Jundishapur Journal of Chronic Disease Care
Volume:14 Issue: 2, Apr 2025

 Total knee arthroplasty (TKA) surgeries are among the most significant orthopedic procedures. The high sensitivity of these surgeries makes surgical site infections (SSIs) a critical concern worldwide.

This study aims to determine the prevalence of SSIs following TKA procedures. Evidence Acquisition: This systematic review and meta-analysis were conducted up to November 2024. Searches were performed in PubMed, Scopus, and Embase to identify relevant studies. The Joanna Briggs Institute Critical Appraisal Checklist was applied for quality assessment. A total of 375 articles were identified through database and hand searches, with 44 articles included in the statistical analysis. The results from the forest plot studies indicated heterogeneity among the studies.

The study found a low prevalence of SSIs in TKA surgeries, with a rate of 1.59% (95% CI: 1.44 - 1.73). Controlling the occurrence of SSIs is crucial due to the significance of these conditions, particularly in high-risk procedures like TKA.

Given the importance of SSIs, hospital managers should design training courses for patients and healthcare workers to improve awareness of risk factors and preventive measures. Efforts should be made to control the factors that contribute to SSIs as much as possible.

Chronic kidney disease (CKD) is defined as kidney damage or reduced kidney function for three months or more, regardless of the cause. Hemodialysis (HD) has become the dominant renal replacement therapy in many parts of the world. Currently, due to the absence of definitive evidence on safety and efficacy, there is no consensus on the optimal sodium concentration in dialysis.

Considering the importance of sodium regulation in HD patients, we conducted a study on the impact of low sodium levels in dialysis fluid on the hemodynamics of chronic HD patients.

In this double-blind randomized controlled clinical trial, 84 adult patients undergoing chronic HD at the dialysis centers of Golestan and Imam Khomeini Hospitals in Ahvaz, Iran, in 2023 were enrolled. One group of patients was treated with HD using a sodium concentration of 140 mmol/L, and another group was treated with a sodium concentration of 135 mmol/L. Patients underwent HD sessions three times a week for 3 to 4 hours. Systolic blood pressure (SBP), diastolic blood pressure (DBP), and weight before and after dialysis were compared between the 135 and 140 mmol/L groups.

The mean age of the patients was 53.99 ± 14.61 years, and the duration of dialysis was 7.95 ± 3.45 years. Systolic blood pressure after dialysis was 122.73 ± 7.01 mm Hg and 122.90 ± 6.97 mm Hg for the 135 and 140 mmol/L groups, respectively, with no significant difference between the two groups (P = 0.91). Diastolic blood pressure after dialysis was 74.94 ± 3.74 mm Hg and 75.51 ± 2.78 mm Hg for the 135 and 140 mmol/L groups, respectively, with no significant difference (P = 0.42). The weight after dialysis was 63.99 ± 14.16 kg and 69.91 ± 14.69 kg for the 135 and 140 mmol/L groups, respectively, with no significant difference observed (P = 0.06). The mean ultrafiltration (UF) rate was 1.87 ± 0.44 and 1.99 ± 0.40 for the 135 and 140 mmol/L groups, respectively (P = 0.20).

Reducing the sodium concentration in dialysis fluid had no significant effect on weight control and blood pressure. Further studies with larger sample sizes are suggested to determine the effect of low sodium levels in dialysis fluid on the hemodynamics of patients undergoing chronic HD.

The present study aimed to investigate the prevalence of iron deficiency in non-anemic mothers during the first trimester of pregnancy.

A prospective cohort study was conducted involving 876 pregnant women who visited Mahdieh Hospital in 2022. Blood samples were collected to measure hemoglobin (Hb), hematocrit (HCT), and ferritin levels. A ferritin level below 30 ng/dL was considered indicative of iron deficiency.

The study found that patients with ferritin levels ≥ 30 ng/dL had higher average age (95% CI: -1.92 to -0.16; P = 0.02) and Hb levels (95% CI: -0.51 to -0.15; P < 0.001) were higher in patients with ferritin levels ≥ 30 ng/dL. No significant correlation was found between ferritin levels and weight (95% CI: -2.78 to 1.01; P = 0.36), height (95% CI: -0.45 to 1.11; P = 0.40), or BMI (95% CI: -0.86 to 1.27; P = 0.44). Additionally, there was no significant relationship between ferritin levels and parity (P = 0.06), education (P = 0.85), income (P = 0.98), dietary habits (P = 0.27), or abnormal uterine bleeding (AUB) (P = 0.51) with ferritin level in patients (P > 0.05). However, the incidence of abortion was higher in patients with ferritin levels ≥ 30 ng/dL (P = 0.01). Logistic regression analysis revealed that only Hb levels had a statistically significant relationship with ferritin levels (95% CI: 0.02 to 0.28; P = 0.02).

In general, it can be said that Hb and abortion factors can be related to iron deficiency in pregnant women in the first trimester of pregnancy.

Migraines are a cause of disability, affecting individuals, families, and communities. Scientists believe that efforts are needed to improve the best management practices for migraines.

This study aimed to determine the effect of neck and head massage on the intensity of headache and headache-induced disability in migraine patients.

In this double-blinded randomized controlled trial, 90 dyads of migraine patients and families were assigned into three groups (massage, touch, and control) equally by the random minimization method. The massage group received head and neck massage twice a week for 30 minutes over four weeks. The touch group received light touch. The pain and headache impact test (HIT) scores were measured before, immediately, and one month after the intervention. Data were analyzed by SPSS software V.22 using Shapiro-Wilk, chi-square, and repeated measures ANOVA tests, and statistical modeling at a significance level of 0.05.

The results of the Multivariate test showed that the time, group, and interaction between time and group effects were significant (P = 0.001). Results of statistical modeling in within-group pairwise comparisons showed that in the massage group, the mean difference of pain and HIT scores decreased significantly after the intervention compared to baseline and one month after intervention (P = 0.001). In intergroup pairwise comparisons, the pain and HIT in the massage group were significantly lower than the two others (P = 0.001).

Massage therapy can be useful in the management of headache in the short term and its induced disability in the short and long term in migraine patients.

Injection of platelet-rich plasma (PRP) into the ovary is a therapeutic strategy to increase the fertility of infertile women. PRP also regulates the expression of sex hormones, including follicle-stimulating hormone (FSH) and anti-Müllerian hormone (AMH), through growth factors and cytokines.

In this study, we evaluated the effect of PRP injection on increasing ovarian reserve in infertile patients.

This semi-experimental study was conducted on 17 infertile women referred to Nikan Hospital between 2021 and 2022 who were candidates for PRP due to reduced ovarian reserve. After ovarian puncture, 3 cc of PRP was injected. In the third menstrual cycle, after checking the FSH and AMH serum levels and the presence of at least one antral follicle count (AFC) in the ultrasound, the patients underwent the ovulation stimulation cycle again. The improvement of the ovarian response was determined by evaluating the parameters of the number and quality of retrieved oocytes, the number and quality of the obtained embryos, the serum levels of AMH and FSH, and the number of AFC in ultrasound. The relevant data were then entered into SPSS26 software for analysis.

The average age of the participants was 36.94 ± 3.76 years, and the average Body Mass Index (BMI) was 22.36 ± 2.89 kg/m2. The results showed that the average AFC, the average number of oocytes retrieved in IVF, and the average number of embryos obtained in IVF increased significantly after PRP intraovarian injection (P = 0.009). Additionally, the mean FSH level after PRP intraovarian injection was significantly reduced (P = 0.014). However, the average AMH level did not change significantly after PRP intraovarian injection (P = 0.661).

Based on this study, it appears that PRP intraovarian injection can improve ovarian reserve and increase the number of oocytes and embryos.

Anxiety and depression are common comorbidities in patients with chronic obstructive pulmonary disease (COPD) but are often mistreated. Self-management (SM) is a non-pharmacological intervention and a key element in the care of patients with COPD.

This study aimed to determine the effect of a SM program on anxiety and depression in patients with COPD.

This study was a double-blinded randomized controlled trial conducted in two central hospitals in Tehran, Iran. A total of 100 patients with COPD were randomly assigned to either the control or intervention groups. Both groups received routine care and education. The intervention group received face-to-face education on SM skills from the researcher. Anxiety and depression were assessed at three time points: Baseline, six months after the intervention, and twelve months after the intervention. The instrument used for measuring anxiety and depression was the Hospital Anxiety and Depression Scale (HADS). Data were analyzed using descriptive and analytical statistics with SPSS version 23.

The mean anxiety and depression scores were not significantly different between groups at baseline (P = 0.630 and P = 0.647, respectively). Six months later, the mean anxiety and depression scores were more reduced in the intervention group than in the control group (P = 0.009 and P = 0.004, respectively).

The findings of this study demonstrated a positive effect of the SM education program on reducing anxiety and depression in patients with COPD.

Malnutrition is prevalent among dialysis patients and can significantly affect the efficacy of hemodialysis (HD).

The present study aimed to explore the relationship between nutritional status and HD adequacy in dialysis patients in Khuzestan province, Iran. The findings may aid in enhancing nutritional management and improving treatment quality for these patients.

This cross-sectional descriptive-analytical study included 290 dialysis patients selected based on inclusion criteria and proportional allocation stratified sampling from hospitals and dialysis centers in Khuzestan province, southwest of Iran, in 2023. Nutritional status was assessed using the subjective global assessment (SGA), which evaluates changes in the patient’s condition over the past 6 months. Hemodialysis adequacy was assessed using the Urea Clearance Index (KT/V). Data were analyzed using descriptive and analytical statistical tests in SPSS version 22.

The study found that 185 patients had suboptimal nutritional status. ANOVA testing revealed a significant difference in KT/V scores (HD quality) among patients with varying nutritional statuses (P < 0.001). The Tukey post hoc test indicated that patients with normal nutritional status had higher KT/V scores compared to those with malnutrition or severe malnutrition. Additionally, patients with malnutrition had higher KT/V scores than those with severe malnutrition.

The findings of this study demonstrate a relationship between nutritional status and HD quality in dialysis patients. These results can inform healthcare policymakers in implementing strategies to improve nutritional status and subsequently enhance the quality of HD in dialysis patients.

Therapeutic plasma exchange (TPE) is the treatment of choice for several neurological disorders. However, performing TPE in patients is accompanied by some complications.

This study investigates the complications caused by TPE in patients with neurological disorders.

This retrospective study was conducted from October 2020 to October 2021 at the Neurology Department of Shariati Hospital, Tehran, Iran, on all patients undergoing TPE for any neurological indication. Data related to complications in TPE patients were collected based on the information in their files. The complications recorded in the patients’ files were documented in the relevant checklist based on the documentation, tests, and clinical examinations that had been performed. Complications were assessed on days 1 and 5 during the TPE procedure. Statistical analysis was performed using IBM SPSS Statistics, version 25.

On the first day after TPE, anxiety (P = 0.002) and citrate-induced hypocalcemia (P = 0.012) were observed in 10 (10.5%) and 37 (38.9%) patients, respectively. By the 5th day after TPE, 31 patients (32.6%) experienced albumin depletion (P < 0.001). This was despite the fact that there was no significant relationship in terms of other side effects, including albumin hypersensitivity, homeostasis, vascular access, pain, and cardiac complications, between days 1 and 5 (P > 0.05).

The incidence of complications on days 1 and 5 after TPE differs among patients, and their identification can aid in the better management of patients with neurological disorders.

Restless legs syndrome (RLS) significantly affects sleep quality. A lack of awareness regarding this condition often results in delays in both diagnosis and treatment.

This study aimed to assess the prevalence of RLS and identify comorbidities associated with the disorder.

This cross-sectional study was conducted on patients with RLS registered in the sleep clinic at Mashhad University of Medical Sciences from 2019 to 2024. The diagnosis of RLS was made using the four minimum criteria established by the International Restless Legs Syndrome Study Group (IRLSSG). The Pittsburgh Sleep Quality Index (PSQI ≥ 6), Epworth Sleepiness Scale (ESS ≥ 10), Insomnia Severity Index (ISI), and Depression Anxiety Stress Scales (DASS-21) were employed to evaluate sleep quality, excessive daytime sleepiness, insomnia, and mood disorders, respectively. Data analysis was performed using STATA version 7 software, with a significance threshold set at (P < 0.05).

The prevalence of RLS was found to be 9.2%. The average RLS score for men was 15.71 ± 13.19, while for women it was 19.35 ± 11.72 (P = 0.004). A significant negative correlation was observed between RLS scores and sleep duration (P < 0.001). Conversely, there were significant positive correlations between RLS scores and sleep latency, PSQI, ISI, and DASS-21 (P < 0.001). Rare variants of RLS, including restless head, back, bladder, abdomen, and perineum syndrome, were identified in a total of 11 cases (3.6%) among the participants.

Enhancing awareness of RLS and its comorbidities is crucial for the accurate diagnosis and management of patients, which can subsequently improve sleep quality and alleviate mood disorders. It is important to recognize that restlessness mimicking RLS can manifest in different areas of the body.

Cancer-related fatigue (CRF) has a significant negative impact on the quality of life of affected patients.

This study aimed to examine the effect of mindful yoga on fatigue in women with breast cancer.

This quasi-experimental study employed a pre-test and post-test design with a control group. The research population included all women with breast cancer who visited the cancer care department of the Mehr Cancer Patient Support Center in Shahin Shahr for periodic care in 2023. A total of 40 eligible participants were selected through convenience sampling and allocated into two groups — intervention and control (20 participants each) — via permuted block randomization. The intervention group received mindful yoga sessions weekly for 16 weeks. Data were collected using the Cancer Fatigue Scale and analyzed using SPSS-22 software with multivariate analysis of covariance (MANCOVA).

The average age of participants was 47.23 ± 6.07 years. Over 80% of patients in both groups were diagnosed with stage 2 cancer. Post-intervention, the intervention group showed significant reductions in physical, affective, and cognitive cancer fatigue scores compared to pre-intervention scores (P < 0.001). These changes were not observed in the patients in the control group.

The data in this study suggest that the mindful yoga intervention had a positive effect on reducing cancer fatigue in women with breast cancer. Emerging non-pharmacological and supportive interventions, such as mindful yoga, can serve as complementary therapies to help these patients and improve their quality of life and psychological well-being.

Cancer is the second leading cause of death in human societies. Patients with various types of cancer experience high levels of psychological disorders, emotional disturbances, and fear of disease progression.

Therefore, this study aimed to investigate the effectiveness of cognitive-behavioral stress management on fear of disease progression in women with breast cancer.

This study was a clinical trial conducted on a population of women with breast cancer referred to the radiotherapy department of Ahvaz Hospital in 2022. Fifty four of these patients, who scored 85 or higher on the Fear of Progression Questionnaire (FOP) Hershbach, were randomly assigned to intervention and control groups (27 patients in each group). Patients in the intervention group received cognitive-behavioral stress management in 10 sessions of 90 minutes each, while the control group did not receive any intervention. Data analysis was performed using the chi-square test, independent t-test, and repeated measures ANOVA with a significance level of 0.05 using SPSS22 software.

The results showed that before the intervention, the mean score of fear of disease progression in the intervention group was 135.51 ± 8.18, which immediately after the intervention and one month later changed to 75.48 ± 7.91 and 74.55 ± 8.17, respectively. Comparison of the overall score of fear of disease progression immediately after the intervention and at the one-month follow-up in the intervention group compared to the control group showed a statistically significant difference (P < 0.001).

Cognitive-behavioral stress management reduces fear of disease progression in women with breast cancer. Therefore, this method can be used as an effective approach by healthcare professionals for women with breast cancer who fear disease progression.