Iranian Red Crescent Medical Journal
Year:2023 | Volume:25 | Issue:12|Papers Count:8

Background: During the COVID-19 pandemic, health professionals have experienced a variety of mental health challenges. Studies on the anxiety levels of Turkish midwives during the pandemic are limited. The present research aimed to describe the anxiety levels of midwives during the COVID-19 pandemic. Materials and Methods: This cross-sectional study was conducted using a web-based basis between 08-29 June 2020. The sample of the study consisted of 606 midwives. The Generalized Anxiety Disorder 7-item (GAD-7) scale was used to measure the midwives' anxiety. Results: The mean general anxiety disorder score of the participants in the study was found to be 7. 88 ± 5. 36. It was observed that 259 (42. 7%) showed symptoms of generalized anxiety disorder. Key risk factors,the state of midwives experiencing anxiety disorder symptoms increases 12. 182 times in individuals with a family at risk of COVID-19, and 5. 458 times in cases where working hours are 45 hours or more per week (P<0. 05). Coclusion: Based on the findings of the present research, symptoms of generalized anxiety disorder were observed in nearly half of the midwives. Major reasons for anxiety among midwives included having family members in the COVID-19 risk group that they were responsible for and working over standard working hours. Midwives should be protected from the risk of contamination and provided with adequate personal protective equipment, working hours should be improved, and personal empowerment programs should be offered to support them in coping with anxiety.

Background: Blood cancer is a type of cancer that affects the blood cells derived from the bone marrow. Leukemia, lymphoma, and myeloma are the most common subtypes. Usually, bone marrow transplantation (BMT) is performed alongside curative treatments, such as chemotherapy and radiotherapy to transfuse healthy hematopoietic stem cells into a person after their own unhealthy bone marrow has been treated to kill invasive cells. Objectives: The aim of this study was to compare the percentage of remission (cure rate) between different types of blood cancer. Methods: In this retrospective cohort study, 458 patients who received BMT between 2007 and 2014 were analyzed. Patients were followed up until 2017 to determine whether they were still alive or had relapsed. The defective Marshall-Olkin Extended Weibull model was used with death being the event of interest. Results: The study included 34 cases of acute lymphoblastic leukemia, 155 cases of multiple myeloma, 59 cases of acute myeloid leukemia, 156 cases of Hodgkins lymphoma, and 54 cases of non-Hodgkin 's lymphoma. The cure rate was highest in patients with Hodgkin 's lymphoma and multiple myeloma, while it was lowest in patients with acute lymphoblastic leukemia. in addition, age had an inverse effect on the cure rate for blood cancer (P=0. 003), and relapse after BMT had a negative effect on the cure rate (P=0. 003). In addition, relapse before transplantation had no effect, and body mass index was found to influence cure rate. A sensitivity analysis showed that the estimated cure rates increased slightly with decreasing cohort length. Conclusion: Multiple myeloma and Hodgkin 's lymphoma had the highest cure rate, while acute lymphoblastic leukemia is barely curable. Obesity may increase the potential for cure and the experience of recurrence after BMT is associated with a lower cure rate.

Background: Although the use of systemic narcotics has been established as the gold standard in pain control after surgery, the literature shows the possibility of a higher incidence of delirium after systemic administration of analgesics compared to regional methods, such as epidural and paravertebral analgesia. Objectives: To compare the rate of postoperative delirium when treated with systemic intravenous patient-controlled analgesia (IVPCA) with regional analgesia methods (continuous or patient-controlled). Methods: We searched PubMed, Web of Science, Embase, and Scopus databases for relevant papers reporting delirium after surgery based on the regional analgesia methods compared with systemic IV analgesia. Risk ratios for delirium were pooled using a random effects model. Results: 6 randomized clinical trials (RCT) with a total of 898 cases were selected in which delirium was observed 2 to 7 days after the operation. In a random-effect model of the risk ratio of delirium in patients receiving IVPCA versus patients receiving regional PCA, with 487 and 486 participants in each arm, there was a retrospective1. 85-fold higher risk of delirium with a 95% confidence interval of 1. 35 to 2. 53 compared with regional methods of analgesia (I2=0%,low heterogenicity). Although we attempted a comprehensive review of the literature, publication bias occurre, so we imputed the missing studies to the literature by the trim-and-fill method, which forced us to imput the missed studies of the literature by trim and fill method that showed the similar adjusted results of RR=1. 75, 95% CI: 1. 29 to 2. 39. The RCTs assessed had relatively low quality evidence. Conclusion: There appears to be a large difference in delirium risk between the methods compared, with blinded trials with larger sample sizes required Safety and cost-benefit aspects should also be considered before the clinical application of these results.

Background: Most proximal humerus fractures (4-5% of all systemic fractures) can be treated without surgery through early mobilization. However, the management of displaced fractures remains a subject of debate. Objectives: To evaluate the outcomes of closed reduction and percutaneous pinning for two-part surgical neck fractures of the proximal humerus. Methods: This was a retrospective analysis of 19 patients (8 men and 11 women with a mean age of 21. 9 years) undergoing treatment in the Third Hospital of Hebei Medical University from January 2017 to December 2018 for surgical neck fractures of the proximal humerus. In 7 cases, the tails of Kirschner wires were linked with bone cement to prevent withdrawal after closed reduction and percutaneous pinning. The tails were attached to the unilateral external fixation in the other 12 patients to promote stability. A paired t-test was used to compare constant scores. Results: The mean constant score after operation was 82. 4 at 3 months, 93. 4 at 6 months, and 93. 7 at 1 year. The score improved significantly from 3 to 6 months in both the bone cement and external fixation groups (P<0. 05). The rate of K-wire loosening was lower with external fixation versus bone cement (8. 3% vs 57. 1%, P=0. 038). Conclusion: The closed reduction and percutaneous pinning method showed good outcomes for two-part surgical neck fractures. External fixation provides better stability compared to cement fixation alone. This minimally invasive approach is an alternative to open reduction in selected patients.

Background: Pulmonary thromboembolism (PTE) is a common and potentially life-threatening disease with manifestations similar to many other diseases, including myocardial infarction, pericarditis, myocarditis, and pneumonia. The present study aimed to assess clinical symptoms, some paraclinical parameters, and related risk factors in patients with confirmed pulmonary embolism. Methods: In this retrospective study, the data of 709 patients who were admitted to Dr. Shariati Research and Treatment Center with confirmed diagnosis of PTE were examined over a period of three years. Results: The mean age of patients was 56. 48±17. 84 years, and 47. 2% of participants were female. The most common signs and symptoms were dyspnea (87. 9), tachycardia (52. 6%), and cough (41. 9%), respectively. The most common comorbidities in the subjects entailed malignancy (51. 1%), postoperative immobility (42%), and pneumonia (41. 2%), respectively. Based on logistic regression analyses, congestive heart failure (CHF) followed by diabetes mellitus (DM) were the most common comorbidities associated with various clinical features of PTE. Moreover, clinical manifestations displayed some associations with electrocardiography (EKG) changes and venous blood gas (VBG) indices. Conclusion: Despite its highly nonspecific clinical manifestations, the diagnosis of PTE remains a challenging issue. This study presented related signs and symptoms, clinical risk factors, comorbidities, and PTE-related EKG changes, which will help physicians properly approach and diagnose this life-threatening disease by considering all aspects.

Background: Burns are among the most life-threatening forms of trauma requiring timely and effective treatment. Objectives: The present study aimed to assess the inhibitory effect of remifentanil on the stress response of burn patients undergoing escharectomy and skin grafting. Methods: A total of 52 patients undergoing burn scab removal surgery were selected and randomly assigned to two groups: remifentanil group (group R) and fentanyl (group F). Anesthesia induction: Group R was administered an intravenous injection of propofol, rocuronium, and remifentanil, while Group F received an intravenous injection of propofol, rocuronium, and fentanyl. After tracheal intubation, group R was injected intravenously with remifentanil and propofol to maintain anesthesia. Group F was induced with fentanyl. Thereafter, the patient's blood pressure and heart rate (HR) were recorded. Subsequently, their carotid artery blood was withdrawn, and they were tested for epinephrine (E), norepinephrine (NE), and blood glucose. Finally, the patients' eye-opening time and extubation time at the end of anesthesia were recorded. Results: After anesthesia induction, the mean artery pressure, HR, and E in group R were lower than those in group F. There was no statistically significant difference between the levels of NE in the two groups. Nonetheless, the eye-opening time and extubation time in group R were significantly shorter than those in group F. Conclusion: Compared to fentanyl, remifentanil can more effectively reduce the stress response of surgery and anesthesia. It can integrate anesthetic drugs with blood pressure control. Furthermore, this method is simple, effective, safe, and reliable.

Background: The increasing frequency of traffic accidents within public transportation systems leads to economic and public health challenges. It is essential to investigate predictive factors for high-risk driving behaviors, encompassing physical, psychological, personality, and health-related aspects. Objectives: The present study examines the correlation between a driver's "Mizaj" (temperament) and their driving behavior, as well as the associated risk of accidents. Additionally, the study evaluates the link between smoking habits and drivers' behavior. Methods: In this cross-sectional study conducted in Tehran, Iran, a total of 253 bus drivers participated. They were evaluated using a temperament questionnaire, the Manchester Driving Behavior Questionnaire, data on smoking habits, driving experience, and the number of accidents over the past three years. Correlations among temperament, smoking habits, driving behavior factors, and accident frequencies were determined by Pearson's correlation coefficients. Results: Among the study participants, 97 reported one or more traffic accidents while driving. Statistically significant associations were found between road accidents and factors such as driving experience, smoking, type of temperament, and driving behavior. It is noteworthy that drivers with a hot temperament had a higher incidence of accidents compared to those with cold or moderate temperaments (P-value < 0. 05). Moreover, smokers reported significantly more accidents (P-value < 0. 01) and higher scores for violations and errors in driving behavior (P-value < 0. 01). In addition, drivers with a first-grade driver's license and more than 15 years of experience reported a significantly lower number of accidents (P-value < 0. 05). Conclusion: The results of the present research indicate a clear association between temperament and driving behavior. Bus drivers with a hot temperament were more prone to accidents, violations, and driving errors compared to those with cold or moderate temperaments. Furthermore, drivers with a dry temperament faced a higher risk of accidents than those with a wet temperament.

Background: Hospitals are the main providers of health services during an epidemic. Given their involvement in human life, it is especially vital that they maintain consistent high-quality services. Objectives: This study aimed to identify the challenges in the resilience of hospital service quality during the coronavirus pandemic. Methods: This qualitative study was conducted using a content analysis method in the last quarter of 2021 and the first quarter of 2022. Seventeen senior and middle managers of Shiraz University of Medical Sciences and from affiliated hospitals assigned as coronavirus centers were included in the study. Data were analyzed using Graneheim and Lundman's method in the MAXQDA 2020 software. Results: Challenges affecting the quality of hospital services during the pandemic were summarized under 9 main themes, namely "providing human resources, resolving extra-organizational issues, providing tools and equipment, treating psychosomatic disorders, resolving pharmaceutical issues, hospital management, nature of the disease, providing financial resources, and providing physical infrastructure, " and 58 sub-themes. Senior and middle managers introduced human resources as the main challenge. Conclusion: Resilience of hospital service was one of the governing indicators of the Ministry of Health during the coronavirus pandemic. Despite many efforts in this field, there are still numerous challenges in the country's hospitals, highlighting the need for planning to prepare hospitals for epidemic conditions.