The Effects of Surgery Cancellation on Patients, Families, and Staff: A Prospective Cross-Sectional Study.

PURPOSE: This study aimed to investigate the effects of surgery cancellation, as a common and never-ending problem within preoperative care, and its related factors on patients, family members, and medical staff. DESIGN: The research design implemented a prospective cross-sectional type. METHODS: This study was conducted for four months in two main teaching/general medical centers. The data collection tool was comprised of three researcher-made questionnaires for patients, families, and medical staff, separately. The samples also included a total number of 315 patients, family members, and medical staff. FINDINGS: The results revealed that the frequency distribution of all physical and emotional effects was higher in men than in women though it was not statistically significant. Each patient had been fasting for an average of 13.26 hours until the announcement of surgery cancellation. The most prevalent physical effects in the patients were hunger, thirst, and headache, respectively. The average cost of each surgery cancellation for the patients was almost twice that for the family members. There was a significant correlation between emotional effects in the patients and the families and the reason for cancellation and informants. CONCLUSIONS: Each surgery cancellation increased fasting time in patients by an average of 5 to 7 hours. Cancellation also correspondingly led to economic harms for the patients and the families, waste of operating room resources, and duplications. Since the most common reasons for surgery cancellation were patient-related and a significant correlation was observed between the reason for cancellation and emotional effects in the patients and the families, our recommendation is to strengthen patient protocols in terms of preoperative preparation and to review admission and information processes for patients undergoing surgeries.

Early-onset Alzheimer's disease in two Iranian families: a genetic study.

BACKGROUND: Early-onset Alzheimer's disease (EOAD) represents less than 5% of all AD cases. Autosomal dominant EOAD has been defined as the occurrence of at least three cases in three generations. Mutations in the amyloid precursor protein (APP), presenilin-1 and presenilin-2 genes have been recognized to be the cause of EOAD. OBJECTIVE: We investigated the genotype of EOAD in two generations of two families with EOAD living in an Iranian village. METHODS: The polymerase chain reaction method was used to study the presenilin-1 and APP genes in 25 subjects of these generations. RESULTS: A guanine-to-adenine transition in exon 17 of the APP gene resulting in a valine-to-isoleucine substitution at codon 717 was detected in 14 subjects including 6 patients with EOAD. CONCLUSION: This mutation demonstrates the importance of γ-secretase, the necessity of early detection of patients with memory decline in the susceptible population and raising public awareness of consanguinity marriages.

Association of rs4588 polymorphism in vitamin D binding protein gene with polycystic ovarian syndrome in Iranian women: a case-control study.

OBJECTIVE: Vitamin D deficiency and variations in the vitamin D binding protein (VDBP) gene may play a role in the development of Polycystic ovary syndrome (PCOS). This study aims to investigate the association of the rs4588 polymorphism with PCOS in Iranian women, as well as its association with infertility and recurrent pregnancy loss (RPL) in these patients. RESULTS: The analysis revealed statistically significant differences in the distributions of genotypes and alleles of the rs4588 polymorphism among the three groups (p < 0.0001). The AC genotype and A allele showed an association with an elevated risk of PCOS and infertility. In this study, no association was found between genotypes and alleles of the rs4588 polymorphism and the risk of RPL in women with PCOS. Subjects with the AA or AC genotype exhibited significantly higher levels of LDL compared to those with the CC genotype.

Effects of magnetic field on cell dedifferentiation and callus induction derived from embryo culture in bread wheat (Triticum aestivum. L) genotypes.

Current study was conducted to investigation of effect of magnetic field on cell dedifferentiation and follow it callus induction derived from mature embryo culture in bread wheat genotypes. For this purpose, a factorial experiment based on completely randomized design was carried out with two wheat genotypes and three level of magnetic field strength (0.0, 8.8 and 17.6 Tesla) in three replications. Callus growth rate (CGR), relative growth rate (RGR), callus relative growth rate (CRGR), percentage of callus water content and percentage of callus induction traits were measured. To sum up, the results showed that differences between wheat genotypes and level of magnetic field strength were significant for some studied treats related to callus induction. The effect of magnetic field levels on CGR (from 0.181 to 0.175), RGR (from 1.442 to 0.655) and CRGR (from 0.052 to 0.022) were decreased with increment of magnetic field intensity.

Development and implementation of an intraoperative documentation protocol for enhancing patient safety in the operating room: A mixed methods protocol study.

BACKGROUND: Documentation is an important part of the patient care process; however, there is no regular program for documenting intraoperative care in Iran. This study was conducted to design an intraoperative documentation for enhancing patient safety in the operating room (OR). MATERIALS AND METHODS: This exploratory, mixed-methods, qualitative-quantitative study (in 2021) consists of four phases. The first phase involves a conventional content analysis of healthcare providers in the OR to identify the needs, strategies, and content of a pertinent documentation. In this phase, purposeful sampling will be used to collect data through semi-structured interviews. In the second phase, a literature review will be carried out to extract the documentation procedures in the intraoperative period in many other countries. In the third phase, a panel of experts is recruited and the classic Delphi (RAND) technique is run to validate the initial draft of the designed program and, the protocol is then finalized. In the last phase, the designed protocol will be implemented through a quasi-experimental study in one group (before and after intervention), and the effectiveness of the intervention will be evaluated. DISCUSSION: To design a protocol for intraoperative documentation, healthcare providers' experiences during surgery in the Iranian healthcare setting, where the lack of documentation might forensically harm both the healthcare providers and the patients, will be explored. This information alongside some universal standards developed in other countries should help improve patients' safety in ORs.

Competency assessment of the operating room staff and some related factors: A multi-center cross-sectional study.

Background: Operating Rooms (ORs) are complicated environments that necessitate the improvement of OR staff's knowledge and skills to remain clinically competent and secure patient safety. The aim of this study was to assess clinical competence of OR staff in accordance with some related factors. Materials and Methods: This descriptive analytical cross-sectional study was conducted on 227 OR staff in nine academic hospitals. Sampling was performed from the beginning to the end of May 2019 and the samples were selected by quota sampling. Data were collected using a researcher-made questionnaire encompassing six dimensions of competency including general knowledge, specialized knowledge, general practical skills, specific practical skills, personality, and motivation. Data analysis was performed using descriptive and interpretive statistics. Results: The mean (SD) total score of competence was 80.99, which was optimal (11.28). The lowest score was related to the dimension of general practical skills with the mean (SD) score of 53.32 (10.26). The mean score of specialized practical skills was significantly higher in single-specialty ORs (F = 21.53, p < 0.001). Based on multiple linear regression test, it was possible to predict clinical competency through the age and work experience (R-squared = 0.96, beta = 0.31, p = 0.022). Conclusions: Specialized training has overshadowed the general practical skills that are related to the observation of basic principles of patient safety apart from surgical specialization. Strengthening of competence in general practical skills need to be prioritized in empowerment programs. We need a fixed and permanent space for the continuation of educational programs designed to promote perioperative general practical skills.

Prevalence of surgical site infection after orthopaedic surgery with two types of drainage at three public hospitals in Iran.

INTRODUCTION: Orthopaedic surgical site infections (SSIs) are among the most important and prevalent because implanted devices are used in such surgeries which increase the risk of infection. This study aimed to examine the incidence of infection in orthopaedic surgeries and related factors in a group of public hospitals in Iran. METHODS: This analytical cross-sectional study was condcuted in 2018. Data were collected about the incidence of infection and related factors including use/non-use of drains and well as types of drain . The presence of SSIs were determined using a researcher-devised Wound Infection Checklist (WIC) and microbial cultures. RESULTS: Of 110 included patients undergoing orthopaedic surgeries, 18.2% had an infection. The highest rate of infection was associated with lower extremity surgeries following tibia and fibula fractures. The incidence of infection among individuals under the age of 35 years was also higher. Emergency procedures demonstrated a higher incidence of infection. No significant relationship was observed between use of wound drains and development of SSIs. CONCLUSION: Reducing the incidence of orthopaedic infection can be achieved by focusing more attention on open fractures occurring in the lower extremity. Use of surgical drains for the sole purpose of reducing the rate of infection is not effective. Accordingly, infection provention protocols should be implemented in orthopaedic surgery units to control and reduce rates of infection.

Erratum: Mitochondrial G8292A and C8794T mutations in patients with Niemann-Pick disease type C.

[This corrects the article DOI: 10.3892/br.2018.1095.].

Mitochondrial G8292A and C8794T mutations in patients with Niemann-Pick disease type C.

Niemann-Pick disease type C (NP-C) is a neurovisceral lipid storage disorder. At the cellular level, the disorder is characterized by accumulation of unesterified cholesterol and glycolipids in the lysosomal/late endosomal system. NP-C is transmitted in an autosomal recessive manner and is caused by mutations in either the NPC1 (95% of families) or NPC2 gene. The estimated disease incidence is 1 in 120,000 live births, but this likely represents an underestimate, as the disease may be under-diagnosed due to its highly heterogeneous presentation. Variants of adenosine triphosphatase (ATPase) subunit 6 and ATPase subunit 8 (ATPase6/8) in mitochondrial DNA (mtDNA) have been reported in different types of genetic diseases including NP-C. In the present study, the blood samples of 22 Iranian patients with NP-C and 150 healthy subjects as a control group were analyzed. The DNA of the blood samples was extracted by the salting out method and analyzed for ATPase6/8 mutations using polymerase chain reaction sequencing. Sequence variations in mitochondrial genome samples were determined via the Mitomap database. Analysis of sequencing data confirmed the existence of 11 different single nucleotide polymorphisms (SNPs) in patients with NP-C1. One of the most prevalent polymorphisms was the A8860G variant, which was observed in both affected and non-affected groups and determined to have no significant association with NP-C incidence. Amongst the 11 polymorphisms, only one was identified in the ATPase8 gene, while 9 including A8860G were observed in the ATPase6 gene. Furthermore, two SNPs, G8292A and C8792A, located in the non-coding region of mtDNA and the ATPase6 gene, respectively, exhibited significantly higher prevalence rates in NP-C1 patients compared with the control group (P<0.01). The present study suggests that there may be an association between mitochondrial ATPase6/8 mutations and the incidence of NP-C disease. In addition, the mitochondrial SNPs identified maybe pathogenic mutations involved in the development and prevalence of NP-C. Furthermore, these results suggest a higher occurrence of mutations in ATPase6 than in ATPase8 in NP-C patients.

Prevalence of the rs7903146C>T polymorphism in TCF7L2 gene for prediction of type 2 diabetes risk among Iranians of different ethnicities.

BACKGROUND: Pharmacogenetics is the study of genetic polymorphisms affecting responses to drug therapy. The common rs7903146 (C>T) polymorphism of the TCF7L2 gene has recently been associated with type 2 diabetes (T2D). In this study, prevalence of the rs7903146 (C>T) polymorphism in the TCF7L2 gene for prediction of T2D risk was examined in an Iranian population of different ethnicities. METHODS: The prevalence of rs7903146 (C>T) and the predicted phenotypes, including extensive metabolizers, intermediate metabolizers, and poor metabolizers were investigated in blood samples of 300 unrelated healthy individuals in an Iranian population, including Fars, Turk, Lure, and Kurd, using polymerase chain reaction restriction fragment length polymorphism and direct genomic DNA sequencing. RESULTS: The homozygous wild-type (C/C), heterozygous (C/T), and homozygous (T/T) allelic frequencies of rs7903146 (C>T) in the TCF7L2 gene were 29% (extensive metabolizers), 66.34% (intermediate metabolizers), and 4.66% (poor metabolizers), respectively. The C/C, C/T, and T/T genotypic frequencies of the rs7903146 (C>T) allele were significantly different (P<0.01) among Iranians of different ethnicities. The frequency of the homozygous T/T variant of the rs7903146 (C>T) allele was significantly low in the Lure (P<0.01) and high in the Fars (P<0.001) ethnicities. Additionally, the frequency of the T/T variant of the rs7903146 (C>T) allele in the South of Iran was the highest (P<0.04), while the East of Iran had the lowest frequency (P<0.01). CONCLUSION: The prediction of rs7903146 (C>T) is required in drug research and routine treatment, where the information would be helpful for clinicians to optimize therapy and adverse drug reactions and predict drug response in individuals at risk of T2D.

Prevalence of the CYP2D6*10 (C100T), *4 (G1846A), and *14 (G1758A) alleles among Iranians of different ethnicities.

The presence of polymorphisms in the CYP2D6 gene may modulate enzyme level and activity, thereby affecting individual responses to pharmacological treatment. Here, we compared the prevalence of the CYP2D6*10, *4, and 14* alleles in an Iranian population of different ethnicities with those of other populations. Allele and genotype frequency distributions of CYP2D6*10 variants and predicted phenotypes including extensive metabolizers, intermediate metabolizers, and poor metabolizers were analysed in blood samples of 300 unrelated healthy individuals in an Iranian population using polymerase chain reaction (PCR)-restriction fragment length polymorphism, PCR-single-strand conformation polymorphism, and direct genomic DNA sequencing. The CYP2D6*4 (G1846A) and *14 (G1758A) allelic frequencies were not detected in different ethnicities, demonstrating the absence of a significant contribution of these alleles in Iranian populations. However, the T/T, C/T, and C/C genotype frequencies of the CYP2D6*10 allele were significantly different (P<0.01) in all Iranian ethnic groups. Additionally, the frequency of the homozygous T/T variant of the CYP2D6*10 allele was significantly high in the Lure (P<0.017) and low in the Kurd (P<0.002) ethnicities. The frequency of the T/T variant of the CYP2D6*10 allele in central Iran was the highest (P<0.001), while the south of Iran had the lowest frequency (P<0.001). The frequency of the C/T variant of the CYP2D6*10 allele was significantly a bit high (P<0.001) in females compare to males, while the frequencies of the T/T variant in females is similar to males, which are 24.4% and 24.3%, respectively. In contrast to absence of the CYP2D6*4 (G1846A) and *14 (G1758A) alleles in Iranian populations of different ethnicities, the prediction of the CYP2D6*10 allele is required in drug research and routine treatment, where the information would be helpful for clinicians to optimize therapy or identify persons at risk of adverse drug reactions before clinical trials. Approximately 39.3% of subjects (24.3% homozygous T/T CYP2D6*10 as poor metabolizers and 15% heterozygous C/T CYP2D6*10 as intermediate metabolizers) had this allele; therefore, the harmful effects of drugs are relatively common among Iranians.

Health-State Utilities in Liver Cirrhosis: A Cross-sectional Study.

OBJECTIVES: Liver cirrhosis can change many aspects of life of the patients and their family and effects society. We aimed to study the utility of cirrhosis from the point of view of the patients, their family, and their care takers to find appropriate interventions, and training and counselling programmes to support patients. METHODS: In this cross-sectional study with a goal-based sampling method, 66 individuals constructed of 30 decompensated patients with cirrhosis, 21 of the patients family members, and 15 care takers were included. The data were collected through face to face interview and completing of questionnaire consisted of demographic information (age, gender, marital status, and income), the duration of illness, and assessment of utility of cirrhosis using techniques of time trade, standard gamble, rating scale, and the willingness to pay. RESULTS: 52% of participants were men and 48% women which consisted of 58 married, 4 single, and 4 divorced or widowed with the mean duration of having cirrhosis of 3.7 ± 1.4 years. The mean scores of utility of the three groups in all preference-based measures had significant differences (P < 0.05). Different techniques of patient utility in this research from the highest to the lowest were standard gamble (0.55), willingness to pay (0.54), rating scale (0.25), and rating scale (0.05), respectively. CONCLUSIONS: The results of the currents study suggested that the cirrhosis status has had the most negative effect on patients, and that patients had a lower utility rate than their family members and caretakers.