RESUMEN
Various severe acute respiratory syndrome coronavirus 2 vaccines with different platforms have been administered worldwide; however, their effectiveness in critical cases of COVID-19 has remained a concern. In this national cohort study, 24 016 intensive care unit (ICU) coronavirus disease-2019 (COVID-19) admissions were included from January to April 2022. The mortality and length of ICU stay were compared between the vaccinated and unvaccinated patients. A total of 9428 (39.25%) patients were unvaccinated, and 14 588 (60.75%) patients had received at least one dose of the vaccine. Compared with the unvaccinated, the first, second, and third doses of vaccine resulted in 8%, 20%, and 33% lower risk of ICU mortality in the adjusted model, with risk ratio (RR): 0.92, 95% confidence interval (CI): 0.84-1.001, RR: 0.80, 95% CI: 0.77-0.83, and RR: 0.67, 95% CI: 0.64-0.71, respectively. The mean survival time was significantly shorter in the unvaccinated versus the fully vaccinated patients (hazard ratio [HR]: 0.84, 95% CI: 0.80-0.88); p < 0.001). All vaccine platforms successfully decreased the hazard of ICU death compared with the unvaccinated group. The duration of ICU stay was significantly shorter in the fully vaccinated than in unvaccinated group (MD, -0.62, 95% CI: -0.82 to -0.42; p < 0.001). Since COVID-19 vaccination in all doses and platforms has been able to reduce the risk of mortality and length of ICU-stay, universal vaccination is recommended based on vaccine availability.
Asunto(s)
COVID-19 , Vacunas , Humanos , COVID-19/prevención & control , Irán/epidemiología , SARS-CoV-2 , Vacunas contra la COVID-19 , Estudios de Cohortes , Unidades de Cuidados IntensivosRESUMEN
BACKGROUND: The intensive care unit (ICU) is the most important department for critically ill patients. Different scoring systems are used to assess the severity of the disease and evaluate organ failure during the patient's stay in ICU. AIMS: Our purpose was to evaluate the C-reactive protein/Albumin (CRP/Alb) ratio and SOFA score as indicators of 28-day mortality in ICU patients. MATERIALS AND METHOD: A total of 55 patients were enrolled in this study. CRP and CRP/Alb rates, SOFA scores, and demographic data were used to evaluate 28-day mortality in a referral hospital. RESULTS: Survived and dead patients were significantly different in the CRP, CRP/Alb rates, and SOFA scores. However, in the adjusted model, the SOFA score was the predictor of 28-day mortality in ICU patients. CONCLUSION: SOFA score was also confirmed as a predictor of mortality in ICU patients. Besides, the role of CRP and CRP/Alb in the prediction of disease prognosis or mortality requires further studies.
RESUMEN
This study aims to compare the efficiency of Pregabalin and Ketotifen in treatment of uremic pruritus in hemodialysis (HD) patients. Thirty HD patients were randomly divided into two groups: A (Pregabalin 50 mg three times a day) and B (Ketotifen 1 mg twice a day). Efficacy of treatment and quality of life were weekly evaluated by visual analogue scale (VAS) and Itchy Quality of life, respectively. There was no significant difference between the two groups regarding demographic features, laboratory data, quality of life, and VAS before treatment. In the second week of treatment, the pruritus intensity was significantly lower in the Pregabalin group than the Ketotifen group (p = 0.026). The mean of life quality was significantly lower in Ketotifen than Pregabalin group in weeks 1, 2, and 4 (p = 0.001, p = 0.001, and p = 0.036, respectively). There was no significant difference between the two groups regarding the side effects of drugs. This study showed that a higher dose of Pregabalin could be a more effective treatment than Ketotifen without additive side effects in improving the quality of life in dialysis patients.
Asunto(s)
Cetotifen , Uremia , Humanos , Cetotifen/efectos adversos , Pregabalina/efectos adversos , Prurito/diagnóstico , Prurito/tratamiento farmacológico , Prurito/etiología , Calidad de Vida , Diálisis Renal/efectos adversos , Uremia/complicaciones , Uremia/diagnóstico , Uremia/terapiaRESUMEN
BACKGROUND: Hemoglobin A1C (HbA1C) test is the best care evaluation measurement due to a strong correlation between the test results and diabetic complications. So, this cross-sectional study aimed to assess whether the level of HbA1C can predict Diabetic Retinopathy (DR) among Type 2 diabetes mellitus (T2DM) in the Iranian population. METHOD: One hundred sixty-eight diabetic patients were selected via the convenience sampling method. Data were collected by research made questionnaire scale and laboratory test had been done. To estimate the cut off point for some variables statistical tests, formal measures of classification performance, model evaluation criteria and a decision Tree were used. RESULTS: The prevalence of DR was 29.8%. The Receiver Operating Characteristic (ROC) curve and decision tree showed the optimal cut-off point for the HbA1C variable that separates the patient with and without DR is HbA1C = 8.15. CONCLUSION: Current study showed an appropriate cutoff point for detecting the development of DR among diabetic patients. So, this cutoff point can be used as guide evidence in several clinical judgments on the Iranian population.
Asunto(s)
Diabetes Mellitus Tipo 2 , Retinopatía Diabética , Humanos , Hemoglobina Glucada/análisis , Diabetes Mellitus Tipo 2/complicaciones , Estudios Transversales , Irán/epidemiología , Factores de RiesgoRESUMEN
PURPOSE: Acetazolamide is utilized as a treatment which falls effective in treating some type of CSA. Hence, it might be effective as far as opium addicts who suffer from CSA are concerned. MATERIALS AND METHOD: The current study was a double-blind, placebo-controlled, cross-over study ( clinicalTrials.gov ID: NCT02371473). The whole procedures were identical for both placebo and acetazolamide phases of clinical research. There were 14 CSA more than 5/h and more than 50% of apnea-hypopnea index (AHI). Out of these 14 patients, 10 volunteered to participate in the study. Fast Fourier transformation was used to separate heart rate variability (HRV) into its component VLF (very low frequency band), LF (low frequency band), and HF (high frequency band) rhythms that operate within different frequency ranges. RESULT: There are significant results in terms of decreased mix apnea and central apnea together due to acetazolamide compared with placebo (P < 0.023). Time of SatO2 < 90% is decreased as well (P < 0.1). There is also decrease of SDNN and NN50 after treatment with acetazolamide respectively (P < 0.001). Regarding fast Fourier transformation, there is increase of pHF and decrease of pLF after acetazolamide treatment (P < 0.001). CONCLUSION: Acetazolamide seems to be effective in improving oxygenation and a decrease of mixed and central apnea events together. In HRV analysis section, LF power has decreased significantly, which may more likely improve prognosis of the patients.
Asunto(s)
Acetazolamida/uso terapéutico , Analgésicos Opioides/efectos adversos , Trastornos Relacionados con Opioides/fisiopatología , Apnea Central del Sueño/inducido químicamente , Apnea Central del Sueño/tratamiento farmacológico , Estudios Cruzados , Método Doble Ciego , Femenino , Humanos , Masculino , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
Following publication of the original article [1], the authors flagged that name of the author 'Batoul Khoundabi' had been provided with an incorrect spelling: 'Batoutl' was given in place of 'Batoul'.
RESUMEN
BACKGROUND: Idiopathic pulmonary arterial hypertension (IPAH) is a fatal illness. Despite many improvements in the treatment of these patients, there is no unique prognostic variable available to track these patients. The aim of this study was to evaluate the association between fractional exhaled nitric oxide (FeNO) levels, as a noninvasive biomarker, with disease severity and treatment outcome. METHODS: Thirty-six patients (29 women and 7 men, mean age 38.4 ± 11.3 years) with IPAH referred to the outpatient's clinic of Masih Daneshvari Hospital, Tehran, Iran, were enrolled into this pilot observational study. Echocardiography, six-minute walking test (6MWT), FeNO, brain natriuretic peptide (BNP) levels and the functional class of patients was assessed before patients started treatment. Assessments were repeated after three months. 30 healthy non-IPAH subjects were recruited as control subjects. RESULTS: There was no significant difference in FeNO levels at baseline between patients with IPAH and subjects in the control group. There was also no significant increase in FeNO levels during the three months of treatment and levels did not correlate with other disease measures. In contrast, other markers of disease severity were correlated with treatment effect over the three months. CONCLUSION: FeNO levels are a poor non-invasive measure of IPAH severity and of treatment response in patients in this pilot study.
Asunto(s)
Espiración , Hipertensión Pulmonar Primaria Familiar/metabolismo , Óxido Nítrico/análisis , Adulto , Antihipertensivos/uso terapéutico , Biomarcadores/análisis , Estudios de Casos y Controles , Hipertensión Pulmonar Primaria Familiar/tratamiento farmacológico , Femenino , Humanos , Irán , Masculino , Persona de Mediana Edad , Proyectos Piloto , Pronóstico , Resultado del TratamientoRESUMEN
Lymph node (LN) status is an essential prognostic factor in breast cancer (BC) patients, with an important role in the surgical and therapeutic plan. Recently, we have been developed a novel system for real-time intra-operative electrical LN scanning in BC patients. The ELS scores were calibrated by pathological evaluation of the LNs. Herein, we evaluated the efficacy of ELS in a prospective study for non-chemo-treated breast cancer patients. This is a prospective study in which ELS scores are blind for pathologists who declare the clearance or involvement of LNs based on permanent pathology as the gold standard. ELS and frozen-section (FS) pathology results were achieved intra-operatively, and samples were sent for the permanent pathology. The score of ELS did not affect the surgeons' decision, and the treatment approach was carried out based on FS pathology and pre-surgical data, such as imaging and probable biopsies. Patients were recruited from October 2021 through November 2022, and 381 lymph nodes of 97 patients were included in the study. In this study we recruited 38 patients (39.2%) with sentinel lymph node biopsy (SLNB) and 59 patients (60.8%) with ALND. Of the 381 LNs scored by ELS, 329 sentinel LNs underwent routine pathology, while others (n = 52) underwent both FS and permanent pathology. ELS showed a sensitivity of 91.4% for node-positive patients, decreasing to 84.8% when considering all LNs. Using ROC analysis, ELS diagnosis showed a significant AUC of 0.878 in relation to the permanent pathology gold standard. Comparison of ELS diagnosis for different tumor types and LN sizes demonstrated no significant differences, while increasing LN size correlated with enhanced ELS sensitivity. This study confirmed ELS's efficacy in real-time lymph node detection among non-chemo-treated breast cancer patients. The use of ELS's pathological scoring for intra-operative LN diagnosis, especially in the absence of FS pathology or for non-sentinel LN involvement, could improve prognosis and reduce complications by minimizing unnecessary dissection.
Asunto(s)
Axila , Neoplasias de la Mama , Ganglios Linfáticos , Metástasis Linfática , Humanos , Neoplasias de la Mama/patología , Neoplasias de la Mama/cirugía , Femenino , Persona de Mediana Edad , Ganglios Linfáticos/patología , Estudios Prospectivos , Anciano , Adulto , Biopsia del Ganglio Linfático Centinela/métodos , Escisión del Ganglio Linfático/métodosRESUMEN
Background: This study aims to investigate the clinical and demographic features of underlying medical conditions and the potential relationship between underlying diseases and the increased rate of morbidity and mortality due to COVID-19. Materials and Methods: This study was conducted on 350 COVID-19 patients hospitalized at the Masih Daneshvari Hospital from February-July 2021. All participants had confirmed COVID-19 diagnosis based on symptoms and/or positive PCR test or chest X-ray results. Data was collected from medical records on demographics, disease severity, symptoms, underlying conditions like diabetes, hypertension, coronary heart disease, obesity, renal disease/transplantation, and outcomes like hospital stay, ICU admission, and mortality. Relationships between age, underlying diseases, and mortality were analyzed using chi-square and Fisher's exact tests." Results: A total of 350 patients diagnosed with COVID-19 were included in the study, with an average estimated age of (60.8±15.4). The age group of 56 and above had the highest morbidity rate, which accounted for 50% of the total participants. Among the COVID-19 patients, diabetes was the most common underlying medical condition, accounting for 31.4% of the cases. High blood pressure was present in 27.1% of the patients, and 17.1% of the total participants had coronary heart disease (CHD). Additionally, 10.9% of the participants were overweight, and 30 of them had previously experienced kidney failure or transplantation. Moreover, the study found that 40% of patients with diabetes died, while the mortality rate was 38.3% in patients with CHD and 47.4% in overweight participants. High blood pressure patients had a mortality rate of 43.2%, and patients with renal failure or kidney transplantation had a significantly increased risk of mortality at 83.3%. The research also revealed a significant and direct relationship between mortality rate, age group, and underlying disease among the patients (P<0.05). Conclusion: The findings of the present study hold significant implications for preventive interventions and policy adoption, particularly in relation to the use of calendar age as the key criterion for risk evaluation. These results underscore the need for a more precise and focused approach to prioritizing patients with identified risk factors.
RESUMEN
Background: Altered heart rate variability (HRV) has been associated with a number of disorders affecting autonomic tone, including recent myocardial infarction, congestive heart failure, and diabetic neuropathy. Furthermore, obstructive sleep apnea (OSA) has been shown to be associated with characteristic disturbances in heart rhythm. In this study, using HRV frequency analysis, an attempt has been made to diagnose or possibly diagnose OSA. Materials and Methods: Using Somnologica version 3.3.1 software (Medcare-Embla), polysomnographic recordings were done. Electrocardiographic signals were digitalized with a sampling rate of 250 Hz. Using the HRV analysis report of this software, low-frequency (LF) and high- frequency (HF) information and LF to HF ratio (LF/HF) were obtained at 5-min intervals, then at cutting points 30, 35, 40, 45, and 50, which indicate the intensity of the apnea and hypopnea index (AHI), were analyzed with mean and standard deviation of HRV frequencies. Results: According to the results reported in this study, comparison of mild, moderate, and severe cases led to no significant differences, while frequency-domain analysis displayed significant LF/HF increase in more severe AHI cases. This can probably be applied in screening high-risk patients, reducing the application of PSG in high probable cases, and providing an estimate of prognosis of potentials patients for the physicians. Conclusions: In the study of frequency-domain analysis, LF/HF increases in more severe AHI cases. These can probably be applied in screening high-risk patients, reducing the application of PSG in high probable cases.
RESUMEN
Background: A family approach and obtaining consent from the families of potential brain-dead donors is the most important step of organ procurement in countries where an opt-in policy applies to organ donation. Health care staff's communication skills and ability to have conversations about donation under circumstances of grief and emotion play a crucial role in families' decision-making process and, consequently, the consent rate. Methods: A new training course, called the Iranian family approach-specific course (IrFASC), was designed with the aim of improving interviewers' skills and knowledge, sharing experiences, and increasing coordinators' confidence. The IrFASC was administered to three groups of coordinators. The family consent rate of participants in the same intervals (12 months for group 1, 6 months for group 2, and 3 months for group 3) was measured before and after the training course. The Wilcoxon signed-rank test was used to make comparisons. Results: The family consent rate was significantly different for all participants before and after the training, increasing from 50.0% to 62.5% (P=0.037). Furthermore, sex (P=0.005), previous training (P=0.090), education (P=0.068), and duration of work as a coordinator (P=0.008) had significant effects on the difference in families' consent rates before and after IrFASC. Conclusions: This study showed that the IrFASC training method could improve the success of coordinators in obtaining family consent.
RESUMEN
Introduction: COVID-19 (coronavirus disease-2019) still causes a high rate of death globally with no definite curative treatment described. The traditional plant Borage (Borago officinalis L.) is a good source of gamma-linolenic (GLA). We hypothesized that Borage plus syrup (BPS) would be beneficial in severe COVID-19 patients within an intensive care unit (ICU) setting. Materials and methods: A pilot single center, randomized trial with no placebo was undertaken. A total of 60 PCR-positive severe COVID-19 participants admitted to ICU from June 2020-December 2020 at Masih Daneshvari Hospital Tehran-Iran gave informed consent. The participants were randomly assigned to either Borage Plus Syrup (BPS, 5 ml for 5 days) (n = 30) or standard care (IFN-ß and favipiravir) as a control group (n = 30). Pao2/Fio2, serum ferritin, CRP, bilirubin, IL-6, TNF-α, ALT, AST, PCT and serum IL-8 was measured upon admission and on release. Results: All the measured parameters decreased significantly with BPS treatment. In the control group, most parameters significantly improved apart from AST and PCT. In addition, the suppression of serum TNF levels in the BPS group was greater than that seen in the control group (P ≤ 0.05). Moreover, the length of ICU stay was significantly lower in the BPS group compared with the control group (P ≤ 0.05). Conclusion: Our study shows that addition of BPS to the standard treatment regime of COVID-19 patients in ICU improved outcomes and reduced the length of ICU treatment. Natural products could be considered as new approaches for reducting the harmful consequences of COVID-19.
RESUMEN
BACKGROUND AND OBJECTIVES: The use of mHealth applications depends on cognitive and social factors of individuals in different nations. This study aimed to identify the factors influencing the use of mHealth applications for both "contact-tracing" and "symptom-monitoring" of COVID-19 among Iranian citizens. METHODS: A cross-sectional study with an online survey was conducted among Iranian citizens. Correlation calculation and multiple linear regression analysis were performed on the studied variables to find the effective factors. RESULTS: A total of 1031 Iranian citizens over the age of 18 participated in this survey. A large percentage of the participants wanted to use the mHealth app to trace contacts of COVID-19 (74.5%) and the mHealth app to identify and monitor COVID-19 symptoms (74.0%). Gender, age, level of education, attitude towards technology, and fear of COVID-19 were among the factors that influenced the intention to use these two apps. The top reasons for using these apps were: "to keep myself and my family safe", "to control the spread of the coronavirus in general", and "to cooperate with healthcare professionals". The reasons given for not using these two apps were related to the issues of "security and privacy" and "doubt in efficiency and usefulness" of them. CONCLUSIONS: The study showed that many participants in this survey were interested in using the COVID-19 apps. Policies, regulations and procedures are needed to protect the privacy of individuals by ensuring data governance. Further investigation with a larger sample is suggested to generalize these results.
Asunto(s)
COVID-19 , Telemedicina , Adulto , Trazado de Contacto , Estudios Transversales , Humanos , Irán , Persona de Mediana Edad , SARS-CoV-2RESUMEN
BACKGROUND: Mesenchymal stem cells (MSCs) have received particular attention because of their ability to modulate the immune system and inhibit inflammation caused by cytokine storms due to SARS-CoV-2. New alternative therapies may reduce mortality rates in patients with COVID19. This study aimed to assess the safety and efficacy of injecting intravenous Wharton's jelly-derived MSCs in patients with COVID-19 as a treatment. METHODS: In this study, five patients with severe COVID-19 were treated with Wharton's jelly-derived mesenchymal stem cells (150 × 106 cells per injection). These patients were subject to three intravenous injections 3 days apart, and monitoring was done on days 0, 3, 6, and 14 in routine tests, inflammatory cytokines, and flow cytometry of CD4 and CD8 markers. A lung CT scan was performed on base and days 14 and 28. In addition, IgM and IgG antibodies against SARS-CoV-2 were measured before and after treatment. RESULTS: The results showed that IL-10 and SDF-1 increased after cell therapy, but VEGF, TGF-ß, IFN-γ, IL-6, and TNFα decreased. Routine hematology tests, myocardial enzyme tests, biochemical tests, and inflammation tests were performed for all patients before and after cell therapy on base and days 3, 6, and 14, which indicated the improvement of test results over time. COVID-19 antibody tests rose in 14 days after WJ-MSC injection. The total score of zonal involvement in both lungs was improved. CONCLUSIONS: In patients, the trend of tests was generally improving, and we experienced a reduction in inflammation. No serious complications were observed in patients except the headache in one of them, which was resolved without medication. In this study, we found that patients with severe COVID-19 in the inflammatory phase respond better to cell therapy. More extensive clinical trials should be performed in this regard. TRIAL REGISTRATION: IRCT, IRCT20190717044241N2 . Registered April 22, 2020.
Asunto(s)
COVID-19 , Células Madre Mesenquimatosas , Gelatina de Wharton , Diferenciación Celular , Tratamiento Basado en Trasplante de Células y Tejidos , Células Cultivadas , Humanos , SARS-CoV-2RESUMEN
BACKGROUND: In December 2019, pneumonia associated with a novel coronavirus (COVID-19) was reported in Wuhan, China. Acute respiratory distress syndrome (ARDS) is the most frequently observed complication in COVID-19 patients with high mortality rates. OBJECTIVE OF STUDY: To observe the clinical effect of plasmapheresis on excessive inflammatory reaction and immune features in patients with severe COVID-19 at risk of ARDS. MATERIALS AND METHODS: In this single-center study, we included 15 confirmed cases of COVID-19 at Masih Daneshvari Hospital, in March 2020 in Tehran, Iran. COVID-19 cases were confirmed by RT-PCR and CT imaging according to WHO guidelines. Plasmapheresis was performed to alleviate cytokine-induced ARDS. The improvement in oxygen delivery (PaO2/FiO2), total number of T cells, liver enzymes, acute reaction proteins, TNF-α and IL-6 levels were evaluated. RESULTS: Inflammatory cytokine levels (TNF-α, IL-6), and acute phase reaction proteins including ferritin and CRP were high before plasmapheresis. After plasmapheresis, the levels of PaO2/FiO2, acute phase reactants, inflammatory mediators, liver enzymes and bilirubin were significantly reduced within a week (pâ¯<â¯0.05). In contrast, although the number of T helper cells decreased immediately after plasmapheresis, they rose to above baseline levels after 1 week. Nine out of fifteen patients on non-invasive positive-pressure ventilation (NIPPV) survived whilst the six patients undergoing invasive mechanical ventilation (IMV) died. CONCLUSION: Our data suggests that plasmapheresis improves systemic cytokine and immune responses in patients with severe COVID-19 who do not undergo IMV. Further controlled studies are required to explore the efficacy of plasmapheresis treatment in patients with COVID-19.
Asunto(s)
COVID-19 , Plasmaféresis , Síndrome de Dificultad Respiratoria , COVID-19/mortalidad , COVID-19/terapia , Citocinas/sangre , Humanos , Interleucina-6/sangre , Irán , Síndrome de Dificultad Respiratoria/terapia , Síndrome de Dificultad Respiratoria/virología , Linfocitos T Colaboradores-Inductores , Factor de Necrosis Tumoral alfa/sangreRESUMEN
BACKGROUND: Considering that tracheostomy is being done for huge amount of critically ill patients, the ideal time for this procedure is still controversial among different intensive care units (ICU). MATERIALS AND METHODS: 70 intubated patients were included in our study which was sorted into two subgroups: half of our patients received an early tracheostomy (ET) within 1-10 days post intubation and the rest received late tracheostomy (LT) within 11-21 days after getting intubated. RESULTS: 61.9% of the study population was male and the mean age was of 54 + 10.5 years. ET group mean Mechanical Ventilation (MV) duration was 8.11±4.9 days and was 16.3 ± 6.01 in the LT group (p<0.05) with a mean sedation duration of 6.1 ± 4.4 vs. 12.0 ± 6.5 (ET vs. LT) (p<0.05). Mean time of weaning process from ventilator was 2.7 ±2.3 for ET group and 5.5 ± 5.0 for LT group (p<0.05). The Mean ICU stay was 18.8 ± 2.2 in the ET group, and 22.1 ± 4.1 in the LT group (p: 0.98) at the same time. Length of stay at hospital for two group of patients did not show a meaningful difference (p= 0.279). CONCLUSION: Early tracheostomy decreases duration of mechanical ventilation and sedation use and more rapid weaning process in those patients who will require mechanical ventilation. Our findings revealed that tracheostomy timing has no significant impact on rate of hospital mortality and LOS at ICU and hospital.
RESUMEN
BACKGROUND: Sleep complaints are common problems in the general population and insomnia and sleep disorders place significant economic and social burdens on the community. Postmenopausal women are 2.6 to 3.5 times more likely to develop obstructive sleep apnea (OSA) compared to non-menopausal women. In this study, we evaluated sleep disorders and mental health in postmenopausal women. MATERIALS AND METHODS: This study was a descriptive cross-sectional study and the samples were selected from postmenopausal women above 50 years who had participated in a survey entitled, "Evaluation of Sleep Disorders among Adults in Tehran" in 2017. Cluster sampling method was applied with proportional allocation. A total of 4021 samples were collected, 2075 of which belonged to women. In addition, 174 out of 2075 samples were related to postmenopausal women over the age of 50. The data were analyzed using the statistical package IBM SPSS version 22.0. P-values less than 0.05 were considered significant. RESULTS: In this study, 118 (67.8%) women had insomnia for less than three months, and 23 (13.2%) women had insomnia for more than three months. The prevalence of STOPBANG parameters in this group of postmenopausal women was 37% and significantly related to Body mass index (BMI) and neck circumference at P < 0.001 and 0.006, respectively. There was no significant relationship between social dysfunction and insomnia. However, anxiety in General Health Questionnaire (GHQ) was significantly associated with insomnia, sleepiness, sadness, and irritability. CONCLUSION: Our results indicate that the impact of insomnia symptoms, OSA comorbidity and mental disorders could extend far beyond. The use of urgent health care and quality of life issues is essential for long-term mental and physical well-being; if there is no treatment in the menopause population, there will be serious mental and physical complications.
RESUMEN
BACKGROUND: Inflammatory mediators are an important component in the pathophysiology of the coronavirus disease 2019 (COVID-19). This study aimed to assess the effects of reducing inflammatory mediators using hemoperfusion (HP) and continuous renal replacement therapy (CRRT) on the mortality of patients with COVID-19. MATERIALS AND METHODS: Twelve patients with confirmed diagnosis of COVID-19 were included. All patients had acute respiratory distress syndrome (ARDS). Patients were divided into three groups, namely, HP, CRRT and HP+CRRT. The primary outcome was mortality and the secondary outcomes were oxygenation and reduction in inflammatory mediators at the end of the study. RESULTS: Patients were not different at baseline in demographics, inflammatory cytokine levels, and the level of acute phase reactants. Half of the patients (3 out of 6) in the HP+CRRT group survived along with the survival of one patient (1 out of 2) in the HP group. All four patients in the CRRT group died. Serum creatinine (SCr), Interleukin-1 (IL1), Interleukin-6 (IL6), Interleukin-8 (IL8), partial pressure of oxygen (PaO2), O2 saturation (O2 sat), and hemodynamic parameters improved over time in HP+CRRT and CRRT groups, but no significant difference was observed in the HP group (All Ps > 0.05). CONCLUSION: Combined HP and CRRT demonstrated the best result in terms of mortality, reduction of inflammatory mediators and oxygenation. Further investigations are needed to explore the role of HP+CRRT in COVID-19 patients.
RESUMEN
OBJECTIVE: To determine the effect of vitamin D supplementation on postoperative pain and analgesic requirement in brain tumor surgery. METHODS: A total of 60 patients with vitamin D serum levels ≤20 ng/dL were randomly assigned to 2 groups equally. The study group (n = 30) received intramuscular injection of 300,000 IU vitamin D before surgery. RESULTS: Preoperative serum level of vitamin D was 15.9 ± 3.8 ng/dL and 14.5 ± 3.6 ng/dL in the study and control groups, respectively (P = 0.13). Serum level of vitamin D on day 5 of surgery was 22.5 ± 4.3 and 13.7 ± 3.8 in the study and control groups, respectively (P < 0.001). A percentage of 50% had pain scores >4 on the first postoperative day, which decreased with time. The median (interquartile range) of the visual analogue scale score during the 3 postoperative days was 3 (5), 3 (5), 1 (3), and 5 (7), 2 (5), 1 (3) in the study and control groups, respectively, with no significant difference. There was no difference in analgesic consumption between the 2 groups. Analysis through the generalized estimating equation model indicated that patients who had received vitamin D for a longer time before the operative time had an insignificantly less pain score. CONCLUSIONS: On the basis of the study results, one half of our patients reported moderate-to-severe pain scores on the first day after surgery. The pain in the study group was insignificantly less than that in the control group, but it seems that chronic high level of vitamin D may lead to promising results.
Asunto(s)
Analgésicos/administración & dosificación , Neoplasias Encefálicas/cirugía , Craneotomía/efectos adversos , Dolor Postoperatorio/tratamiento farmacológico , Vitamina D/administración & dosificación , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Resultado del Tratamiento , Vitamina D/sangreRESUMEN
INTRODUCTION AND AIM: Malnutrition is a complication of hospitalization in critically ill patients. This event is occurred because of disease and therapeutic processes for curing the patients. Determination of nutritional status helps physicians and clinical nutritionists decide on the best regimen which should be prescribed for a patient. In the current study, we aimed to report the nutritional status ofpatientshospitalizedin the intensive care unit (ICU). METHOD OF STUDY: We used three standard tolls, including Subjective global assessment (SGA), Nutrition Risk in the Critically Ill (NUTRIC) Score and nutrition risk screening (NRS) questionnaires via a multi-stage sampling for different ICU wards of 32 university hospitals in Iran. Frequencies and rates of nutritional scores, comparative studies, and determined agreement of scoring systems and nutritional status in any ward of hospitals were evaluated. RESULTS: There were 771 males and 540 female Cancer and trauma patients had the best and worst nutritional scores, respectively. Using NRS and NUTRIC, the low-risk scores were more frequent than thehigh-riskscores among ICU patients. SGA showed that most patients were in grades A (well nutritional status) or B (moderate nutritional status), andfew caseswere in grade C (poor nutritional status).The high-risk nutritional score wasobtained for older patients. NUTRIC and NRS had better agreement for diagnosis and differentiation of malnutrition than NUTRIC-SGA or NRS-SGA pairs. However, there was no strong agreement between the mentioned pairs. CONCLUSION: Nutritional status of patients hospitalized in ICU wards in Iran wassomewhat better than other countries that this could be due to the highly observed guidelines of patient's care in Iran. Anyway,it is suggested that a more precise tool of nutritional scoresto be validated for patients hospitalized in ICU·In addition, better medical care needs a well evaluation of nutritional insufficiencies and what is necessary for compensation using complementary regimens.