Iranian Red Crescent Medical Journal
Volume:23 Issue: 9, Sep 2021

Patients undergoing on-pump cardiac surgery are at risk of postoperative acute kidney injury (AKI). This is mainly due to some ischemic events and also pre-and postoperative stress responses which can result in postoperative organ dysfunction. Selenium (Se) as an antioxidant may help reduce inflammation and subsequent related complications. This study aimed to test if administration of oral Se complement before and after the on-pump cardiac surgery can reduce the incidence or severity of AKI following the operation.

In this randomized double-blind trial, the patients who were a candidate for on-pump cardiac surgery were randomly divided into two groups of intervention and control who received Se (n=60) or nothing (n=60), respectively. In the Se group, 500 µg of Se was administrated orally 14 and 2 h before surgery and every 12 h postoperatively for 2 days (overall 3000 µg), while the control group only received the routine and standard care. The patients were closely observed for the incidence and severity of postoperative AKI, using both Risk/Injury/Failure/Loss/End-stage (RIFLE) and the Acute Kidney Injury Network (AKIN) criteria.

The study sample included 46 (38.3%) males and 74 (61.7%) females with a mean±SD age of 52.8±16.7 years. Both groups were similar in terms of demographic characteristics, comorbidities, and Euro-SCORE. According to the RIFLE criteria, AKI occurred in 11 (17.9%) and 13 (21.4%) patients in the Se and control group, respectively. However, based on AKIN criteria, there were 17 (28.6%) and 21 (35.7%) cases of AKI in the Se and the control group, respectively (P=0.73). The most frequent stage of AKI among patients was the first stage in both groups and the highest rate of AKI was observed within 3-4 days after the surgery in both groups.

The obtained results did not approve the effect of Se in AKI prevention in coronary artery bypass grafting patients.

To investigate the relationship between creatine kinase (CK) and major bleeding in non-ST-segment elevation acute coronary syndrome (NSTE-ACS) patients during hospitalization, and to analyze the predictive value of CK for major bleeding in NSTE-ACS patients during treatment.

A total of 1469 NSTE-ACS patients admitted to our hospital from January 2017 to December 2019 were collected, including 1024 unstable angina pectoris patients and 445 non-ST-segment elevation myocardial infarction patients. Plasma CK and hemoglobin concentrations were measured after admission. The patients were divided into major bleeding group (n=31) and non-major bleeding group (n=1438) according to Thrombolysis In Myocardial Ischemia bleeding classification standard, and they were given routine treatment.

During the treatment period, major bleeding occurred in 31 of 1469 NSTE-ACS patients, accounting for 2.11%. CK value in major bleeding group was higher than that in non-major bleeding group (P<0.001). According to the quartile, CK was divided into groups Q1-Q4, and the incidence of major bleeding in group Q4 was higher than that of the other three groups (P<0.001). Plasma CK was positively correlated with major bleeding in NSTE-ACS patients (r=0.59, P<0.001). Receiver operating characteristic curve analysis showed that the area under the curve of baseline CK value was 0.793 (SE=0.062, P=0.001, 95％CI 0.711-0.872) in NSTE-ACS patients during treatment.

CK was associated with major bleeding in NSTE-ACS patients.

Wound repair cause extra pain and inflammation and can lead to post-repair discomfort in patients. Previous studies have indicated that pre-operative use of NSAIDs may reduce post-surgery pain; however, there is a dearth of data on traumatic wound repair.

This study aimed to investigate the effect of intravenous Ibuprofen on patient satisfaction and pain relief following wound repair.

Based on the inclusion and exclusion criteria, 194 participants in this double-blind randomized controlled trial were randomly assigned toeither intervention or control group. Ibuprofen 800 mg was infused in 100 cc normal saline before wound repair in the intervention group, while the control group received 100 cc normal saline. Numeric pain scores were recorded at the beginningof wound repair and 30 min after that. Patients’ satisfaction with analgesia was also recorded 15 min after the drug infusion, during wound repair, and 6 h after the wound repair.

Mean pain scores were similar in both groups during the wound repair, and before the application of local anesthesia (i.e. lidocaine). However,the mean pain score was significantly lower in patients who received Ibuprofen (3.86±1.93), compared to the control group (4.46±1.89), 30 min after the wound repair (P=0.043). Patients’ satisfaction with pain management 6 h after the wound repair was higher in the intervention (P=0.000), compared to the control group.

Based on the obtained results, the application of IV Ibuprofen before the wound repair can reduce pain score afterthe wound repair and lead to improved patients' satisfaction.

Orthopedic and vascular trauma can be clinically observed and have negative consequences if not treated appropriately. This study aimed to present the clinical experiences of the authors regarding vascular traumas in combination with extremity fractures or dislocations.

In total, 95 patients (78 males, 17 females, with the mean age of 34.7±5.6 years old) who underwent surgical treatment for combined orthopedic and vascular trauma between November 2012 and February 2020 were included in the study. Patients were retrospectively evaluated according to their clinical properties, treatment strategies, and results.

Traffic accidents were the most common reason for trauma with a rate of 36.8% (n=35). The most common orthopedic injury was seen in the femur, whereas the most common vascular injury was on the superficial femoral artery. The most commonly performed treatment methods for vascular and orthopedic trauma were primary repair and external fixation, respectively. Based on findings, the mortality and amputation rates were 2.1% (n=2) and 15.7% (n=15), respectively.

Combined orthopedic vascular traumas are less frequent than isolated vascular traumas, but they have higher mortality and amputation rates. In order to decrease mortality and amputation rates, communication should be perfectly coordinated between the emergency department and orthopedic and cardiovascular surgery clinics; moreover, urgent intervention is crucial.

Convalescent plasma (CP) transfusion is one of the suggested treatments for Coronavirus disease 2019 (COVID-19) especially in critically ill patients.

This study aimed to investigate the efficacy and safety of CP transfusion were investigated in severe/critically ill COVID-19 patients.

This study was performed on 50 consecutive COVID-19 patients with severe/critically ill disease. Severe disease was defined as having at least one of the following symptoms: shortness of breath, respiratory frequency ≥ 20/min, blood oxygen saturation ≤ 93%, partial pressure of arterial oxygen to fraction of inspired oxygen ratio < 300, lung infiltrates > 50% within the last 24-48 h.Critically ill disease was identified by intensive careunit admission,respiratory failure, septic shock, or multiple organ dysfunction or failure. Primary outcomes included the safety of CP transfusion, 14-day and 30-day survival rate, and change in lung computed tomography (CT) scan score. Several other clinical and laboratory features were evaluated as the secondary outcomes.

Based on the results, 21 out of 50 consecutive patients were on mechanical ventilation at the time of CP transfusion. In total, 32 patients (64%) survived 30 days after CP transfusion. The survival rates were 74% and 44% in patients who received CP < 7 and ≥ 7 days after admission, respectively. While 92% of patients without mechanical ventilation survived, the survival rate of patients on mechanical ventilation was 29%. Moreover, the CT scan score and some other clinical features were improved inthe group that received CP transfusion, and no adverse effects were observed.

The CP transfusion is a safe and effective treatment in severe/critically ill COVID-19 patients. The best outcome can be achieved in patients who are not on mechanical ventilation, especially early in the disease course.

Coronavirus disease 2019 (COVID-19) has become a global health challenge with high transmission and mortality rates.

This study aimed to identify the risk factors for mortality in hospitalized patients with COVID-19 in Behbahan, Southwestern of Iran.

In this cross-sectional study, information of 800 patients with COVID-19 admitted to Shahidzadeh Hospital in Behbahan, Southwest of Iran, were investigated from March 20, 2020, to January 20, 2021. Subsequently, the demographic characteristics,clinical symptoms, vital signs, pharmacotherapy, laboratory findings, and the patients' underlying diseases were extracted from their medical records. Multivariable Cox regression with proportional hazard assumption was used to investigate the risk factors of death.

The present study included 800 patients with COVID-19 with a mean age of 57.51±16.83 years at the time of diagnosis. Overall, 447 (55.8%) male and 353 (44.1%) female patients were included in this study, respectively. Among the total patients, 116 (14.5%) and 684 (85.5%) cases died and recovered, respectively.Based on the multivariable Cox regression analysis, age (HR=1.04; 95% CI: 1.03-1.05; P<0.001), cardiovascular diseases (HR=2.46; 95% CI: 1.63-3.70; P<0.001), and renal failure (HR=2.77; 95% CI:1.43-534; P<0.001) were found to be associated with the death hazard in patients with COVID-19.

According to the findings of this study, the patient's age at the time of diagnosis, cardiovascular diseases, and renal failure were indicated to be the risk factors of high mortality rate in patients with COVID-19. Identification of these risk factors can be helpful in the timely intervention of patients at high risk of death for health care providers.

Refugees may have problems in recognizing their illnesses and accessing treatment due to communication and sociocultural factors.

This study aimed to present whether there was a difference in complicated appendicitis rates between Turkish and refugee patients.

A total of 563 patients who underwent appendectomy surgery in our hospital between September 2018 and June 2020 and met the study criteria were examined in this study. The patients were divided into two groups of Turkish (Group 1) and refugee (Group 2) patients. The demographic, clinical, and histopathological characteristics of the patients were compared in this study.

Groups 1 and 2 consisted of 489 (86.9%) and 74 (13.1%) patients, respectively. Moreover, there were 278 (56.9%) and 36 (48.6%) male patients in Groups 1 and 2, respectively. The median age of all patients was obtained at28 (age range: 18-81 years), and the median (interquartile range ages of the Turkish and refugee patients were estimated at 28 (age range: 23-36) and 27 (age range 21-36) years, respectively. Perforated appendix detection rate, open appendectomy ratio, preoperative C-reactive protein level, histopathological gangrenous or perforated appendicitis ratio, and postoperative hospital stay length were found higher in the refugee patients (P<0.05).

Refugee patients are intense in countries, such as Turkey. It is believed that general surgery specialists should consider the possibility of complicated appendicitis in refugee patients scheduled for surgery for acute appendicitis.

Due to the outbreak of coronavirus disease 2019 (COVID-19), applying telehealth and telemedicine to prevent the spread of the disease is inevitable.

Therefore, this study aimed to investigate the application of telehealth and telemedicine in the human coronavirus epidemic.

The systematic search was conducted using Medline (through PubMed), Scopus, and ISI Web of Science to identify relevant studies published until June 10, 2020. The inclusion criteria were the usage of telemedicine and telehealth as healthcare servicesduring COVID-19, severe acute respiratory syndrome (SARS), or Middle East respiratory syndromeepidemics.This review was performed according to the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

In total, 598 articles were identified after the removal of the duplicates. After the systematic screening, 18 studies met the inclusion criteria.The analysis showed that only one study was related to SARS, and the rest were on COVID-19 disease. Teleconsultation and televisit were more prevalent (55.6%) than the other types of telemedicine services. The most mentioned obstacles were access to suitable technologies and lack of assessment or follow-up to achieve outcomes.

The results indicated that telehealth and telemedicine could have advantages, such as prevention of the spread of COVID-19, reduction of the healthcare burden, and maintenance of appropriate patient care. In addition to these benefits, several limitations and obstacles, including organizational, technological, and patient-related barriers, may be encountered. Hence, it is better to consider the necessary arrangements before implementing telemedicine.

Fabrication of a prosthesis for people who lose an eye and parts of their cheekbones and nasal tissues is a challenge. The prosthesis suspension is a significant problem due to the open nasal cavity and the vast lesion area on the face.

The present case report describes the application of a new suspension technique for a maxillofacial prosthesis on a person with an exenterated left eye. Moreover, parts of the patient’s maxillary and frontal sinuses had been as well removed due to infection. The conventional methods for suspending the prosthesis (i.e., anatomical, mechanical, chemical, and surgical methods) could not be used due to the fact that the patient’s sinus and nasal cavities were exposed. Therefore, a new prosthetic suspension technique was used to solve this problem.

In this clinical report, an optimal and effective method was adopted to make a prosthesis that can be used in similar cases of eye loss and extensive loss of the face. This new method does not need the application of adhesives and minimizes the donning and doffing time of the prosthesis.

Since late 2019, the outbreak of COVID-19 has rapidly spread worldwide. Due to the novelty unknown of this disease, manyof its manifestations are in an aura of ambiguity. We describe a Cardiac involvement of this disease that presented with a complete atrioventricular block in a child.