فهرست مطالب

Thrita - Volume:3 Issue: 9, 2014
  • Volume:3 Issue: 9, 2014
  • تاریخ انتشار: 1393/07/23
  • تعداد عناوین: 8
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  • Afsaneh Amouzegar, Sahra Emamzadeh Fard * Page 1
    Background
    Paracentesis is a common bedside therapeutic and diagnostic procedure that requires insertion of a catheter into the peritoneal cavity; however, lack of a specialized fixator for securing the catheter causes frequent catheter kinking and patient discomfort..
    Objectives
    This study aimed to demonstrate the efficacy of a designed paracentesis fixator in reducing patient discomfort and procedure failure rates..
    Materials And Methods
    This interventional study was conducted on 20 patients referred to Imam Khomeini General Hospital for therapeutic paracentesis. A fixator was used to secure the catheter in the experimental group. This designed fixator consisted of an inverted plastic cup with six square-shaped appendages, a cylinder-shaped tube, a flexible silicone hose in continuation of the cylindrical tube, and a connector piece. In the control group, catheter was fixed using tape and sterile gauze. A questionnaire regarding subjective discomfort and overall satisfaction was filled by patients after the procedure..
    Results
    Mean score for subjective discomfort was significantly lower (P = 0.03) and patients’ overall satisfaction was higher in the experimental group (P = 0.04) in comparison to control group. Failure occurred in 20% and 70% of patients in the experimental and control groups, respectively.. Coclusions: The designed paracentesis fixator effectively secures the catheter, reduces catheter kinking incidents, and improves patient''s comfort and satisfaction..
    Keywords: Ascites, Paracentesis, Equipment, Supplies, Fixator
  • Abolfazl Taheri, Asghar Akhavan, Hamidreza Zangeneh, Reza Ajudani, Hamidreza Karimi Sari * Page 2
    Background
    Inferior turbinate hypertrophy (ITH) is one of the common causes of nasal obstruction. In some case with ITH due to allergic rhinitis medical therapy can be useful and in cases with refractory ITH surgical techniques may be helpful. Although there is no excellence [or superiority] among these surgical methods, radiofrequency (RF) has recently become popular..
    Objectives
    This study compared the therapeutic effects of intranasal corticosteroid and RF in patients with ITH due to allergic rhinitis..Patients and
    Methods
    In this randomized clinical trial, patients with ITH due to allergic rhinitis, referred to Baqiyatallah University of Medical Sciences Allergy Clinic, were randomly assigned to RF and intranasal corticosteroid spray groups (fluticasone 125 µg). Patients were evaluated by the symptoms severity, which were measured by visual analogue scale (0-10 score) and rhinomanometry, four times (before the intervention and the 1st, 3rd and 6th month after the intervention). Data were analyzed by SPSS version 21..
    Results
    Sixty patients with ITH due to allergic rhinitis were evaluated, among which 26 were male and 34 were female. The mean age was 35.5 ± 8.86 years old and the mean body mass index (BMI) was 22.97 ± 3.12 kg/m2. There was no significant difference in demographic data among the groups. All the patients showed significant improvements in symptoms severities and rhinomanometry at all the after intervention visits. The best results were obtained in the 6th month of follow-up. The mean nasal obstruction severity and rhinomanometry results were significantly higher in the RF group at all the after intervention visits (P < 0.05)..
    Conclusions
    According to the results, we suggest using RF technique for patients with ITH due to allergic rhinitis, which is an outpatient procedure with local anesthesia; long-term effects of these two therapeutic methods (corticosteroid an RF) could be evaluated in future studies..
    Keywords: Allergic Rhinitis, Nasal Obstruction, Catheter Ablation, Adrenal Cortex Hormones, Signs, Symptoms, Rhinomanometry
  • Saeed Nouri, Shima Farokhi *, Bardia Jamali, Mohammad Reza Sharif Page 3
    Background
    Controlling parenchymal hemorrhage especially in liver parenchyma, despite the progress in surgical science, is still one of the challenges that surgeons face when trying to save patients’ lives. Researchers in the field are challenging to introduce a more effective method..
    Objectives
    The current study aimed to determine the haemostatic effect of alum [KAl (SO4)2] and compare it with that of standard method, suturing technique, in controlling bleeding from liver parenchymal tissue..
    Materials And Methods
    In this animal model study, 60 male Wistar rats were used. An incision, two centimeters long and half a centimeter deep, was made on each rat’s liver and the hemostasis time was measured once using alum with different concentrations (5%, 10%, 15%, 25%, and 50%) and then the control method, controlling bleeding by suturing, was employed. The liver tissue was examined for pathological changes..
    Results
    Complete hemostasis occurred in all the groups. There was a statistically significant difference between the two haemostatic times (P < 0.001). The haemostatic times in different concentrations of alum were significantly less than that of the control group (P < 0.001). The pathologic examination showed the highest frequency of low-grade inflammation based on the defined pathological grading..
    Conclusions
    Alum might be an effective haemostatic agent in controlling liver parenchymal tissue hemorrhage in an animal model..
    Keywords: Hemostasis, Alum Compounds, Liver, Rats
  • Banafshe Hosseini, Ghazaleh Eslamian * Page 4
    Context: The aim of this study was to review research articles concerning association between dietary factors and infertility in males and females..Evidence Acquisition: Literature review was performed on articles concerning male and female infertility and nutrition using the PubMed, EMBASE, and Scientific Information databases between January 1978 and July 2014. The bibliographies of included studies were searched for additional references..
    Results
    The effect of macronutrients (fat, carbohydrate, and protein) and food groups (dairy) on ovulatory infertility is related to their quality and quantity. High intake of antioxidants, fruits, vegetables, poultry, seafood, skim milk, and shellfish as well as low intake of full-fat dairy food intake, sweets, and processed meat with especially high-saturated fat foods were reported to have favorable association with sperm quality..
    Conclusions
    Studies revealed that nutritional factors play a substantial role in preventing or facilitating infertility..
    Keywords: Dietary Supplements, Food, Ovulation, Spermatogenesis, Infertility
  • Kaveh Hosseini *, Mehrnam Amouei, Mahmood Alemohammad Page 5
    Background
    Higher life expectancy and increased ischemic heart disease (IHD) have resulted in increasing number of the elderly patients undergoing cardiac surgeries. Age along with many other comorbidities influence the outcome of major surgeries in the elderly patients; hence, case selection before major surgeries is challenging..
    Objectives
    The pure effect of age after adjusting for other major preoperative risk factors is on the center of debate in literature..
    Materials And Methods
    In this retrospective study, 1377 patients who had undergone coronary artery bypass graft surgery (CABG) from June 2006 to August 2012 were included. Patients were categorized in two age groups: group A, < 70 and group B, ≥ 70 years old. Preoperative and postoperative variables were evaluated between these groups. Sex, diabetes mellitus (DM), hypertension (HTN), left ventricular ejection fraction (LVEF), and glomerular filtration rate (GFR) were assessed as preoperative factors. Postoperative complications such as sternal wound infection, nosocomial pneumonia, prolonged ventilation, atrial fibrillation (AF), and operation for rebleeding were registered to evaluate their association with age groups and preoperative comorbidities..
    Results
    Patients in group B were more likely to have DM, HTN, and GFR < 60. In binary logistic regression, age ≥ 70 years was significantly associated with postoperative AF (OR = 2.26, 95% CI, 1.33-3.83) and prolonged ventilation (OR = 2.38, 95% CI, 1.2-4.5) while it was not associated with other complications. Nonetheless, the age was not a major risk factor for prolonged ventilation after adjustment for other main risk factors in multivariate analysis. AF was the most common complication of CABG in the elderly (age ≥ 70 years old). There was not a significant sex predilection in two age subgroups. In logistic regression, GFR > 60 mL/min/1.73 m2 was significantly associated with all complications except reoperation for bleeding, and it was a protective factor in those complications. After adjustment for age, in binary logistic, GFR < 60 mL/min/1.73 m2 was significantly associated with prolonged ventilation (P value = 0.036, OR = 2.2) and sternal wound infection (P value = 0.022, OR = 7.7). In multivariate analysis, the effect of GFR < 60 mL/min/1.73 m2 on AF was not significant. Left ventricular dysfunction (EF < 40%) was significantly associated with postoperative pneumonia (OR = 2.95; 95% CI, 1.2-7.6) and reoperation for bleeding (OR = 1.74, 95% CI: 1.09-2.85)..
    Conclusions
    CABG in the elderly patients is accompanied with higher morbidity. In addition, comorbidities are also major determinants of postoperative outcomes even after adjustment for age. Age alone is not a strong predictor of complications and preoperative health status of the elderly patient is also a major factor..
    Keywords: Coronary Artery Bypass, Adverse Effects, Comorbidities
  • Sima Ghorabi, Zahra Vahdat Shariatpanahi * Page 6
    Background
    There is evidence that early enteral nutrition can improve clinical outcomes in patients hospitalized in the intensive care unit..
    Objectives
    The purpose of this study was to evaluate the effect of early enteral nutrition on clinical outcomes in medical patients admitted to the intensive care unit..
    Materials And Methods
    This prospective study was performed on 94 patients admitted to the medical intensive care unit (ICU). The patients were divided into two groups according to nutrition onset. Enteral nutrition for group one was started within the first 48 hours of admission to the ICU and group two received enteral nutrition after the third day of admission to the ICU. Patients were monitored for ICU length of stay, organ failure (SOFA score), aspiration pneumonia, duration of mechanical ventilation and mortality..
    Results
    The average daily caloric intake between the two groups did not differ significantly (P = 0.4). Both groups received more than 75% of the calculated required calorie. The mean duration of hospitalization, occurrences of organ failure and mortality were lower in patients who received their calculated daily nutrition during the first 48 hours of admission (P < 0.05). Regarding ventilator-associated pneumonia, there was no significant difference between the two groups of early and late enteral nutrition. There was no significant difference between the two groups of early and late nutrition in the duration of mechanical ventilation. Logistic regression analysis showed that late nutrition causes a 3.3 times increase in mortality rate, 1.3 times in the length of ICU stay and 1.8 times in organ failure (P < 0.05)..
    Conclusions
    Early enteral nutrition within 24 to 48 hours of admission to ICU reduces the duration of hospitalization, organ failure and mortality of the medical patients..
    Keywords: Enteral Nutrition, Critical Ill Patients, Mortality, SOFA Score
  • Azimeh Ghorbanian, Mohsen Ghorbanian, Sodabeh Vatankhah, Mohammadkarim Bahadori *, Ramin Ravangard Page 7
    Background
    In today''s changing and uncertain environment, there is a need for transformational leaders. Besides, due to lack of effective leaders in organizations, identifying factors influencing managers to act as transformational managers is very important. Spirituality is one of the factors, which cause managers to act as transformational managers..
    Objectives
    This study aimed to investigate the association between managers'' spirituality at work and their leadership styles in Tehran University of Medical Sciences, Tehran, Iran in 2012..
    Materials And Methods
    This was an applied, cross-sectional and descriptive-analytic study conducted on all managers at different levels (n = 44) and a sample of 74 employees of the Vice Chancellor of Management Development and Resource Planning of Tehran University of Medical Sciences, Tehran, Iran in 2012. Data was collected using two questionnaires evaluating managers'' leadership styles and their spirituality at work. Collected data was analyzed using SPSS 16.0 by Pearson Correlation Coefficient and Multiple Linear Regression (Stepwise method). P < 0.05 was considered statistically significant..
    Results
    There were positive and significant correlations between transformational leadership style and managers'' spirituality at work (r = 0.364, P < 0.001) and between transformational leadership style and all dimensions of managers'' spirituality at work (P < 0.05). Multiple Linear Regression showed that among the dimensions of managers'' spirituality at work, only interpersonal communication had a significant effect on using transformational leadership style by managers (P = 0.001)..
    Conclusions
    If managers'' spirituality at work, especially interpersonal communication skills improves, their use of transformational leadership would be increased. Therefore, it seems necessary to employ individuals with great interpersonal communication skills and good communication with other people and colleagues, teams, formal and informal organizations as managers. Furthermore, it is recommended to continuously improve managers'' communication skills to enable them to act as transformational managers..
    Keywords: Transformational Leadership, Transactional Leadership, Laissez, Faire Leadership
  • Soheil Ashkani Esfahani *, Sedigheh Ebrahimi, Saeid Ashkani, Shima Rafiee, Parisa Iloon Page 8
    Introduction
    Arthrogryposis multiplex congenita (AMC) with incidence of 1 in 3000 of births is characterized by multiple rigid joint and soft-tissue contractures..
    Case Presentation
    We present a case of AMC with severe soft tissue and joints contractures, especially joints of lower limb and elbows, bilateral complete dislocation of hips (CDH) and knees (CDK) (type III), bilateral elbow joint dislocations and severe bilateral clubfeet, who had had some successful operations during five years on lower extremities..
    Discussion
    The main goal of our treatment was achieving the maximal function of lower limbs. Passive stretching range of motion on stiff joints especially of lower limbs must be started as soon as possible; serial castings, open reduction of CDH followed by derotational femoral osteotomy and shortening was helpful. Surgery performed at earlier age gives the best functional outcome..
    Keywords: Arthrogryposis, Knee Dislocation, Hip Dislocation