Journal of Iranian Medical Council
Volume:7 Issue: 3, Summer 2024

After the imposed war, Iran’s ranking in number of publications and citations, especially compared to Iran’s traditional competitor, Turkey, was not acceptable. Several approaches were used to surpass Turkey beginning in 2010 based on Scopus data and again in 2017 based on Clarivate Analytics data (1-3) (Figure 1).1. Increasing share of research funding from the GDP.2. Establishing and equipping research canters.  3. Revising policies to promote academic staff and successfully graduating students.4. Increasing postgraduate education programs.5. Awarding scholarships to students to study in postgraduate programs abroad.6. Increasing number of Iranian scientific journals indexed in Clarivate Analytics, Scopus and PubMed.7. Development of international relations.8. Meritocracy in scientific environments.9. Increasing salaries of academic staff members to accommodate for inflation.10. Most importantly, encouraging hope for the future and attracting young and elite professionals to Iran.Unfortunately, since 2021, due to economic problems in Iran and decrease in share of research funds from the GDP, as well as changes in the above-mentioned 10 approaches, we first lost our position in the Clarivate Analytics and then in Scopus. Turkey has surpassed Iran, and Saudi Arabia is developing scientifically due to proper investments. If we want to return to path of development, we must first invest in basic sciences. With our average research grants for basic science projects, we can no longer compete at any level in the world. Let’s think of a solution to attract young and elite graduates. There is no doubt that increasing income of academic staff members, especially in basic sciences, will help improve scientific development of Iran. For development of research in clinical fields, other solutions are needed, such as restarting MD-PhD programs and recruiting basic science faculty members in clinical departments. Comprehensive research training in the residency curriculum, recruitment of academic staff with research experience to clinical departments, development of biobanks, disease registry studies and cohort studies are just some of the steps we can initiate.

 Current therapies for depression are moderately effective, as response and remission rates were reported at 50% and 15-40%, following the first trial with current medications, respectively, and electroconvulsive therapy is not beneficial for more than half of the resistant patients. Recent research suggests that medication with glutamatergic modulatory properties may have antidepressant effects and would be of benefit to refractory patients. This study aims to review the efficacy of these medications in the treatment of unipolar depression. Ketamine, as the leading drug acting through the glutamatergic system, appears to be effective in treating depression IV and orally and in combination with electroconvulsive therapy. There is also clinical evidence of the promising effects of amantadine and lanicemine. Supplements and herbs such as L-carnosine, Crocus sativus (saffron), and Cinnamomum tamala, which were reported to be effective in randomized controlled trials on patients with depression, may act through this system as an antidepressant. Taken together, glutamate receptor modulators are alternative drugs for patients with resistant depression. Further high-quality clinical studies are recommended.

 Islamic Republic of Iran has provided a legal framework for embryo transfer so that fertility becomes possible with third party intervention. The use of this method of fertility as well as its effects and rules are subject to cultural, social and religious factors. The brief nature of the embryo donation law indicates the lack of adequate measures for the child’s future. The present study aimed to review the embryo donation law in Iran and some challenges in determining the rights of the child. This study employed a library, descriptive and analytical method and is based on Shia jurisprudence and law books. By using the keywords of “Donation, Alimony, Custody, and Inheritance”, various aspects of the embryo donation law have been investigated. Article 3 of the Embryo Donation Law considers the duties and responsibilities of the couples who donate the embryo and the born child in terms of maintenance, alimony and being mahram (. An unmarriageable kin in Islamic Sharia legal terminology), similar to the duties and responsibilities of children and parents. However, the important issues of lineage and inheritance are not considered. Neither it elaborates compliance with the principle of confidentiality and the non-identification of the genetic parents, the coercive guardianship of the father, and the prohibition of marriage (being mahram). There is neither enough clarity about the method of evaluating the recipient couple’s moral competence, the limit of the number of gamete donations, alimony, or custody. It is necessary to explain the kinship and genetic inheritance, amend birth certificate registration law, specify the rejection of anonymity to prevent the phenomenon of mixing lineage based on Shia jurisprudence, or to add new materials to this law.

There is still disagreement about the prevalence and incidence of dysphagia in Parkinson’s Disease (PD). Since the prevalence of dysphagia has been reported very differently in the related literature, it is imperative to estimate pooled prevalence in PD patients. Thus, we conducted a systematic review and meta-analysis to estimate the pooled prevalence of dysphagia in PD overall and separately for each assessment method (subjective and objective). 

These databases were searched: ScopusPubMed Web of Science ,and Google Scholar, January 1990 to October 2021. A random-effects model was used to pool the prevalence rates reported in the included studies by the Comprehensive Meta-Analysis (CMA( software .All designs of the studies were included. 

Thirty-nine articles entered the current meta-analysis. The global estimation of the overall prevalence of dysphagia in PD patients was 50.4% )95%CI:42.2-58.6) in all the 39 studies, which proved statistically heterogeneous (p<0.001). Moreover, the pooled prevalence by the subjective (30 studies) and objective (19 studies) methods of assessment were estimated to be 39.5 and 68.8%, respectively. There was also a significant relationship between the prevalence of dysphagia and age of Parkinson’s patients )r=0.44, p=0.011) and also between the prevalence of dysphagia and the duration of PD (r=0.55, p=0.006). 

Based on the results, one in two patients with PD has dysphagia. This is proven that dysphagia is common in PD. The prevalence of objective dysphagia and subjective dysphasia were very different. It suggests that all Parkinson’s patients should be evaluated for swallowing disorders regularly with objective tools.

It is well known that disclosure of Medical Errors (MEs) is the duty of physicians and it is the right of patients to be aware of any error occurring in their medical care process. This study was planned to asses to what extent the patients expect to be informed of the occurrence of MEs, they prefer who reports the medical error to them, and what are the influential factors in taking legal action against physicians in disclosed MEs from their point of view.

In this cross-sectional study, eligible patients admitted to academic hospitals of Guilan (Poorsina; Razi; Alzahra; Amir Al-Momenin; Dr. Heshmat), were interviewed directly and a questionnaire which was divided into four sections was filled out. The first part was about socio-demographic data of the responders and the next three sections included their preferences towards the type of MEs to be disclosed, who is responsible for this task, and in which conditions they sue against the medical team.

About 96.6% of the patients believed that MEs had to be disclosed to the patients. Moreover, 29.3% preferred to be informed about all MEs that occurred during their medical care even if it caused no harm. 51.1% expected that physician who committed the error informs the error. On the whole age, gender, employment status, residency and education were among the influential factors of the patients’ willingness and point of view and filing a lawsuit against physicians. 

Based on the findings of this study, it is recommended that all minor and major MEs should be disclosed sympathetically by the physician who committed the error.

The development of societies relies on the type and manner of activities performed at universities. Professors play a pivotal role in the development of universities and societies. Assessment of professors’ motivation and behavior and factors affecting them can improve the educational system and increase its performance. This study aimed to assess the validity and reliability of the Physician Teaching Motivation Questionnaire (PTMQ) from the viewpoint of clinical professors at Iran University of Medical Sciences (IUMS).

This is an instrument psychometric study in which the questionnaire’s validity was determined through the face and content validity and its construct validity through exploratory and confirmatory factor analysis. Reliability was determined through the calculation of Cronbach’s alpha and intraclass correlation coefficient and consistency between agreers. The data were analyzed in SPSS 23 and LISREL 8.8.

The results showed that all 18 items had acceptable content validity (0.68-0.97). The Cronbach’s alpha and intraclass correlation coefficients were 0.81 and 0.86, respectively. The number of items remained unchanged at 18 according to exploratory factor analysis which classified them into six categories (intrinsic motivation, identified motivation, introjected motivation, career motivation, external motivation, and teaching assistant motivation) and explained 54% of the total variance of the mentioned variables. Also, the value of CFI was equal to 0.93 and the value of Cohen’s kappa was between 0.77 and 0.84.

The Persian version of PTMQ is a valid and reliable instrument that can be used for research, educational, and practical purposes to evaluate the teaching motivation of clinical professors in other groups.

Despite the breadth and diversity of physiotherapy healthcare services, the entry of physiotherapists into the field of prevention and also direct access of physiotherapists to patients in the world for 10 years ago, Iranian physiotherapists have not had direct access to clients, yet. One way to overcome the current situation and move towards the growth and development of the profession is to identify the opportunities and threats of the field. The purpose of this study is to explain the obstacles to the professional development of physiotherapy from the point of view of graduates of this field. 

In a qualitative study of the content analysis type, the experiences of 12 physiotherapy scholars in three levels of study, bachelor’s, master’s and doctorate were obtained through a structured and semi-in-depth face-to-face interview. Simultaneously, as the data was collected, the data was analyzed based on Granheim and Ludman’s content analysis method.

A total of 28 codes were extracted to explain the obstacles to the development of physiotherapy in Iran, which include “low attention to professional ethics”, “inefficient policies of the Ministry of Health, Treatment and Medical Education” and “traditional teaching methods”.

If the adherence to the principles of professional ethics is not strengthened, the policies of the Ministry of Health and Medical Education (MHTME) cannot facilitate the growth and development of the profession, and fundamental changes in the education and training of students will not take place, not only will the quality of physiotherapy services be lower than international standards, but many high medical expenses will also be imposed on people and insurances.

Faculty Development Programs (FDPs) aim to improve the academic careers of faculty members. This study was designed to assess the attitudes of faculty members and the impact of FDP on their academic improvement.

12 faculty members took part in the research from 2016 to 2019. Using a Delphi method, an open secure questionnaire was provided to 12 junior faculty members in the Department of Anesthesia, Critical Care (DACC), Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran. Then, the keywords of the latter were analyzed, leading to a 32-item closed-answer questionnaire, filled out by the same participants. Also, the impact of the study was assessed using bibliometric improvement indices.

Both the response rate and participation rate were 100%. Approximately all the participants considered FDP an advantageous and promising academic program. 65 percent of the participants had academic improvement, from “Assistant Professor” to “Associate Professor” rank. Besides, the cumulative number of citations to the participants had a 16.2 times improvement. Both latter results were significantly higher than the mean improvement of the cohort faculty members in the DACC, SBMU.

Faculty members of DACC, SBMU had positive attitudes towards FDP and described it as “a well-designed multilateral academic teamwork, thriving ethical, educational, managerial and research-related capacities”. Also, objective improvement in some academic indices was observed. In many academic environments including developing countries, FDPs are effective scientific investment methods.

This study aimed to investigate the characteristics of psychiatric consultations in a general hospital. 

All the patients hospitalized in Rasoul Akram Hospital from April 2011 to March 2019 who were asked for a psychiatric consultation were studied. Patients’ information was obtained from the patients’ records. The records of the year 2008 were also used to compare the characteristics between the years 2008 and 2017. 

Over an eight-year period, 0.61% of the patients received psychiatric consultations. 54% of the consulted patients were male and 46% were female. The mean age of the patients was 44.7±18.72 years. The highest requested consultations (28.4%) were from the internal department followed by the surgery department (11.8%). The highest frequency of the reasons for requesting consultation was presence of psychiatric symptoms (27.5%). The most common psychiatric diagnosis was adjustment disorder (18.4%) followed by major depressive disorder (14.2%). Comparing consultations in the year 2008 with 2017 demonstrated that 1.57% of the patients admitted in 2008 and 1.17% of the patients in 2017 received psychiatric consultations, and in both years, the number of male patients was higher than females, the highest demand for consultation was from the internal department, and the most common reason for seeking consultation was the presence of psychiatric symptoms and then depressive symptoms. In 2008, the most common diagnosis was major depressive disorder and in 2017 was substance use disorder. 

The consultation rate was alarmingly low in this study compared to the other studies.

The aim of this study was to investigate the role of psychological variables in medication adherence in OCD. 

This descriptive and correlational study was carried out at Tehran Institute of Psychiatry in Tehran. The statistical population of the present study includes all OCD patients referred to the Tehran Institute of Psychiatry. The participants were selected by available sampling method. The patients completed the demographic questionnaire, Yale Brown Obsessive-Compulsive Disorder Scale-Second Edition (Y-BOCS-II), Vancouver Obsessional Compulsive Inventory (VOCI), Medication Adherence Rating Scale (MARS), Drug Attitude Questionnaire (DAI-10), Multidimensional Scale of Perceived Special Support (MSPSS), Coping strategies scale of Lazarus and Folkman (WOCQ), and Temperament and Character Inventory (TCI). Multiple Linear Regression (MLR) was used to analyze the data. 

The variable of education status (r=0.18) had a positive relationship and the variable of hospitalization history (r=-0.26) had a negative relationship with medication adherence. Medication adherence is only negatively associated with obsessive thoughts (r=- 0.18, r=-0.20). Duration of drug use (r=0.27), attitude to treatment (r=0.25) and social support (r=0.54) had a positive relationship with medication adherence. Among the various dimensions of temperament and character, four dimensions of harm avoidance (r=-0.29), reward dependence (r=-0.44), persistence (r=-0.20) and self-transcendence (r=0.32) had a significant correlation with medication adherence. Variables of social support, reward dependence, persistence, harm avoidance and education status had the highest regression effect on medication adherence. 

Medication adherence is one of the behaviors that predicts successful treatment and reduces the negative side effects and severity of the OCD.

Despite the direct access to clients in physiotherapy worldwide, Iran has yet to achieve significant improvements in the educational standards and professional responsibilities of physiotherapists. Currently, Iranian physiotherapists do not have direct access to patients. This study aims to present solutions for the professional development of physiotherapy, based on the perspectives of scholars in this field.

This qualitative content analysis study explored the experiences of 12 physiotherapy scholars from three levels of study (bachelor’s, master’s, and doctorate) through structured and semi-in-depth face-to-face interviews. Data analysis was conducted concurrently with data collection using Granheim and Ludman’s content analysis method. 

The identified potential solutions include continuous review of the curriculum, strengthening clinical education, elevation of the basic level of physiotherapy education to a professional doctorate or master’s degree, post-graduation competency assessment, revision of educational priorities, establishing a strong presence in hospital and community departments, preventing the influence and interference of other disciplines, raising public awareness of the capabilities and potential of the profession, and paying greater attention to professional ethics.

In the absence of entry-level general doctor of physiotherapy and direct access to patients, the quality of physiotherapy services will not improve, leading to suboptimal health outcomes for clients and consequent waste of time and financial resources for both patients and insurance providers.

During the Coronavirus Disease 2019 (COVID-19) pandemic, the demand for hospital beds has exceeded substantially. Thus, we aimed to conduct this study to identify factors associated with the risk of readmission in order to introduce the best discharge plan for patients with high risk of hospital readmission. 

This is a multicenter, case-control study including 1357 patients hospitalized with COVID-19 infection. Age-sex-matched case and control groups were paired at 1:2 ratios, and COVID-19 readmission rate was assessed. Moreover, the logistic regression analysis was applied to determine the factors associated with readmission.  

Of the 1357 patients, 99 (7.29%) subjects were readmitted. The most common cause of readmission was respiratory distress. The median (interquartile) of the interval between hospital discharge and the second admission was 5 (2-16) days. Upon adjusting with the main risk factors, having at least one underlying disease and being treated with the corticosteroid were significantly associated with a higher rate of readmission (OR: 2.76, 95%CI: 1.30- 5.87) and (OR: 8.24, 95%CI: 3.72-18.22), respectively. 

Identification of risk factors of COVID 19 readmission will improve resource utilization and patient care.

Knee osteoarthritis is an important age-related public health issue characterized by progressive loss of articular cartilage and as a result functional impairment, disability and reduced quality of life. The present study aimed to investigate the effect of an Orem-based self-care educative supportive nursing system on the quality of life in patients with knee osteoarthritis.

This semi-experimental study was conducted on 130 patients with knee osteoarthritis, who were selected as available samples and randomly assigned to the intervention and control groups. In addition to demographic characteristics, information related to patients’ quality of life was collected using EQ-5D questionnaire. With the help of Oram’s health status checklist, first, self-care deficiencies were determined as nursing diagnoses. Then, based on that, the educational support system that includes education, consultation and follow-up of the patients were done for the patients of the intervention group. The interventions were carried out during 6 weeks (every week a session of 45-60 min). Data were collected before and three months after the intervention. The data were analysed using SPSS21 software through descriptive and inferential statistics (p=0.05).

The overall score of quality of life in the intervention and control groups before the intervention was 48.4±13.1 and 45.8±12.9, respectively; however, it increased to 70.2±19.4 and 61.8±17.6 after the intervention, respectively. In other words, there was a significant difference between the mean score of quality of life dimensions in the intervention and control groups after the intervention (p<0.05).

According to the results of this study, Orem’s self-care model has had a positive significant effect on subjects’ quality of life.

The prevalence of kidney stones reduces the patients’ quality of life and imposes high costs on patients and health care system. Extracorporeal shock wave lithotripsy is a safe procedure to treat urinary stones. Appropriate strategies such as self-care programs can effectively reduce the prevalence and recurrence of this disease, and increase quality of life, save costs, and prevent diseases by increasing patient participation. The aim of this study is to design and implement a web-based self-care application for patients with kidney stones undergoing extracorporeal shock wave lithotripsy.

This paper is an applied study and was performed in Sabalan Hospital in Ardabil affiliated to the Social Security Organization of Iran in three stages including needs assessment, design and evaluation. For needs assessment and application design, a questionnaire was designed by searching library resources. The questionnaire was completed by clinical specialists and specialists in health information management and information technology. Then, based on the approved information elements and capabilities, a web-based self-care application was designed. The usability of the designed program was evaluated with the participation of 20 users.

The results of the survey showed that the experts confirmed all the identified items and components, and considered them necessary. Users rated the usability of the self-care program at a good level with an average score of 7.9 out of 9.

The usability of the self-care application was satisfactory to users in various areas of overall application performance, screen, terminology and information, learning and general impressions.

Breast cancer is the most common female cancer and the second leading cause of death worldwide. The gold standard tool for screening breast cancer, mammography has limitations in some instances, such as patients with dense breast tissue. This study evaluates the correlation of Ultrasound (US) to mammography in breast lesions in BI-RADS.

This prospective cross-sectional study was conducted at a tertiary hospital during 2019-2021. Women who referred to the radiology department for mammography with abnormalities appearing in their mammograms, with a minimum age of 40 and older, underwent ultrasonography. The results of mammography and US evaluations compared according to BI-RADS category. Statistical software SPSS was used to analyze the form data.

In this study, 156 women with a mean age of 48/9 years registered. The US reports were equivalent to mammographic BI-RADS category 2 in 23 cases. All the 26 patients with mammographic BI-RADS category were categorized into BI-RADS 2 by US. Among 43 lesions with BI-RADS category 4 and 21 with BI-RADS category 5, 90/6% and 95/2% of sonography reports were similar to mammography findings. Based on the Pearson correlation coefficient of 0/68, there is a correlation between the results of US and mammography in this study.

This study reveals that US can be an excellent complement to mammography, particularly in identifying early-stage breast cancer in mammographic BI-RADS category 0 lesions. The mammographic-sonographic correlation should lead to more accurate diagnoses and better patient care.

The study of the angles between the vertebrae and the curvatures of the spine plays an important role in the pathogenesis of spinal disorders. The nature of the cervical region makes it susceptible to various cervical disorders, many of which can be caused by imbalanced alignment. 

In the present study, patients with chronic neck pain were compared with the normal population for cervical indexes. 

One hundred subjects were selected, including 57 males (57%) and 43 females (43%). Neck tilting was significantly lower in the case group than control (41.5 vs. 45.8) (p=0.01). The mean of C0-C2 angle did not differ between groups (p=0.503), however, a significant increase was found for C2-C7 and C0-C7 angles (p=0.012) and (p=0.05), respectively. Further analysis revealed that cranial offset (21.9 vs. 8.6) and cranial tilting (21.3 vs. 10.1) significantly increased in patients with chronic neck pain (p<0.001) and (p=0.004), respectively. Also, cervical Sagittal Vertical Axis (SVA) has shown a significant increase in patients than control (24.8 vs. 9.7) (p<0.001). 

The data have indicated that cervical indexes. Thus, spine surgeons should obtain standing cervical radiographs and evaluate the relationship between T1 slope, Spino Cranial Angle (SCA), and cSVA in all cases affected by cervical pathogenesis, even without obvious deformity.

In recent years, there has been a growing emphasis on exploring the influence of spirituality/religion on the management of mental health disorders. The aim of this study was to investigate the viewpoints of Iranian patients with mental health disorders regarding the incorporation of spirituality into their assessment.

This cross-sectional study was conducted in 2021 at Iran University of Medical Sciences. Initially, a questionnaire was developed based on key spiritual concepts identified from a literature review. The content and face validity of the questionnaire were evaluated by an expert panel, and its reliability was assessed using Cronbach’s alpha coefficient. Data collection was carried out in the second phase, with the questionnaire consisting of 4 questions examining the patients’ perceived need and willingness for their therapist to explore their spiritual and religious dimensions. Data analysis was performed using appropriate statistical tests.

The questionnaire’s validity was confirmed, and its reliability was demonstrated with a Cronbach’s alpha value of 0.79. A total of 368 patients participated in the study. No significant associations were observed between the participants’ educational level, diagnosis type, gender, and the questionnaire scores. Approximately half of the patients with mental health disorders expressed a desire to incorporate spiritual assessments into their psychological evaluations, with most welcoming this integration.

The findings of this study suggest that despite challenges and barriers, efforts should be made to integrate spiritual dimensions into the treatment of patients.

Phytochemical-rich foods have anti-inflammatory effects and play a role in the prevention and control of inflammatory diseases such as Multiple Sclerosis (MS). Although some aspects of a diet high in phytochemicals promoting health and preventing chronic diseases are known, further studies are required to confirm the previous findings. 

This cross-sectional study investigated the relationship between Dietary Phytochemical Index (DPI) and fatigue severity in patients with MS. A total of 240 patients aged 18 to 65 years were selected from the MS Association center of Golestan province. A valid and reliable food frequency questionnaire was used to evaluate the diet, and fatigue severity was assessed using the Fatigue Severity Scale (FSS) questionnaire. DPI was calculated using the formula [daily energy from foods rich in phytochemicals (kcal) divided by total daily energy intake (kcal)] and was calculated as 100. 

After controlling for potential confounding factors, the highest tertile of DPI had a lower prevalence of fatigue symptoms (odds ratio (OR: 0.27; 95%CI: 0.03-0.36; p=0.012) compared to those in the lowest tertile. The average age of the study participants was 31.9±7.7 years, and the fatigue score scale among the participants was 39.31±11.62. 

In conclusion, a significant inverse relationship between DPI and fatigue severity was observed in patients with MS. Further prospective studies are needed to confirm these findings.

Weakness of the gluteus muscle is associated with multiple types of injuries such as low back, hip and knee pathology. However, there is no research regarding the effect of gluteal isometric exercises on abdominals, back extensors and quadriceps muscles strength. Hence, this study aimed to demonstrate the effect of gluteal isometric exercises on abdominals, back extensors and quadriceps strength. 

A total of 100 healthy students aged between 18 and 25 years were recruited to participate in an 8-week program of gluteal muscle isometric exercises. The strength of the abdominal, back extensor, and quadriceps muscles was assessed both at baseline and after the 8-week intervention period.

A paired sample t-test revealed significant improvements in abdominal muscles, back extensor muscle strength (p<0.001), and quadriceps muscle strength (p=0.037) after an 8-week intervention. The greatest increases were observed in the abdominals (59.05%), back extensors (46.78%), and quadriceps (7.13%). 

This study demonstrates that gluteal isometric exercises had a significant positive effect on the strength of abdominals, back extensors and quadriceps muscles.

At present, combined provision of direct composite restorations and dental bleaching has become increasingly popular to meet the esthetic demands of patients. This study aimed to assess the effect of internal bleaching on microtensile bond strength of composite to freshly veneered enamel. 

In this in vitro experimental study, 50 sound extracted human premolars were randomly divided into five groups (n=10). All teeth received composite veneers. Two groups underwent no further intervention and were subjected to measurement of microtensile bond strength of composite to enamel 24 hr and one week after the veneering. The remaining three groups underwent internal bleaching. Group 3 underwent bleaching one month after the veneering, and microtensile bond strength was measured after 24 hr. In groups 4 and 5, bleaching was performed immediately after the veneering. Microtensile bond strength was measured after 24 hr in group 4 and after one month in group 5. Data were analyzed using one-way ANOVA.

All the groups were not significantly different regarding the mean bond strength (p=0.110), but they were significantly different in terms of the mode of failure (p=0.01) such that the mode of failure was mainly adhesive in the three bleached groups. 

Internal bleaching after composite veneering has no significant effect on microtensile bond strength of composite to the enamel.

Respiratory failure following COVID-19 can lead to the death of COVID patients. Monitoring these patients during their ventilation is essential. The present study investigated the effect of measuring esophageal pressure in preventing barotrauma while receiving Noninvasive Positive Pressure Ventilation (NIPPV) in patients with COVID-19.

The present study is a single-blind clinical trial conducted on patients with COVID-19 hospitalized in the Intensive Care Unit (ICU). The patients were divided into two groups; one group had their esophageal pressure measured while receiving NIPPV, their ventilation was adjusted based on this pressure, and the second group was only ventilated according to anesthesia protocols. Finally, the data was entered into SPSS V.23 software and analyzed according to the study’s objectives.

The results of the present study showed that the incidence of subcutaneous emphysema-type barotrauma in the Esophageal Pressure (EP) monitoring group was lower than in the non-Esophageal Pressure (nEP) monitoring group. Also, the IPAP level in the EP group was lower than in NEP. The incidence of complications such as abdominal bloating and gavage intolerance was lower in EP than in NEP. The blood oxygen level in NEP was higher than in EP, but there was no significant difference between them.

Esophageal pressure measurement in patients with COVID-19 receiving NIPPV can reduce barotrauma in the patients.

Poisoning with Organophosphates (OP) and/or Pyrethroids (PYR) pesticides is common. We present a rare case of OP+PYR poisoned patient who suffered from Atrial Fibrillation (AF) at the beginning of treatment by a low dose of atropine and reviewed the literature. 

A 50-year-old man had ingested about 5-10 ml of a mixture of chlorpyrifos/cypermethrin.  Half an hour later, he went to the rural hospital and 2 hr later, after gastrointestinal decontamination, he was referred to the clinical toxicology department with normal vital signs except normal sinus tachycardia [Heart rate (HR)]=105. On admission, he had nausea, vomiting, diarrhea, mild sialorrhea, symmetric mid-size pupils, wet skin, and bilateral moist rales in his lungs. His cardiac rhythm changed to rapid AF (HR >140 beats/min) after treatment with 3 mg midazolam followed by 0.3 mg of atropine (0.1 mg every 1-3 min). Atropine administration was discontinued and he was treated with 0.5 mg of digoxin. 6 hr later, his arrhythmia disappeared and all cardiac and laboratory evaluations changed to normal except reduced serum cholinesterase activity.  

AF may be induced by Organophosphates (OP) and Pyrethroids (PYR) intoxication or during the treatment by atropine. We could not find any known risk factor (cardiac or medical issues) for AF in the current case. It may be suggested that poisoning with OP, PYR (alone or mixed) or atropine (in general or in low dose), or combination is the trigger of AF. However, AF is not life threating and can easily cure by antiarrhythmic therapy.