Iranian Red Crescent Medical Journal
Year:2022 | Volume:24 | Issue:10|Papers Count:10

Background: Pain and wound dehiscence cause physical and emotional traumas, impacting the mothers' quality of life, mental health, and maternal-child bonding. Objectives: The present study aimed to examine the effect of self-perineal care (SPC) education on episiotomy pain scores and wound healing outcomes. Methods: A quasi-experimental design was used in this study. In the third trimester, 125 primigravida mothers attended the antenatal clinic and were assigned to a SPC education group (n=62) and a control group (n=63). The intervention group received two phases of SPC education apart from the study hospital’, s routine care, and the mothers in the control group received only routine care. The primigravida mothers in the treatment group were provided SPC education content on their smartphones using the “, SPCE”,mobile application. Mothers in both groups self-reported their episiotomy pain score and wound healing outcome over 7 days post-childbirth using this mobile application. Results: The overall pain and REEDA scores (redness, oedema, ecchymosis, discharge, approximation) were significantly lower in the intervention group than in the control group for the first 7-days post-delivery with P < 0. 001 except for 4 h of baseline observation. For each activity of daily living, the scores were lower in the intervention group for the 7 days post-delivery. Conclusion: Self-perineal care education positively reduced episiotomy pain scores and enhanced wound healing outcomes. This study empowered the primigravida mothers to take responsibility for their health by involving in a self-care education program.

Background: With leading morbidity among malignant tumors in otorhinolaryngology, Nasopharyngeal carcinoma (NPC) is one of the most frequent malignant tumors in China. Objectives: This study aimed to help radiotherapy doctors recognize and segment nasopharyngeal organs at risk of NPC and make a radiotherapy plan. Methods: The authors used B-spline and mutual information to transform, register, and fuse Chinese Visible Human images with the volunteer’, s personalized computed tomography (CT) images, and integrated them into the Treatment Planning System (TPS). Consequently, Three-Dimensional Visualization Treatment Planning System (3DV+TPS) was created. To verify it, 3DV+TPS was deployed to identify and segment the nasopharyngeal organs at risk of NPC, and a questionnaire was filled out by radiotherapy doctors. Results: Results showed that 3DV+TPS can finish the registration and fusion of four sets of sectional anatomical images and individual CT images of volunteers in approximately 3 min and 50 sec. Conclusion: The registered and fused images can accurately reflect the position, outline, and adjacent space of the nasopharyngeal structure which is not clear in CT images. Therefore, it is helpful for recognizing and segmenting neural, muscular, and glandular structures. Through automatically registering and fusing color and CT gray images, 3DV+TPS improves the accuracy and efficiency of recognizing nasopharyngeal structures in making radiotherapy plans. It is also useful to improve the teaching quality of tumor radiotherapy for medical students and interns as well.

Background: The increase in the workload of healthcare workers during the coronavirus disease 2019 (COVID-19) pandemic has added further responsibilities for their health. Objectives: This study was conducted to measure the amount and economic value of COVID-19-related absenteeism and presenteeism and its affecting factors among physicians, nurses, and paramedics working frontline with COVID-19 patients. Methods: This cross-sectional study was conducted in a COVID-19 tertiary central hospital in Tehran, Iran. Totally, 250 hospital staff who were working frontline with COVID-19 patients between October to December 2020 were entered in the study. The samples included 100 physicians, 96 nurses, and 56 paramedics. The Valuation of Lost Productivity Questionnaire was used to measure job characteristics, absenteeism, and presenteeism. The human capital approach was employed for the valuation of absenteeism and presenteeism. Data were analyzed using ordered logistic regression with backward elimination and the removed value of 0. 1 in Stata 14. Results: Based on the results, the COVID-19 infection rate was 14. 4% among healthcare workers, 8% among physicians, 18. 6% among paramedics, and 18. 7% among nursing staff. A significant association was found between the amount of absenteeism and working in intensive units (odds ratio [OR]: 3. 511, P=0. 000). A higher amount of absenteeism was related to first-time COVID-19 infection among all participants (OR: 4. 918, P=0. 000). Current smoker staff, in comparison to quitted smoking staff, was 2. 995 times more likely to have a higher amount of presenteeism (OR: 2. 995, P=0. 030). Conclusion: COVID-19 had a significant effect on both absenteeism and presenteeism of healthcare workers and its amount and value were unequal among physicians, nurses, and paramedics. Policymakers should do their best to minimize the productivity loss of healthcare workers.

Background: More than 75% of epithelial ovarian cancer (EOC) cases are diagnosed in advanced stages, which is associated with tumor recurrence and chemotherapy resistance. So far, to the best of our knowledge, a similar study has not been conducted in Iran to investigate the clinical characteristics and survival rate of these patients treated with neoadjuvant chemotherapy (NACT). Objectives: This study aimed to evaluate the clinical characteristics and survival of patients treated with NACT followed by cytoreductive surgery and the factors affecting survival. Methods: This retrospective cohort study was conducted on 147 advanced ovarian cancer cases who were treated with NACT referring to the Gynecology Oncology Department of Imam Khomeini Hospital in Tehran, Iran, between 2011 and 2021 and met the inclusion criteria for this study. The survival curve and Cox regression method were used to analyze the data. Results: The results revealed that 8. 9% of advanced EOC (147/1, 650) were treated with NACT and the average number of NACT courses was 4. 12 periods. The survival rates of 1, 3, 5, and 8 years were 85. 31%, 44. 05%, 18. 35%, and 13. 77%, respectively. The mean and median of survival time were 47. 7 and 36 months, respectively. Nearly 80% of the patients had stages 3C and 4A before receiving NACT. Based on the results of the adjusted Cox regression model, tumor marker level showed a significant relationship with survival rate (P=0. 008), and also peritoneum involvement had a clinically significant impact on survival with a hazard ratio of 2. 88. Conclusion: The results suggested that 8. 9% of ovarian cancer cases were treated with NACT. It was also revealed that the average number of NACT courses was 4. 12 periods and the 8-year survival rate was 13. 77%. CA125 tumor marker level showed a significant relationship with survival rate, and peritoneum involvement had a clinically significant impact on survival.

Background: The covid-19 pandemic has affected the health insurance industry in numerous ways. Objectives: The present study aimed to examine the impacts of the covid-19 on the referral times of insurance policyholders to hospitals and diagnostic centers throughout the country. Methods: This was a cross-sectional descriptive study conducted on the data collected from a private insurance company. The statistical population included all insured individuals covered by the insurer in 31 provinces throughout the country who have used the services provided in hospitals and other diagnostic centers from March 21, 2019 to September 21, 2019 (1, 699, 930 insured people), considered as the pre-covid-19 incidence period, and from March 20, 2020 to September 20, 2020 (1, 862, 657 insured people), as the post-covid-19 incidence period. Data were analyzed using the SPSS and GIS statistical software. Results: In the 2019 half-year, 10, 416, 591 medical expense records have been filed in the country, which decreased by 17. 1% in the same period in 2020 to 8, 633, 613 records. The average referral times in the pre-covid-19 period was 7. 02, which decreased by 32. 9% during the post-covid-19 period, falling to 4. 71. Conclusion: The overall frequency of referrals to receive all services covered by the insurer, including visits, medicine, hospital services (general surgeries), and laboratory services in the post-covid-19 period decreased significantly, compared to a similar period in the previous year. It seems that in many different provinces, non-emergency patients avoided referring to healthcare centers and unnecessary visits to medical centers. Moreover, the number of general surgeries decreased because of the therapists’,cautiousness and the changing behaviors of the patients, making diagnostic and medical services more real.

Background: Temperament is a critical concept in Persian Medicine (PM) school, and its determinants independently affect human metabolism. Objectives: The present study investigated the potential relationship between PM-based temperament and metabolic parameters. Methods: This cross-sectional study was carried out at the PERSIAN Organizational Cohort Study at Mashhad University of Medical Sciences Research Center, Imam Reza Hospital, Mashhad, Iran. The participants temperament, physical activity, and dietary intakes were assessed through valid questionnaires. Anthropometric indices were measured by bioelectrical impedance analysis, and energy expenditure components were evaluated using indirect calorimetry. Results: A total of 334 individuals entered the study. Cold-tempered participants were similar to the warm-tempered in terms of age, sex, general physical activities, and environmental conditions. Warm-tempered participants had lower intakes of spices (P=0. 01). Moreover, warm-tempered subjects had more muscle mass (P=0. 008) and body water (P=0. 007). Finally, the lower metabolic rate in cold-tempered participants was not significant (resting energy expenditure=1468±, 337 vs. 1519±, 366 Kcal/day, for cold and warm-tempered subjects, respectively) Conclusion: Findings of the present study supported the potential relationship between PM-based temperaments and dietary intakes, anthropometric indices, and metabolic parameters. However, further large-population-based studies are required to find the exact mechanisms and interrelations between modern nutrition propositions and PM concepts.

Background: Hepatitis B is an older and more common infection worldwide than hepatitis C virus (HCV) and human immunodeficiency virus (HIV). Nonetheless, there is a dearth of studies on hepatitis B-related stigma and discrimination compared to HCV and HIV. Objectives: It aimed to evaluate stigma and discrimination by classifying them as social environment, work environment, and while receiving health care. It was planned to examine the relationship of these data with hiding behaviors and anxiety levels. Methods: In this study, a questionnaire prepared for chronic hepatitis B patients was applied using the face-to-face interview technique. The questionnaire used included a total of 43 items, the first 10 of which were descriptive data, and the others were aimed at determining stigma and discrimination. Results: A total of 505 patients were interviewed. The mean age of the patients was 41 years, and 56% were male. Moreover, 47. 1% of patients asserted that they hid their illness from those around them, 47% feared stigma, and 36% feared exclusion. In addition, 20 (4%) cases stated that they broke up with their spouse or lover due to their illness, and 47 (11. 7%) subjects indicated that they did not plan to marry due to their illness. It was determined that 73. 8% of participants were afraid of transmitting the disease to others. Moreover, 21. 6% of patients revealed that they experienced stigma while receiving health services. The rate of exposure to any stigma and discrimination in the workplace was 12. 3% (n=43). Furthermore, 21 (5. 8%) participants asserted that they lost their job due to their illness. There was a significant difference between those who hid their disease and those who did not, in terms of age, education level, marital status, place of residence, worrying about the course of the disease, fear of infecting others, and exposure to any stigma. It was observed that the individuals shared their hepatitis positivity with fewer people, with a gradual increase in their level of education (P=0. 002). Conclusion: The results of this study demonstrated that hepatitis B virus (HBV) positive people in Turkey accept this situation as a reason for stigmatization and discrimination. Participants pointed out that they often avoid disclosing their illness out of fear of being stigmatized and excluded.

Background: Head trauma may cause an increase in intracranial pressure (ICP). The use of ocular ultrasound to measure optic nerve sheath diameter (ONSD) is a method to determine the ICP. The use of the rigid cervical collar in head trauma patients contribute to elevating ICP, and therefore, potentially causing further deterioration in their condition. Objectives: This study aimed to describe changes in ONSD after the placement of a c-collar and analyze these changes depending on the time in the c-collar. Methods: This prospective study measured the ONSD of minor head trauma patients before and after the placement of a c-collar. Patients aged , 18 with blunt head trauma and Glasgow Coma Score , 13 were included in the study. Each eye was scanned twice. This was done before c-collar placement, at 5 and 20 min after placement. The mean values of both eyes were calculated and analyzed. Results: This study investigated 50 patients. The mean baseline ONSD was obtained at 4. 71mm±, 0. 22 (4. 54-4. 77). Furthermore, T5 and T20 measurements were 5. 19±, 0. 41 (5. 07-5. 31) and 5. 26±, 0. 45 (5. 14-5. 39), respectively. The ONSD increased at T5 and T20. The changes from the baseline measurements were statistically significant (P=0. 000, P=0. 000). The difference between T5 and T20 groups was an increase in ONSD, and these differences were also statistically significant (0. 07±, 0. 19,P=0. 008). Conclusion: Our results revealed that minor head trauma patients using a c-collar may increase ONSD by timeline the clinical effects of which have to be determined with further studies. Enlargement in ONSD should be considered when interpreting ICP.

Background: Central venous catheterization (CVC) insertion is a prevalent invasive procedure performed in critical care patients. Although this procedure is considered to provide better patient comfort and a lower infection risk compared to other methods, it has a higher risk of complications, such as pneumothorax, arterial puncture, nerve injury, and bleeding. Ultrasonography (USG)-guided subclavian catheterization has recently become a popular technique. This study retrospectively analyzed 50 patients in the intensive care unit (ICU) who underwent infraclavicular subclavian catheterization with the out-of-plane technique under USG guidance. Objectives: This study aimed to evaluate the effectiveness of subclavian catheterization applied with the out-of-plane technique in the ICU. Methods: This retrospective study included 50 patients who underwent subclavian CVC insertion via the out-of-plane technique under USG guidance in the ICU between March and December 2020. Age, gender, height, weight, body mass index, admission to the ICU, use of anticoagulant and/or anti-aggregant medicine, and coagulation parameters were recorded for each patient. The success of the procedure, the number of attempts, and the duration of the procedure were scanned retrospectively from the records. Malposition and complications were monitored using USG throughout the procedure and chest radiographs after the procedure. Results: The 50 patients comprised 27 (54%) men and 23 (46%) women, with a mean age of 72. 8±, 11. 8 years. In all patients, subclavian CVC insertion was successfully performed under USG guidance via the out-of-plane technique. The mean procedural time was 220. 90±, 60. 20 sec. The procedure was completed in a single session for 27 (54%), two sessions for 22 (44%), and three sessions for 1 (2%) patient. Only one complication (pneumothorax) developed in one patient, who underwent tube thoracostomy. No catheter malposition was observed in other patients. Conclusion: USG-guided subclavian catheterization is a safe technique to be performed by experienced practitioners.

Background: Although tracheostomy is not performed as frequently as in adults, it is also used in children. There is no clear consensus on timing and risk factors, especially in early infancy and in cases who underwent cardiac surgeries. In the early infancy period, pediatric cardiac surgery patients have to receive an inotropic agent after the cardiac surgery due to poor general condition or hemodynamic instability. As a result of prolonged intubation, tracheostomy is required to be performed in some of these patients. Objectives: The present study aimed to investigate the relationship between vasoactive inotropic scores (VIS) and tracheostomy in pediatric cardiac surgery patients. Methods: A total of 47 patients, 21 with tracheostomy and 26 without tracheostomy, who underwent cardiac surgery were included in this retrospective study. The VIS and inotrope score (IS) values were calculated and recorded hourly for 48 h postoperatively. Scores were calculated by multiplying the inotropes infusion rate of the patients with certain coefficients. It was attempted to determine objective formalized models and cut-off values that may benefit the relationship between VIS values and tracheostomy. Results: The median weight was 3, 630 g (range, 2, 040-13, 400), and the median age was 69 days (range, 1-1, 081) on the surgery day. The majority (93. 6%) of the patients were aged < 1 year. Preoperative C-reactive protein measurements were significantly higher by 50% in patients who underwent tracheostomy (P=0. 005). The albumin levels in the tracheostomy group (TG) were low, although not significantly (P=0. 057). The VIS values of TG had 50% higher values than the non-tracheostomy group (NTG) (P<0. 001). In addition, formula 1 predicted with 57% accuracy that a tracheostomy could be performed (VIS =18. 170-0. 170* HOUR,P < 0. 001), and formula 2 predicted with 72% accuracy that a tracheostomy could not be performed (VIS =17. 170-0. 170* HOUR,P < 0. 001). Hospital stay (P<0. 001), mechanical ventilation duration (P<0. 001), and the number of ongoing intubation on the 7 th day post-surgery were significantly higher in TG. Conclusion: After pediatric cardiac surgery, VIS values can predict tracheostomy status and help intensive care professionals make decisions.