Shiraz Emedical Journal
Volume:23 Issue: 1, Jan 2022

Procedural sedation (PS) plays an important role in facilitating emergency procedures. Dexmedetomidine is an alpha-adrenergic agonist which can play a role in this issue. This study aimed to systematically review the literature about the role of dexmedetomidine in PS in the emergency department (ED).

In this study, several databases, namely PubMed, Embase, Ovid, ProQuest, Scopus, Web of Science, and Cochrane Library, were searched since 1999 up to November 30, 2020. The inclusion criteria in this study were randomized clinical trials performed on ED patients using dexmedetomidine for PS and articles only in the English language. The exclusion criteria were the studies that were not clinical trials or were not performed in the ED, low-quality studies or animal studies.

A total of 473 articles were identified in this study. Five studies fulfilled the inclusion and exclusion criteria. Three articles studied the adult population. One study used dexmedetomidine in an intranasal way, and one study used an intramuscular route for drug administration.

Although the reviewed studies reported dexmedetomidine as a safe and effective agent for PS, there are not sufficient data on this issue. Therefore, it is required to perform further studies to a draw firmer conclusion.

Coronavirus disease 2019 (COVID-19) is a coronavirus outbreak caused by severe acute respiratory syndrome coronavirus 2 infection.

This study aimed to investigate the relationship between laboratory variables and COVID-19 severity.

A total of 731 confirmed cases were included in this study. Based on the clinical course of the disease, the patients were divided into non-severe (n = 599) and severe (n = 132) groups. The area under the curve was estimated for each of the significant predictive factors by the receiver operating characteristic curve. Youden’s index was used to determine the optimal cut-off points to predict the severity of COVID-19.

Out of 731 patients, 407 (55.56%) cases were male. The mean age value and age range of the patients were 58.37 and 1 - 98 years, respectively. The age (OR = 1.03, 95% CI: 1.02 - 1.05), international normalized ratio (INR) (OR = 2.09, 95% CI: 1.11 - 3.96), lactate dehydrogenase (LDH) (OR = 1.003, 95% CI: 1.001 - 1.1.003), and neutrophil/lymphocyte ratio (NLR) (OR = 1.08, 95% CI: 1.02 - 1.14) were associated with the severity of COVID-19 in the multivariate analyses. The areas under the curve of LDH, NLR, and INR for the diagnosis of disease severity were 0.76, 0.69, and 0.62, respectively.

The results of this study revealed that LDH, NLR, and INR could help to discriminate between non-severe and severe COVID-19 cases. Therefore, clinicians can use these variables to improve therapeutic effects and reduce disease severity.

Pregnancy and childbirth are sensitive and particular periods in women’s lives. Midwives play an essential role in ensuring mother’s and fetus’s health by the recognition of the needs and complexities of this period. Midwives increase the quality of care, gain the trust of pregnant women, communicate more effectively with them, and increase their satisfaction and cooperation by following the ethical principles and standards that express their professional commitment to society. Therefore, the awareness of the principles of professional ethics and adherence to the Charter of Patients’ Rights is a critical element of the midwife’s success in ensuring mother’s and neonate’s health. Therefore, monitoring the observance of these principles by midwives, similar to other health care providers, is essential to improve the quality of services and ultimately parturients’ satisfaction. For this purpose, it is necessary to have a valid and reliable tool to assess midwives’ professional ethics status.

In this study, a questionnaire was developed to assess this issue by parturients, who are primary stakeholders in this process.

This qualitative and quantitative study was performed to design a reliable and valid questionnaire evaluating midwives’ professional ethics by parturients. Based on the literature review and consultation with midwifery professors and staff, the initial questionnaire was prepared with 26 items. A survey of 15 experts evaluated the content and face validity ratio. The final questionnaire with 20 items was completed by 200 parturients hospitalized in Valiasr Hospital of Fasa University of Medical Sciences, Fars, Iran, within 2018 - 2019. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) assessed the construct validity. The reliability was confirmed by the determination of internal consistency.

The 26 items of the questionnaire defined in the first step were reduced to 20 items with a content validity ratio higher than 0.49 and a content validity index higher than 0.79. Using EFA and CFA, 20 items were included in two dimensions and confirmed. Its reliability was reported as 0.89 using Cronbach’s alpha.

This study aimed to design a valid and reliable questionnaire for the assessment of midwifery professional ethics in the delivery process. One strength of the present study, compared to those of mentioned studies, is performing both EFA and CFA. In this study, some goals of EFA consist of determining questionnaire dimensions, standardizing questionnaires, reducing the items (from variables to factors), and assessing homogeneity and discrimination in construct validity. The EFA is often used in the early stages of research to collect information about the interactions in a set of variables. The obtained results revealed that the designed questionnaire is a valid and reliable tool for the evaluation of midwifery professional ethics by parturients, which can be applied in other studies in Iran.

Adnexal mass is one of the most common gynecologic diseases among women of all ages.

In this cross-sectional study, we enrolled 126 patients with large adnexal masses (≥ 10 cm) managed by laparoscopic surgery during 2013 - 2020. The rates of intraoperative complications, conversion to open surgery, and incidence of cancer were assessed.

Mean mass size was 15.08 ± 5.03 in all participants without significant difference based on the tumor type (P = 0.624). Mean age and operation time were higher in the malignant type compared to the benign type (P < 0.001). Type of surgery and frequency of intraoperative complications were also different among patients with different tumor types (P < 0.001 and P = 0.816, respectively).

Our study showed that large adnexal tumors can be operated by laparoscopic approach, while the most important factor for increased surgical complications and duration was malignancy.

One of the complications of cesarean section (C/S) is related to the incision site. Considering the effectiveness of platelet–rich plasma (PRP) on healing of wounds and management of scars, the present study aimed to inquire the effect of PRP on the thickness and completeness of the uterine scar.

In a randomized double-blinded, placebo-controlled clinical trial, the women who underwent C/S from November 2019 to 2020 were included and randomized into two studied groups, including the control (n = 15) and intervention (n = 15) groups. In the intervention group, PRP, extracted from patients’ blood samples, was injected to the incision site (between decidua and myometrium), while the control group did not receive this treatment. The scar thickness of C/S as the primary outcome and postpartum hemorrhage as the secondary outcome were compared between the groups. Both groups were followed for 12 weeks.

The two groups (intervention and control) were not significantly different in terms of weight, height, BMI, age, parity, gravidity, duration of surgery, and blood hemoglobin (HB) level (P > 0.05). Comparison of scar characteristics showed the creation of a niche in the PRP group, which was almost one-fourth of that of the control group; a difference that was statistically significant (P = 0.002). The thickness of adjoining myometrium was comparable between the two groups. Mean uterine niche height in the intervention group was lower than in the control group, which was statistically significant (P = 0.048). The mean of residual myometrium thickness (RMT) in the intervention and control groups were 7.62 ± 0.95 and 5.6 ± 3.5 mm, respectively, a difference that was statistically significant (P < 0.001).

Local injection of PRP is an effective and viable measure for reducing the uterine niche; therefore, it is suggested to be included in the routine wound care of CS. Future studies are needed to confirm PRP efficacy in different settings.

Journal articles published by Iranian dental school faculty members have followed an upward trend Since 2000, based on: (1) the global growth rate; (2) the increase in the number of country’s dental schools and their relatively higher number of faculty members; and (3) the health ministry’s emphasis on research and scientific publications. Hence, it is important to keep ourselves up to date about the trend of scientific articles published by Iranian dental schools.

This study aimed to extract the number and quantitative value of articles authored by faculty members of Iranian dental schools that are indexed in three databases of SCOPUS, PubMed, and the Web of Science (WoS/ISI) from 2015 to 2019.

A five-year cross-sectional study was conducted on the above-mentioned databases, using a similar strategy for all databases. Words “Iran” and “dent*” were searched in affiliations. The obtained results were investigated in-depth. The details of search results were checked out one by one. Only those articles with at least one author genuinely affiliated to an Iranian dental school were included for further assessment. The “number of articles” authored by at least one author and those with the “first author” affiliated to an Iranian dental school were counted. Then, the “quantitative value” or share of each author was calculated by dividing one by the number of authors of the article. The three variables were compared among databases, dental schools, and study years.

A total of 3922, 2473, and 2345 articles were retrieved from SCOPUS, PubMed, and WoS, respectively. Concerning SCOPUS and WoS databased, all three study variables had an increasing trend from 2015 to 2018 but decreased in 2019. In PubMed, however, the decline started from the beginning of the study period.

The observed decline in the number of scientific papers produced or published at the end of the study period is worrying. The novel variable of “quantitative value” that was calculated in this study can be regarded as an appropriate and feasible indicator to determine the number of scientific papers published by individuals, dental schools, and the whole country’s dental research society, compared to other variables. Policymakers should rethink facilitating publication in accredited journals, especially those indexed in PubMed.

Cerebral palsy is a leading cause of disability among children, and most of these children depend on their care provider or parents all the time. Mothers of these children spend a great amount of time taking care of them, which could have adverse effects on their mental health.

The present study was conducted to investigate the impact of the continuous care model (CCM) on the mental health of mothers with children suffering from cerebral palsy.

This randomized clinical trial was performed among 80 mothers of hospitalized children with cerebral palsy. Subjects were randomly divided into the two groups of intervention and control. In the intervention group, the CCM was administered to the mothers up to eight weeks after discharge, and for the control group, only routine nursing education was provided to the mothers at hospital discharge. Before and one and eight weeks after the intervention, in both groups, the mothers' mental health was assessed using the General Health Questionnaire. Data were analyzed using SPSS version 21 through descriptive and inferential statistics.

The mean age of the mothers was 33.2 ± 2.1 years and 34.3 ± 2.2 years in the intervention and control groups, respectively. In the intervention group, the CCM had a positive effect on the mental health of mothers one and two months after discharge from hospital compared to before the intervention (P = 0.04, P = 0.02, respectively); however, in the control group, the mean score of mothers' mental health was decreased over time. No significant relationship was found between mental health and the demographic characteristics of the mothers (i.e., age, education, participation in any child caring programs, having anxiety, having any other children with cerebral palsy, and experiencing depression due to having a child with cerebral palsy) (P > 0.05).

The CCM had a positive effect on the mental health of mothers of children with cerebral palsy. Thus, this intervention might be useful, but further studies are needed about the cost effectiveness of this intervention and its long-term impact on a larger sample.

COVID-19 pandemic, which started in late 2019, has brought various ups and downs worldwide. Planned policies were highly useful in the first wave of the COVID-19 pandemic in Iran. However, due to several reasons, the country faced the second wave.

The current study aimed to compare patients’ features in the first two waves of the COVID-19 pandemic in the city of Tehran, Iran.

Following a retrospective, cross-sectional design, the current study was carried out on 5000 suspected/confirmed COVID-19 cases who were randomly selected from all cases transferred by ambulance to hospitals located in the city of Tehran. The first wave of the COVID-19 epidemic was from February 20 to May 04, 2020, and the second wave was from May 05 to August 05, 2020. Data for both waves, were collected using a researcher-made checklist.

In this study, data of 5000 suspected/confirmed COVID-19 cases were analyzed (2773 cases belonged to the first wave and 2227 to the second one). The older mean age of patients (P < 0.001), the frequency of cigarette smoking (P < 0.001), opium abuse (P = 0.004), and the presence of underlying diseases (P < 0.05) were more frequent in the second wave than in the first one. The notable finding in this study was the significant increase of non-respiratory symptoms of patients in the second wave. The number of cases who reported close contact with COVID-19 patients was higher in the second wave. Also, hypoxia, intubation during the hospital stay, length of hospitalization, and mortality rates were significantly lower in the second wave. During the second wave, the odd ratio of positive findings in lung CT-scan was 3.4 times more (95% confidence interval: 2.51 to 4.55) compared to the first wave (P < 0.001).

This study demonstrated considerable differences between the first and second waves of the COVID-19 pandemic concerning the patients’ features.

Breaking bad news to patients is an unpleasant process, but it is essential for the medical team, which is giving information about a person’s illness; without proper planning, it leads to a negative impact on people’s feelings and quality of life. Cultural differences can be effective in telling bad news.

This study aimed to identify the attitudes of physicians, patients, and patients’ families towards breaking bad medical news.

This cross-sectional study was performed among physicians, patients, and their families referred to Namazi Hospital, Shiraz, Iran, during 2016 - 2017. Their attitudes regarding how to tell bad news were evaluated by self-administrated questionnaires.

A total of 397 valid questionnaires completed by physicians, patients, and their families were analyzed in this study. All groups of participants preferred telling bad news to patients about the diagnosis of their disease; they also believed that in the case of a patient’s dissatisfaction, this information should not be given to other family members. Patients’ family members would rather tell lies to the patient about their diagnosis.

There is a tendency towards not telling bad news in Iranian culture; Iranian people tend to protect those around them, and the desire to give bad news to those around them is lower than the tendency to hear bad news about one’s own illness. With increasing education, the tendency to telling bad news increases.

Coronavirus disease 2019 (COVID-19) pandemic has had a great impact on reducing organ transplantation activities.

The aim of this study was to determine the donation and transplantation activities before and after COVID-19 outbreak in Iran.

This retrospective study compared the donation and transplantation activities in two specific 9-month periods (Average period of March - Dec 2018-2019 Vs. March - Dec 2020). The questionnaire included the numbers of brain death confirmations, family consents, organ recoveries, and transplanted solid organs. The questionnaire was sent by email to the chief executive of the organ procurement unit.

A total of 15 organ procurement units responded to the survey. The largest reduction was seen in tissue transplantations (62.5%) during two time intervals. Brain death due to head trauma significantly decreased in two time intervals and suicide increased by 14.44% during the COVID-19 pandemic compared to 2018-2019 period. Significant reductions between the median of donation (P = 0.0187), median of potential donor (P = 0.005), median of family consent (P = 0.002), and median of eligible donor (P = 0.009) were observed during the two time periods.

A significant reduction was observed in organ donation and transplantation during COVID-19 pandemic. Developing protocols and establishing new strategies for evaluation of organ donation to ensure the safety of organ recipients and medical staff is necessary.