Journal of Isfahan Medical School
Year:2023 | Volume:41 | Issue:751|Papers Count:3

Background: Congenital heart disease is one of the most common birth defects. This study aims to examine the process of clinical guideline implementation to identify strengths and weaknesses.Methods: In this cross-sectional study, healthy term and term neonates born from January 2023 to July 2023 were evaluated at Shahid Beheshti Hospital in Isfahan. The data collection tool was a checklist. The pulse oximetry (POX) was performed for healthy newborns within the first 24 hours after birth and before discharge from the hospital. Oxygen saturation (SpO2) < 89% in the baby's hand and foot was considered positive screening. If the SpO2 level was between 90-94%, the screening was repeated one hour later and if in the case of the same results, the newborn was referred to a specialist for further assessment. Healthy neonates with positive test results were followed up two months after primary POX screening.Findings: Out of 500 neonates, 472 (94.4%) had a SpO2 level ³ 95%. Among the 21 cases who had a positive screening, one case had cardiac diseases (i.e., complete atrioventricular septal defect/pulmonary hypertension). Two healthy neonates with a positive screening were diagnosed with PFO after two months of follow-up. The assessment of the implementation process of newborn screening based on the checklist recommendations of clinical guidelines increased from 58.3 % to 91.6 % within six months.Conclusion: The implementation of the critical congenital heart disease clinical guideline was found to be favorable and acceptable in this study and recommended for other hospitals to implement.

Background: Abdominoplasty due to the two maneuvers of fascia plication and flap resection is associated with the possibility of increased intra-abdominal pressure and its related complications. This study was conducted to evaluate the changes in intra-abdominal pressure during abdominoplasty, as well as its variables and possible complications.Methods: This research was conducted as a cohort study on 20 female patients who underwent lipoabdominoplasty in 2022-2023 at Taleghani and Ghaem hospitals, Mashhad City, Iran. Patient information was collected in both demographic and clinical sections. Intra-abdominal pressure was recorded after anesthesia, plication, at the end of the operation, and the day after the operation, along with monitoring complications for one month.Findings: There was a statistically significant difference in the mean changes in intra-abdominal pressure after anesthesia, plication, at the end of the operation, and the day after the operation. The increase in intra-abdominal pressure after anesthesia and after plication was only significantly related to the increase in the weight of the surgical specimen, but it wasn’t related to plication width.Conclusion: Plication width was not related to increased intra-abdominal pressure in our study. Despite the significant increase in intra-abdominal pressure, no significant systemic complications were observed. In addition to monitoring the patient, the correct technique will ensure the safety and satisfaction of the patient.

Background: Considering the high burden of the COVID-19 disease and the pressure that was put on the health care system, especially in the intensive care unit (ICU), the examination of variables predicting the outcome of this disease can help in better understanding of patients at risk and more useful allocation of limited resources.Methods: Patients with COVID-19 hospitalized in the ICU of Al-Zahra Medical Center were investigated in an observational (descriptive-analytical) study. Demographic, clinical, and laboratory findings were compared to find factors affecting mortality between two groups of deceased and survived patients. A comparison of demographic, clinical, and laboratory findings was conducted to identify factors influencing mortality rates in deceased and survived patients.Findings: 1144 patients with COVID-19 were examined in the study, of which 674 were men (58.9%) and 470 were women (41.1%). The patients were split into two groups: 432 patients (37.8%) died, and 712 patients (62.2%) survived. The variables of white blood cells (P < 0.001), neutrophil (P < 0.001), neutrophil to lymphocyte ratio (P = 0.004), blood urea nitrogen (P < 0.001), creatinine (P = 0.037), procalcitonin (P < 0.001), D-dimer (P < 0.001), length of hospitalization (P < 0.001) and oxygen therapy (P < 0.001) were directly related with mortality and the highest odd ratio was related to neutrophil count (OR = 3.59). Variables of lymphocyte (P = 0.028), eosinophil (P < 0.001), hemoglobin (P < 0.001), platelet (P = 0.007), sodium (P < 0.001), potassium (P < 0.001), magnesium (P < 0.001), prothrombin time (P < 0.001), respiratory rate group (P < 0.022) and respiratory symptom (P < 0.032) were inversely related to mortality and the lowest odd ratio was related to magnesium (OR = 0.01).Conclusion: Examining clinical and laboratory characteristics helps us in better evaluation of patients, recognition of risk factors involved in the progression of the disease, and better management of patients.