Iranian Red Crescent Medical Journal
Year:2022 | Volume:24 | Issue:11|Papers Count:7

Background: Agenesis of the inferior vena cava (IVC) is an extremely rare congenital malformation. Although frequently symptomatic, due to its low prevalence, agenesis of IVC may often be missed in the normal workup. Most of the reports are related to the loss of IVC alone, while the reports of simultaneous loss of IVC and bilateral iliac veins are rare. Acute deep venous th rombosis is also one of the causes of chronic deep venous ulcer, especially in children with acute deep venous thrombosis, which is an important cause of neglect and missed diagnosis. When color Doppler ultrasound cannot be clear, attention must be paid to computerized tomography examination. Case Presentation: We reported a case of IVC below renal vein hypoplasia in an 8-year-old girl who presented bilaterally with persistent pain in both lower limbs. Ultrasonography revealed no clear IVC and iliofemoral venous system under the renal venous plane. Conclusion: This case is a rare congenital malformation of IVC. It is rare in children with venous thrombosis-related symptoms. We intended to demonstrate the etiology of the appearance of venous thrombosis in children through this case.

Background: Early diagnosis of cystic fibrosis (CF) and hence the initiation of symptomatic and prophylactic treatment can help improve the outcomes of CF patients. Fecal calprotectin (FC) is a marker of inflammation in the intestinal tract that is elevated in several gastrointestinal inflammatory diseases, but little is known about its value in CF. Objectives: This study, therefore, aimed to survey the associations of FC among CF patients and its correlation with the clinical manifestations of CF. Methods: This descriptive cross-sectional study was performed on 52 children with CF visiting the Children’, s Hospital of Tabriz, Iran, during 2018-2019, selected through the census sampling method. The calprotectin values of <50 μ, g/g were considered normal. Results: There was no clinically relevant association among FC levels concerning pancreatic insufficiency, diabetes, and airway colonization with Pseudomonas. In a comparison of the number of exacerbations and Forced Expiratory Volume in the first second (FEV1), the levels of electrolytes showed no significant difference between patients with normal calprotectin and elevated FC. The results of the performed analysis indicated no significant difference between the low-fecal elastase and the FC levels in patients with CF (P=0. 53). Conclusion: Demographic and clinical parameters, such as age, gender, FEV1, or Body Mass Index, had no clinically significant relationship with FC. However, serial and longitudinal calprotectin levels should also be checked, which may have clinical relevance during symptomatic episodes.

Background: Specific conditions arising from the COVID-19 pandemic may affect the mental health of nursing students. Objectives: This study aimed to investigate the mental health of nursing students and associated factors during the COVID-19 pandemic at Ahvaz and Kermanshah Universities of Medical Sciences in Iran. Methods: This cross-sectional study was conducted on 384 nursing students at Ahvaz and Kermanshah Universities of Medical Sciences in Iran from May 10, 2021, to June 26, 2021. The required data were collected using a web-based questionnaire via social networks, such as WhatsApp and Telegram. Symptom Checklist-25 (SCL-25) was used to measure mental health. Descriptive statistics and stepwise linear regression were used to analyze the data. Results: The mean total mental health score was 47. 48±, 16. 03, and 235 (61. 0%) students had good mental health, 124 (32. 2%) cases had suspected mental disorders, and 26 (6. 8%) respondents had severe mental disorders. Using the stepwise regression method, four variables, including gender, history of mental illness, history of coronavirus infection or being suspected of having coronavirus, and level of trust in statistics about the incidence and mortality rate of COVID-19 had the greatest impact on mental health modeling. Conclusion: In general, the COVID-19 pandemic may have a negative impact on the mental health of nursing students. Therefore, it is very important to identify and consider the factors that can reduce their mental distress.

Background: Orthotopic liver transplant (LT) is often associated with massive blood loss and significant transfusion requirements. Recent recommendations for resuscitation strategy in massive bleeding include the transfusion of balanced blood products, fresh frozen plasma (FFP), platelets, packed red blood cells (PRBC), and restricted use of crystalloids. Objectives: To evaluate whether the intraoperative transfusion ratio of fresh frozen plasma to packed red blood cell units (FFP: PRBC ≤, 1: 1 versus >1: 1) plays a positive role in reducing PRBC transfusion in LT. Methods: This is a retrospective study of 84 liver transplant recipients who received at least one PRBC unit during the surgery. The patients were grouped into those who received intraoperative FFP: PRBC ratio ≤, 1: 1 (low ratio) versus the ratio>1: 1 (high ratio). Selected perioperative variables were compared between the two groups. Results: Patients in the low-ratio versus high-ratio group had lower intraoperative requirements for PRBC (P<0. 001). Importantly, in the high-ratio group, the mean postoperative PRBC transfused units were 1. 76 times that of the low-ratio group (incidence rate ratio [IRR], 1. 76,95% CI=1. 07-2. 90). There was a significant difference between the two groups in preoperative body mass index (P=0. 047), hemoglobin (P=0. 005), and surgical time (P=0. 071),moreover, all the variables were higher in the high-ratio group. After adjusting the variables, postoperative PRBC consumption in the low-ratio group was 43% less than that in the high-ratio group (P=0. 007). Conclusion: The intraoperative low-ratio transfusion was associated with a reduced need for total PRBC transfusion in LT.

Background: Information dashboards are useful tools for up-to-date decision-making by visualizing data. Objectives: This study aimed to report the development of a dashboard in the emergency department (ED) during COVID-19 in a big hospital in Iran. Methods: The authors developed a dashboard by user-centered design (UCD) methodology in four phases, namely specification of the context of use, specification of the requirements, creation of design solutions, and evaluation. Indicators were determined by reviewing previous studies and interviewing focus groups with an expert panel. The Power BI Desktop software was used for the development of the dashboard. Users’,comments about the dashboard were collected. The dashboard was then developed and revised according to the users’,feedback and suggestions. Finally, user satisfaction was evaluated. Results: The authors identified 30 indicators for COVID-19 ED, classified as input, output, and process indicators. The final version of the dashboard was implemented in 2021, and then 28 ED and managerial staff participated in the evaluation of the dashboard. The average score of the system usability scale of the dashboard was 84. 10 points, and the situation awareness index was 3. 97, which indicates “, good”,usability and situation awareness. Conclusion: This dashboard presented key managerial and clinical indicators for decision-making in ED. Future studies can be designed to develop dashboards for accidents and burns EDs and create emergency information dashboards for several hospitals for better management in times of crisis.

Background: Spindle cell carcinoma (sarcomatoid carcinoma) is a rare carcinoma that accounts for 2-3% of all laryngeal malignancies. Here, we present a case with laryngeal tumor diagnosed as Spindle cell carcinoma. Case Presentation: Fifty-nine-year-old male patient was admitted to our clinic with the complaint of hoarseness and shortness of breath that has been increasing for 10 months. Indirect laryngoscopy performed on the patient, and a polypoid lesion was detected in the anterior of the left vocal cord. The patient was admitted to our clinic for direct laryngoscopy and the lesion was completely excised from the base. The case was diagnosed as “, sarcomatoid carcinoma in histopathological examination. Conclusion: Sarcomatoid carcinoma is usually diagnosed and treated at an early stage. So, it has a good prognosis. However, it has a poor prognosis in the advanced stage.

Context: Insurance plays a significant role in health systems financing. The existence of multiple risks increases the costs of insurance organizations. The present study aimed to identify cost management strategies in health insurance. Evidence Acquisition: A scoping review was conducted by focusing on published Persian and English studies in the field of health insurance worldwide by the end of June 2020. Valid keywords were searched in PubMed, Scopus, Web of Science, SID, Magiran, Google, and Google scholar. A list of authoritative sources and journals was also assessed. A total of 51 articles met the inclusion criteria and were analyzed using MAXQDA software. Results: In total, 97 cost management strategies were identified and classified into 3 groups of providers, insured individuals, and insurance organizations. The most important cost management strategies in the field of insurance internal processes are modifying payment methods and monitoring provided services and prescribed medications to providers, cost sharing, deductible, consumption management, and cultivating the use of services by insured people, strategic purchasing, coverage constraints, internal controls, using risk management and employing specialized personnel. Also, other insurance supervision institutions significantly reduce costs. Conclusion: Policymakers and managers plan and apply corrective interventions and appropriate changes to reduce the costs of insurance companies by understanding the cost control strategies of health insurance.