevention. The purpose of this study was to evaluate the impact of the presence of health information technology experts in clinical wards on the documentation of hospital admissions files.

In this descriptive cross-sectional study, 96 inpatient records in 2014 and 96 inpatient records in Fatemeh Zahra Hospital in Sari were reviewed. Data were collected based on a checklist based on the layout of the data elements in the four main admission sheets, file summary, history and course of the disease. Data entry was defined with yes value of one, no value of zero and no use value of 2. Overall evaluation of the documentation rate was considered as 95-100% “good”, 75-94% moderate and below 75% poor. Using the sample size formula, 192 files were analyzed in a multi-stage (i.e. simple random and stratified) manner. Data were analyzed by SPSS 21 software.

The results showed that the total registration of all four forms in 2013 was about 51.01% and in 2017 was 62.92%. The impact of information technology on the process of admission forms, file summary, history and course of illness was 88.25, 85.63, 31.09, and 84.30% in the middle class, respectively. Among the data categories, the highest mean of authentication was recorded (91.7%) in four forms.

Documentation rate after recruitment of health information technology experts in clinical wards increased by 11.91%. In order to achieve a good situation of recruiting trained personnel in clinical wards of hospitals, it is necessary to create a suitable framework for implementation and development of information technology in order to achieve maximum efficiency in health systems.

Cardiovascular diseases are one of the most common chronic illnesses. Despite the advancement in the management of heart failure, it still remains as one of the most important causes of mortality and morbidity. Anemia is a common finding in heart failure patients and decreases both life quality and bodily function in this group of patients. It is also related with high mortality and morbidity. The aim of the present study was to determine the ferritin levels in heart failure patients.

This cross-sectional study was conducted on heart failure patients admitted in Ganjavian Hospital, Ahvaz, Iran. Sampling was done by census method for three months duration (July-Sept 2019) and finally a total of 100 patients were recruited. Serum ferritin (ELISA), iron level and Total iron binding capacity (TIBC) was measured in all of the patients. Iron and TIBC were measured with Autoanalizer.

Of the 100 patients, 34% were females and 66% were males. Mean age was 65.21 yrs. 49 patients had severe decrease in EF , while 51 had moderate decrease in EF. Based on EF, t-test showed significant statistical difference in regard to age and ferritin between the two groups (p<0.05), while other variables did not show significant difference.Correlation coefficient of variables in regard to patientchr('39')s age with BUN and Creatinine (p<0.05), BUN with Creatinine and serum ferritin (p<0.001), sodium and serum iron (p<0.05), and ESR with TIBC and CRP (p<0.05) demonstrated positive correlation. While a negative correlation was observed in cases of serum sodium and potassium (p<0.001), ESR and serum iron (p<0.05), and TIBC and ferritin (p<0.001). No other significant correlation was found among other variables (p>0.05).

Results did not show significant relation between serum ferritin level with disease severity and complications. Thus, further studies are needed to prove the role of f ferritin as an independent risk factor in developing heart failure.