Bosentan and Pulmonary Hypertension Caused by COVID-19: A Pilot Randomized Double-blind Clinical Study.

INTRODUCTION/OBJECTIVE: Coronavirus disease 2019 (COVID-19) has been the biggest pandemic in history, with severe complications, such as acute respiratory distress syndrome and pulmonary hypertension (PH). An endothelin-1 (ET-1) receptor antagonist, such as bosentan, may be beneficial in treating elevated ET-1 levels. Hence, our study aimed to evaluate the therapeutic effects of bosentan in patients with COVID-19-induced PH. METHODS: A single-centre, randomized, double-blind study involving 72 participants was carried out; 36 received bosentan and the other 36 received a placebo. Pulmonary arterial pressure, tricuspid valve pressure gradient, and right atrial pressure were measured using echocardiography. The Cox proportional hazards regression model was used to investigate the impact of bosentan and patients' age on mortality during a 6-month follow-up period. RESULTS: In-hospital mortality was significantly lower in the case group (13%) compared with the control group (33.3%) (P=0.003). Additionally, bosentan improved echocardiographic parameters, such as systolic pulmonary artery pressure and tricuspid regurgitation gradient (P=0.011 and P=0.003, respectively). Bosentan use was a significant predictor of long-term mortality rates for 600 days [age-adjusted hazard ratio of 5.24 (95% CI 1.34 to 20.46)]. CONCLUSION: This study provided a mixed perspective on the use of bosentan therapy in patients with COVID-19-related PH. Bosentan effectively reduced in-hospital mortality and improved echocardiographic measures. However, the treatment group showed an increased requirement for supplemental oxygen therapy and long-term mortality. Further studies with larger sample sizes are necessary to elucidate the effects of bosentan in PH following COVID-19.

Pattern of Traumatic Injuries in Patients with Tramadol Poisoning: A Cross-Sectional Study in a Tertiary Care Hospital.

Objective: This study aimed to investigate the incidence and pattern of tramadol-induced seizures and injuries in patients admitted to the hospital. Methods: The cross-sectional study included 300 patients with alleged tramadol intoxication. Demographic information, tramadol dosage and duration of abuse, co-existing illicit drug abuse, hospital stay length, and occurrence of seizures and trauma (type and site of injuries) were collected. Different statistical tests, including the Mann-Whitney U-test, Pearson's Chi-square test, and Student's t-test, were conducted to compare the patients with and without seizures, trauma, and co-ingestion of illicit drugs. The analysis was performed using SPSS software (version 21.0). A p value of less than 0.05 was considered statistically significant. Results: The average patient's age was 24.66±5.64 years, with males comprising 84.3% of the sample. The mean tramadol dose and duration of abuse were 1339.3±1310.2 mg and 2.43±1.35 years, respectively. Seizures were observed in 66% of patients, with men having a higher incidence (69.6% vs. 46.8%; p=0.004). Trauma was reported in 23% of patients, accounting for 35.4% of seizure cases. All trauma patients had experienced seizures, with the head and neck being the most prevalent injury sites (55.1%), typically presenting as abrasions (55.9%). Patients with seizures and trauma had an average hospital stay of 1.73±0.94 days, which was significantly longer. Conclusion: Trauma occurs in more than one-third of tramadol-induced seizures, highlighting the need to perform physical examinations to detect and localize injuries. Tramadol-associated traumas prolonged hospitalization times and thus required prompt attention to prevent further injuries during pre-hospital handling and transferring to hospitals.

Factors Determining Primary Coronary Slow Flow Phenomenon among Opium Users and Non-users: A Case Control Study in Northern Iran.

Background: Coronary slow flow phenomenon (CSFP) represents a clinical entity with recurrent chest pain leading to living impairment. The present study aimed to investigate whether opium use correlates with primary CSFP. Methods: This study included Iranian patients with suspected coronary artery disease who underwent myocardial perfusion imaging. Coronary blood flow was measured quantitatively using the thrombolysis in myocardial infarction (TIMI) frame count and slow flow was defined as TIMI grade 2 standard deviations. Age and clinical conditions including diabetes mellitus (DM), hypertension (HTN), hyperlipidemia (HLP), history of chest pain, and opium use were recorded. First, the characteristics of the two groups were compared and then the main analyses were conducted to examine the relationship between CSFP and opium use. Data were analyzed using t test and chi-square test via SPSS 25.0. The significance level was set at P<0.05. Findings: This study was conducted on 44 male patients with documented CSFP who had no stenotic lesions and 134 control group male patients who had normal coronary arteries with normal flow. The mean age was similar in the two groups (54.25 vs.52.69, P=0.474). Two groups were significantly different in terms of history of chest pain (P=0.003), but there was no significant difference in HTN (P=0.084), DM (P=0.284), HLP (P=0.183), smoking (P=0.696), and opium use (P=0.107). Conclusion: This study indicated that opium use is not associated with primary CSFP.

Ivermectin-Induced Clinical Improvement and Alleviation of Significant Symptoms of COVID-19 Outpatients: A Cross-Sectional Study.

Although several drugs have been proposed and used to treat the COVID-19 virus, but recent clinical trials have concentrated on ivermectin. It appears that ivermectin can potentially act against COVID-19 and stop the development in its infancy. The purpose of this study was to determine the effect of ivermectin on the recovery of outpatients with COVID-19. In this cross-sectional study, we compared the symptoms reduction in COVID-19 disease in two groups of patients by administering ivermectin. A total of 347 mild outpatients in the Iranian provinces of Qazvin and Khuzestan with a confirmed PCR were enrolled. The symptoms of outpatients with COVID-19 were analyzed using SPSS (V23). In this cross-sectional study, the sex ratio was 0.64 (female/male: 37.9/59.8) and most patients were under 50 years old (72.8%). The results of this study demonstrated a significant decrease in several COVID-19 disease symptoms, including fever, chills, dyspnea, headache, cough, fatigue, and myalgia in the group administered ivermectin compared to the control group. In addition, the odds ratio of the above symptoms was significantly lower in patients who received ivermectin than in patients who did not receive the drug (OR = 0.16, 95% CI = 0.09, 0.27).

Comparison of elevated cardiac troponin I with SAPS-II and APACHE-II score in predicting outcome of severe intoxications.

Background and Aims: To date, different methods have been invented to risk-stratify critically ill patients, however, there is a paucity of information regarding assessing the severity of poisonings. This study was designed to determine the comparative efficacy of Simplified Acute Physiology Score-II (SAPS-II) and Acute Physiology and Chronic Health Evaluation-II (APACHE-II)score with cardiac troponin I (cTnI) in predicting severe intoxication outcomes. Methods: This was a prospective study conducted on patients who fulfilled defined severe intoxication criteria necessitating intensive care unit (ICU) admission over a period of 6 months. SAPS-II and APACHE-II scores were calculated and cTnI concentrations were measured. These indicators were compared to determine which has the better ability to prognosticate mortality and complications. Results: A total of 55 cases (median age, 35 [24-49] years) were enroled. Eight patients (14.5%) died. Mean SAPS-II, median APACHE-II score and median cTnI concentrations were 32.05 ± 11.24, 13 [10-17] and 0.008 [0.002-0.300] ng/ml, respectively, which were significantly different between the survivors and non-survivors. Receiver operating characteristics curve results of SAPS-II, APACHE-II score and cTnI concentrations in predicting mortality were 0.945, 0.932 and 0.763 and in predicting complications were 0.779, 0.739 and 0.727, respectively. High cTnI concentration (>0.37 ng/ml) correlated with soft clinical outcomes, including length of ventilatory support, length of ICU stay and length of hospital stay (LOS) (r: 0.928, 0.881 and 0.735 respectively; all P < 0.001). Conclusion: SAPS-II scores were superior in predicting death and complications, while cTnI correlated more closely with soft clinical outcomes, such as the length of ventilator support, length of ICU stay or LOS.

Evaluation of domperidone efficacy to prevent aspiration pneumonia in patients with acute ischemic stroke: a randomized clinical trial.

BACKGROUND AND AIM: Aspiration pneumonia is an essential complication of acute ischemic stroke (AIS), which is responsible for increased three-fold mortality within a month. There is an interest towards the effect of prokinetics on prevention of stroke-associated pneumonia. The present study aimed to investigate the effect of domperidone to prevent pneumonia in patients with AIS. METHODS: In this randomized clinical trial, 150 patients with AIS were assigned to receive either domperidone 10 mg daily or placebo during hospitalization. The clinical outcomes including of aspiration pneumonia occurrence, gastrointestinal discomfort, the need for intensive care unit admission, the length of hospitalization, final mRs, and mortality were then evaluated in both groups. RESULTS: 150 [Mean age 67.5 ± 13.5 years, 90 men and 60 women] were randomized in a 1:1 ratio. Both groups were similar in terms of baseline characteristics. The domperidone group experienced significantly less dysphagia, nausea and vomiting, and aspiration pneumonia (P < 0.005). Although domperidone did not considerably reduce the mortality (P = 0.978), it resulted in lower mean mRS and shorter length of hospitalization (P < 0.001). CONCLUSION: Domperidone is an effective and well tolerated agent which could be considered as a promising agent to prevent stroke-associated pneumonia leading to a better clinical recovery.

Finasteride in hospitalized adult males with COVID-19: A risk factor for severity of the disease or an adjunct treatment: A randomized controlled clinical trial.

Background: There is controversy about the efficacy of 5-alpha-reductase inhibitors in COVID-19 patients. Some assumed that finasteride might be a risk factor for deterioration and others proposed it as a possible adjunct treatment for moderate to severe COVID-19 infection in the elderly. Methods: We performed a randomized controlled clinical trial (registration ID IRCT20200505047318N1) on 80 hospitalized male patients aged ≥50 years diagnosed with COVID-19 pneumonia in a tertiary hospital in Qazvin (Iran) from April to July 2020. The patients were randomized into one of the 2 treatment groups using simple randomization. Treatment group patients underwent routine drug therapy and 5 mg finasteride once daily for 7 days. The primary endpoint was mortality rate and length of hospital stay (LOS), and secondary endpoints were peripheral capillary oxygen saturation, respiratory rate, and inflammatory markers changes. The study protocol was approved by the medical ethics committee of Qazvin University of Medical Sciences (registration ID IR.QUMS.REC.1399.080). Data were analyzed by statistical tests and SPSS version 25. Also, p<0.05 was considered to be statistically significant. Results: We found a significant difference on O2 saturation among the 2 study groups on fifth day compared with the admission time (p= 0.018). The results did not show significant differences in mortality rate (2.5% vs 10%; p= 0.166) and LOS (p= 0.866) between patients in the finasteride and the control group. Conclusion: A short course of finasteride administration partially improves O2 saturation but does not influence other outcomes in hospitalized male patients aged ≥50 years with COVID-19 pneumonia. Further research in a large scale with longer follow-up is required to help clarify the role of finasteride in this setting.

Opium-associated QT Interval Prolongation: A Cross-sectional Comparative Study.

BACKGROUND: Toxicity and side effects of long-term use of opioids are well studied, but little information exists regarding electrophysiological disturbances of opium consumption. While natural opium has been regarded safe to a great extent among traditional communities, concerns are emerging owing to the available evidence of QT prolongation that have been exposed during recent outcome surveillance of patients under opioid use. Potential QT prolonging interactions would raise a higher level of such concern in opium users during COVID pandemic and warrant attention. MATERIALS AND METHODS: This study was designed to detect the prevalence of QTc prolongation among opium users and nonusers. Two groups were compared with regard to gender, age, and median QTc interval. Normal and prolonged QTc intervals of user group were compared with respect to age, sex, dose of opium consumption, and duration of opium consumption. RESULTS: 123 opium users and 39 controls were investigated. Median QTc interval in opium user and non-user group was 460 vs 386 milliseconds, respectively (p value < 0.001). In all, 59.3%, (95% CI: 50.51-67.62%) of cases and none of non-user had prolonged QTc interval (p value < 0.001). There was no significance between normal and prolonged QTc intervals with respect to dose and duration of opium use. CONCLUSION: This study indicated that opium consumption is associated with QTc prolongation. This prolongation does not relate to dose and duration of opium use. Further study is propounded to assess the clinical significance of these results and to determine risk rating of opium compared to other opioids in this regard. HOW TO CITE THIS ARTICLE: Javadi HR, Mirakbari SM, Allami A, Yazdi Z, Katebi K. Opium-associated QT Interval Prolongation: A Cross-sectional Comparative Study. Indian J Crit Care Med 2021;25(1):43-47.

Changes in plasma lipid and in-hospital deaths in patients with sepsis.

Background: Lipid profiles are infrequently measured in clinical management of sepsis patients. Sepsis leads to significant alterations in the metabolism of lipids. The aim of the present study was to determine whether changes in plasma lipid concentrations during sepsis treatment were associated with clinical outcome. Methods: In this study, 74 adult septic patients were included in this prospective observational study from January to December 2017. Patients taking lipid lowering agents were excluded. A detailed medical history was obtained and clinical examination was performed. Serum total cholesterol (STC) and its fractions [low-and high-density lipoprotein] and triglyceride levels were measured in the morning of the first day after admission and then once weekly. The primary outcomes of the study were in-hospital mortality, and hospital stay and hypocholesterolemia were defined as STC levels < 50 mg/dL. Manne-Whitney U and chi-squared tests were used for data analysis, and significance level was set at p<0.05. Results: In this study, 78.4% (CI 95%: 67.3-87.1) of patients had hypocholesterolemia. During the study period, 21.6% (CI 95%: 12.9- 32.7) of patients died. All lipid (except TG) concentrations continuously decreased in deceased sepsis patients but increased in recovering patient (p value for STC (p=0.004), LDL (p=0.006), HDL (p=0.010), and TG (p=0.052)). The serum lipids concentration was not associated with length of hospital stay (p value for STC (p=0.524), LDL (p=0.813), HDL (p=0.799) and TG (p=0.581)). Conclusion: In this study it was found that the additional decline of lipid profile was significantly associated with increased mortality rate of sepsis patients. Thus, the clinically termed 'the lipaemia of sepsis' is not true in all situations.

Long-term immunogenicity of hepatitis B vaccine and impact of a booster dose on health care.

Background: Accidental exposure to sharp instruments is an important problem for health care students. Thus, the aim of this study was to determine the rate of immunity in health care students 2 decades after national neonatal hepatitis B (HB) vaccination. Methods: All junior students attending medicine, nursing and midwifery schools were screened for anti-HBs. One dose of hepatitis B vaccine was offered to all participants who did not have antibodies to HB surface antigen (anti-HBs) of > 10 IU/L; then, they were tested for anti-HBs after a month. The participants were classified into 3 groups: postboosting nonimmune, postboosting immune, and preboosting immune. Chi square test and ANOVA were used for data analysis. Results: In the first step, 65.20% of participants did not show immunity, but after receiving a booster dose, only 6.0% remained nonimmune. The mean age of nonimmune students was significantly higher than that of students who had postboosting immune and preboosting immune status (p=0.001 and 0.002, respectively). Also, the mean injection time from last shot was higher in postboosting immune group compared to preboosting immune group (p<0.001). Also, prebooster anti-HBs level was significantly different among participants with suboptimal response and those who developed anamnestic response, indicating preserved immune memory (p=0.001). Conclusion: High anamnestic response to HBV booster dose indicates sufficient immunity to HBV in the majority of health care students. However, identifying students who cannot respond to a booster dose of vaccine seems to be necessary at the beginning of health care courses.

Bacteriology of moderate-to-severe diabetic foot infections in two tertiary hospitals of Iran.

BACKGROUND: Approximately 25% of people with diabetes will experience diabetic foot ulcers (DFUs) during their lifetime. The present study was designed to determine the type of microorganisms isolated from the DFUs and their antibiotic resistance pattern, and to determine predisposing factors contributing to antibiotic resistance at the authors' wound care clinic in Qazvin, Iran. METHODS: A cross-sectional study was conducted from May to December 2017. One specimen for microbiological studies was obtained from the deep tissue. All demographic, clinical, and laboratory data and results of ulcer culture were collected for each case. Antimicrobial susceptibility testing to different agents was carried out using the disc diffusion method. A p value < 0.05 was considered significant. RESULTS: 95 aerobic microorganisms were isolated from 105 specimens. Among Gram-positive and negative bacteria, Staphylococcus spp. and Escherichia (E). coli were the most frequent organisms isolated, respectively. Multidrug resistant (MDR) organisms constituted up to 48.4%, with 37.5% of isolated Enterococcus spp. being VRE, 48.8% of Staphylococcus spp. being methicillin-resistant, 77.8% of isolated E. coli being ESBL and 66.7% of isolated Pseudomonas being MDR. The minimum and maximum prevalence of resistance in Gram-negative bacteria were 17.6% and 87.5% for imipenem and ceftazidime, respectively. The prevalence of Gram-negative bacilli was higher in older patients (p value = 0.039) and rose markedly in patients with a higher number of hospitalizations (p value = 0.015). CONCLUSION: Due to emergence of antibiotic resistance pathogens, culture specimens and antibiotic sensitivity testing are essential for correct management of the DFU infections and the selection of appropriate antibiotics.

Comparison of the Effect of Two Kinds of Iranian Honey and Diphenhydramine on Nocturnal Cough and the Sleep Quality in Coughing Children and Their Parents.

Coughing in a child induced by upper respiratory tract infections (URTIs) can be a problem, both for the child and its parents. Current studies show a lack of proven efficacy for over-the counter (OTC) medications, but promising data support the use of honey for children. The aim of this study was to compare the effects of two kinds of Iranian honey with diphenhydramine (DPH) on nocturnal pediatric coughs and the sleep quality of children and their parents. This was a clinical trial (registered in IRCT; No.: 28.20.7932, 15 October 2013). The study consisted of 87 patients. All the parents completed a standard previously validated questionnaire. The children were randomly assigned to one of three treatment groups: Group 1, Honey type 1 (Kimia Company, Iran) (n = 42), Group 2, Honey type 2 (Shahde-Golha, Iran) (n = 25), and Group 3, DPH (n = 20). Each group received double doses of the respective treatments on two successive nights. A second survey was then administered via a telephone interview in which the parents were asked the same questions. The mean scores for all aspects of coughs were significantly decreased in each group before and after the treatment. All three treatments improved the cough and sleep scores. Honey type 1 was superior to DPH in improving all aspects of coughs, except the frequency, and Honey type 2 was more effective than DPH in improving all aspects of coughs, except the sleep quality of the child. There was no significant difference between Honey type 1 and 2 in any aspects of cough relief in the present study. The results suggest that honey may provide better cough relief than DPH in children and improve the sleep quality of children and their parents.

Comparison between the Outcomes of Intracoronary and Intravenous Administration of Eptifibatide during Primary Percutaneous Coronary Intervention in Patients with Acute ST-Elevation Myocardial Infarction.

AIM: To compare the outcomes of intracoronary (IC) and intravenous (IV) administration of eptifibatide during primary percutaneous coronary intervention (PPCI) in patients with ST-elevation myocardial infarction (STEMI). METHODS: In this prospective double-blind randomized clinical trial, 76 patients with STEMI selected for PPCI were randomly assigned in two groups to receive either IC or IV bolus of eptifibatide. The primary end point was coronary perfusion assessment by thrombolysis in myocardial infarction (TIMI) flow grade (TFG), TIMI perfusion grade (TPG), and corrected TIMI frame count (cTFC). Secondary end points were left ventricular ejection fraction (LVEF) restoration, ST-segment elevation resolution, and in-hospital major cardiovascular adverse events (MACEs) (including recurrent MI, need for target vessel revascularization (TVR), stroke, and death resulting from any cause) until discharge. RESULTS: Assessment revealed significantly better TFG (95% CI: 1.01-10.26, OR=3.224, P=0.042), more TFG 3 (65.79% vs. 86.11% in IV and IC groups, respectively), better TPG (P=0.024), more achieved TPG 3 and TPG 2＋3 (TPG 3: 44.74% vs. 72.22% and TPG 2＋3: 78.95% vs. 94.44% in the IV and IC groups, respectively) with better cTFC in the IC group (37.33±15.84 vs. 32.53± 20.71 in the IV and IC groups, respectively; P=0.034). LVEF was better restored in the IC group (6.21±8.61% vs. 14.72±5.34% in the IV and IC groups, respectively; P＜0.001) and the ST-segment elevation resolution was better achieved in the IC administration (95% CI: -22.55 to -6.23, P=0.001). There were no recurrent MI, stroke, or need for TVR among patients during the in-hospital stay. CONCLUSIONS: IC administration of eptifibatide during PPCI in patients with STEMI in comparison with IV administration of eptifibatide is associated with significantly better coronary reperfusion and improved clinical outcomes (IRCT2012090510751N1).

Seroepidemiology of Varicella and value of self-reported history of Varicella infection in Iranian medical students.

OBJECTIVES: We conducted this study to assess the seroprevalence of Varicella zoster virus (VZV) antibodies in a group of Iranian medical sciences students that were at risk of Varicella and the value of self-reported history as a predictor of immunity. MATERIAL AND METHODS: 255 medical, nursing and obstetrics students who had not entered as a student or worked in a hospital from 3 different schools were enrolled in the study in 2012 (Qazvin province, Iran). Demographics and other information as well as the history of Varicella were obtained through a self-administered questionnaire. Blood samples were collected to determine the Varicella IgG levels via an enzyme-linked immunosorbent assay. A statistical analysis was performed by calculating prevalences and their 95% confidence intervals. Sensitivity, specificity, positive and negative predictive values, Cohen's kappa and positive and negative likelihood ratios of recalled history were determined. p < 0.05 was considered statistically significant. RESULTS: The mean age of participants was 21.3 ± 4.3 years. Seropositivity rate was 74.5%. The relationships between marital status, number of family members, and acquired VZV history with immunity against the virus were statistically significant. The overall rate of reported history was 57%. The positive and negative predictive values of self-reported history of Varicella were 91% and 47.3%, respectively. CONCLUSIONS: Immunization of students of Iranian medical sciences seems logical in the near future. Also, they should be tested for Varicella immunity regardless of the history of previous infection.

Opium dependency and in-hospital outcome of acute myocardial infarction.

BACKGROUND: Impact of substance abuse on outcome of hospitalized patients with acute myocardial infarction (MI) is a frequent question. Available studies show disagreements over its impact, thus we performed this study to find a clear answer. METHODS: In a cross sectional study, 304 patients (include 152 consecutive opium dependents and equal number of independents) with acute MI admitted to coronary care units (CCU) in Bou-Ali Sina Hospital of Qazvin University of Medical Science were enrolled. Data on demographics (e.g. age, sex and education), identified MI risk factor (smoking and diabetes), clinical findings (e.g. Killip class and in-hospital mortality), ECG findings (e.g. localization of infarction and arrhythmia), echocardiographic examinations (e.g. ejection fraction and regional wall motion abnormality) and laboratory findings (lipid profile, glycemic situation) were gathered. RESULTS: The mean age was 63.01±12 years for opium users and 64.3± 10 for non-users. Educational level was higher in patients who used opium. No significant differences were found between opium users and non-users in rate of hypertension, diabetes mellitus, hyperlipidemia, and cigarette smoking. The mean duration of experienced chest pain in hospital stay was significantly higher in non-opium users compared to opium users (1.78± 0.63 vs.1.52±0.54) (p< 0.001). Higher Killip class and arrhythmia have been identified as the most important independent predictors of early in-hospital mortality (in both groups). CONCLUSION: The higher Killip class and age identified as the most important independent predictors of early in-hospital mortality and addiction do not act as a major risk or protecting factor in this context. Nevertheless, we believe that a more comprehensive study with follow up of patients should be carried out for evaluation of opium addicted patients, their outcome after MI, and a better decision making for their treatment.

Varicella immunity in Iran: an age-stratified systematic review and meta-analysis.

OBJECTIVES: To generate synthesized information on the epidemiology of VZV infection, as well as an estimation of prevalence of age-specific antibody in Iranian less than 40. MATERIAL AND METHODS: After exclusion of irrelevant and overlapping reports, 15 papers were included (from nine major cities). Studies were pooled according to the heterogeneity test results. Random effect model methods were used for meta-analysis where significant heterogeneity was observed (age 1-16years).For other age groups, fixed model were used. RESULTS: Significant heterogeneity was observed in prevalence rates of all childhood age-groups. The seropositivity prevalence increased steeply from the age of 1-5 to 6-10 [from 21.9% (95% CI; 10.8-33.1) to 42.1 %(95% CI; 33.6-50.6)]. At the age of 11 15, 59.4% (95% CI; 46.1-72.8) of children showed to be infected. The rate of seropositivity was more than 87% in individuals of 40 and older. CONCLUSION: The varicella seroeprevalence in Iran is in accordance with average tropical and temperate areas. Comparison of conducted studies during 2003 to 2011 didn't show any alteration in VZV seroprovalence in Iran.

Percutaneous exposure incidents in nurses: Knowledge, practice and exposure to hepatitis B infection: Percutaneous exposure incidents in nurses.

BACKGROUND: Nurses are at risk of percutaneous exposure incidents (PEIs), which may lead to serious or even fatal blood-borne infections. OBJECTIVES: To determine the prevalence of PEIs in the last year, among nurses and to assess their knowledge about and frequency of safe method of practice in exposure to blood-borne pathogens (especially, to HBV). MATERIALS AND METHODS: A cross-sectional study in 2008 was conducted on 138 nurses working in general surgery and obstetrics/gynecology services of Qazvin University of Medical Sciences, Qazvin, Central Iran. A questionnaire for assessment of risk factors for contracting HBV infection was completed by nurses. RESULTS: Overall, the prevalence of needle stick injury (NSI) and direct exposure to body fluids were 52.9% (95% CI: 44.5%-61.3%) and 65.4% (95% CI: 57.4% - 73.8%), respectively. There was no statistically significant difference between the two studied centers in terms of sharp injuries; however, the rate of repeated NSI (number per each year ≥3) and mucocutaneous exposures were significantly higher in the general surgery ward. The overall coverage of vaccination in the two studied centers was 96.3%, but the rate of accurate answers to many questions pertaining to knowledge and practice were less than 50%. CONCLUSIONS: Nurses are still at significant risk for developing NSI and mucocutaneous exposure. Continuous educational programs (especially by highlighting the seriousness of the problem) are necessary for improving this situation because inadequate education might increase unsafely practice.