Assessing the predictive capability of machine learning models in determining clinical outcomes for patients with cervical spondylotic myelopathy treated with laminectomy and posterior spinal fusion.

BACKGROUND: Cervical spondylotic myelopathy (CSM) is a prevalent degenerative condition resulting from spinal cord compression and injury. Laminectomy with posterior spinal fusion (LPSF) is a commonly employed treatment approach for CSM patients. This study aimed to assess the effectiveness of machine learning models (MLMs) in predicting clinical outcomes in CSM patients undergoing LPSF. METHODS: A retrospective analysis was conducted on 329 CSM patients who underwent LPSF at our institution from Jul 2017 to Jul 2023. Neurological outcomes were evaluated using the modified Japanese Orthopaedic Association (mJOA) scale preoperatively and at the final follow-up. Patients were categorized into two groups based on clinical outcomes: the favorable group (recovery rates ≥ 52.8%) and the unfavorable group (recovery rates < 52.8%). Potential predictors for poor clinical outcomes were compared between the groups. Four MLMs-random forest (RF), logistic regression (LR), support vector machine (SVM), and k-nearest neighborhood (k-NN)-were utilized to predict clinical outcome. RF model was also employed to identify factors associated with poor clinical outcome. RESULTS: Out of the 329 patients, 185 were male (56.2%) and 144 were female (43.4%), with an average follow-up period of 17.86 ± 1.74 months. Among them, 267 patients (81.2%) had favorable clinical outcomes, while 62 patients (18.8%) did not achieve favorable results. Analysis using binary logistic regression indicated that age, preoperative mJOA scale, and symptom duration (p < 0.05) were independent predictors of unfavorable clinical outcomes. All models performed satisfactorily, with RF achieving the highest accuracy of 0.922. RF also displayed superior sensitivity and specificity (sensitivity = 0.851, specificity = 0.944). The Area under the Curve (AUC) values for RF, Logistic LR, SVM, and k-NN were 0.905, 0.827, 0.851, and 0.883, respectively. The RF model identified preoperative mJOA scale, age, symptom duration, and MRI signal changes as the most significant variables associated with poor clinical outcomes in descending order. CONCLUSIONS: This study highlighted the effectiveness of machine learning models in predicting the clinical outcomes of CSM patients undergoing LPSF. These models have the potential to forecast clinical outcomes in this patient population, providing valuable prognostic insights for preoperative counseling and postoperative management.

Factors associated with long-term mechanical ventilation in patients undergoing cardiovascular surgery.

BACKGROUND: One of the main therapy for coronary artery disease is surgery. Prolonged mechanical ventilation in patients with cardiac surgery is associated with high mortality. This study aimed to determine the factors related to long-term mechanical ventilation (LTMV) in patients undergoing cardiovascular surgery. METHODS: The present study was a descriptive-analytical study in which the records of 1361 patients who underwent cardiovascular surgery and were on a mechanical ventilator during 2019-2020 at the Imam Ali Heart Center in Kermanshah city were examined. The data collection tool was a three-part researcher-made questionnaire including demographic characteristics, health records, and clinical variables. Data analysis was done using descriptive and inferential statistical tests and SPSS Version 25 software. RESULTS: In this study, of the 1361 patients, 953 (70%) were male. The results indicated that 78.6% of patients had short-term mechanical ventilation, and 21.4% had long-term mechanical ventilation. There was a statistically significant relationship between the history of smoking, drug use, and baking bread with the type of mechanical ventilation (P < 0.05). Also, based on the regression test, some parameters, such as the history of respiratory conditions, could predict the prolongation of mechanical ventilation. Creatinine levels before surgery, chest secretions after surgery, central venous pressure after surgery, and the status of cardiac enzymes before surgery also affect this issue. CONCLUSION: This study investigated some factors related to prolonged mechanical ventilation in patients undergoing heart surgery. For optimizing the care and therapeutic measures, It is suggested, healthcare workers have a detailed assessment on patients with factors such as the history of baking bread, history of obstructive pulmonary disease, history of kidney disease, use of an intra-aortic pump, number of respirations and systolic blood pressure 24 h after surgery, creatinine level 24 h after surgery, chest secretions after surgery, and the amount of pre-operative ejection fraction and cardiac enzymes (CK-MB).

The effect of repeated flexion-based exercises versus extension-based exercises on the clinical outcomes of patients with lumbar disk herniation surgery: a randomized clinical trial.

BACKGROUND: Valuable impact of postoperative exercises on the clinical outcomes of patients with lumbar discectomy has been demonstrated. However, there is a lack of consensus on the best kind of postoperative exercises. This study aimed to evaluate the impact of the early postoperative flexion-based and extension-based exercises on the clinical outcomes of patients with lumbar discectomy. METHODS: In this single-blind randomized clinical trial (RCT), 90 subjects with lumbar discectomy were randomly assigned to three groups. The flexion-based and extension-based exercises were planned for the first and the second groups, respectively. The third group was considered as the control group. Subjects in the experimental groups started their exercise program at the end of the 6th postoperative week and continued exercises for 8 weeks. We used Visual analogue scale (VAS), Oswestry Disability Index (ODI), modified Biering-Sorensen test (mBST), and Trunk Flexion Endurance Test (TFET) to evaluate back pain, disability, back and abdominal muscle endurance, respectively. The outcomes were investigated before starting the exercises program as well as at the end of the study. Moreover, return to work was evaluated at the end of the study. Data were analyzed using descriptive and inferential statistics by SPSS-24 software. RESULTS: Our results showed that the VAS pain diminished in all the groups. However, this reduction was most in the McKenzie group (P < 0.001). Moreover, extension-based exercises reduced ODI more than other groups (P < 0.001). We found that extension-based and flexion-based exercises had more efficacy in increasing the back and trunk flexion endurance, respectively (P < 0.001). There was not a significant difference between the three groups in the term of returning to work (P = 0.06). CONCLUSIONS: Both flexion-based and extension-based exercises could reduce postoperative back pain and disability. However, the impact of the extension-based program was more dominant. Moreover, these exercises could increase back and abdominal muscle endurance. Therefore, prescribing such low-cost home-based exercises could be very helpful for patients with lumbar discectomy.

The association between menopausal status and clinical outcomes of female patients with carpal tunnel release: a retrospective observational study.

BACKGROUND: The relationship between menopausal status and clinical outcomes of female patients with carpal tunnel release (CTR) has been not clearly investigated. This study aimed to evaluate the clinical outcomes of CTR among women with different menopausal statuses. METHODS: Two hundred-eighteen consecutive female patients with carpal tunnel syndrome (CTS) who underwent surgery at our hospital between May 2016 and May 2020 were included in this study. Based on whether subjects had undergone menopause before surgery, they were divided into three groups: the premenopausal group, the early postmenopausal group (less than 10 years since menopause) and the late postmenopausal group (more than 10 years since menopause). The clinical outcome was assessed before surgery and at six-month postoperative visits using the Boston Carpal Tunnel Questionnaire (BCTQ). RESULTS: There were 86 patients in the premenopausal group, 70 patients in the early postmenopausal group and 62 patients in the late postmenopausal group. All the groups showed significant improvements in their Symptom Severity Scale (SSS) and Functional Status Scale (FSS) compared with preoperative scores. Although, there was a significant difference between the groups based and post-surgical SSS and FSS (p < 0.05). Patients in the postmenopausal group had less improvement in SSS and FSS in comparison with those in the other groups (p < 0.05). CONCLUSIONS: Our results showed that all the groups had significant improvement in their SSS and FSS. However, the clinical outcomes were poorer in late postmenopausal patients than in premenopausal or early postmenopausal patients. These findings can be used in pre-operative counseling and interpretation of outcomes in women with CTR.

Smoking among High School Students in Iran: A Meta-Analysis Study.

Objective: Cigarette smoking is an important and preventable risk factor, especially for adolescents and high school students. This issue has become one of the challenges for health system. Thus, the present study aimed to investigate the prevalence of smoking among Iranian high school students. Method : This systematic review and meta-analysis study was done by searching PubMed, Scopus, Web Science (WOS), Science Direct, SID, and Google Scholar using the following keywords: "student" and "smoking" from 2000 to March 2018. After initial and critical appraisal, data were entered into a checklist and analyzed by a comprehensive meta-analysis software. Results: The prevalence of smoking was 7.9% by combining the results of 49 articles. Males and females had 10.6% and 4.5% smoking prevalence, respectively. The overall prevalence of smoking was higher in northern areas in Iran (22.4%). Males in the northern (22.4%) and females in western regions (5.3%) were more smokers. There was a significant relationship between the prevalence of smoking with the year of publication, sample size, and age (P < 0.001). Conclusion: In this study, Students' tendency to smoke was different in various regions of Iran, and had a high rate (7.9%). This figure indicates the necessity for planning some coherent educational programs for the public.

Comparison of the Effect of Alpha and Hydrocortisone Ointments on Prevention of Acute Skin Complications Due to Radiotherapy in Breast Cancer Patients.

BACKGROUND: Radiotherapy in breast cancer patients is associated with acute and delayed side effects. This study aimed to compare the effect of alpha and hydrocortisone 1% (H1%) ointments on prevention of acute skin complications due to radiotherapy in breast cancer patients. METHODS: This clinical trial was conducted on 86 patients with breast cancer in the radiotherapy center of Imam Reza Hospital of Kermanshah, Iran. Using the records, the patients were selected and randomly divided into alpha and H1% groups after obtaining informed consent. The severity of dermatitis, complications, and patient complaints during treatment were evaluated weekly for up to 6 weeks by RTOG criteria. Data were analyzed using SPSS-16 software. RESULTS: At the end of the third, fourth, fifth, and sixth weeks, 10 (11.7%), 25 (29.1%), 53 (61.6%), and 28 (32.6%) patients had skin complications, respectively. In weeks 5 and 6 in the H1 group, the incidence of complications was higher (P = 0.001). The frequency of pain and burning complaints at the end of the third, fourth, fifth, and sixth weeks was 15 (17.4%), 37 (43.0%), 52 (60.5%), and 1(1.2%), respectively. Pain and burning intensity in the fourth and fifth weeks in the H1 group was lower than alpha (P = 0010). Complaints of skin itching at the end of the third, fourth, and fifth weeks were 16 (18.6%), 25 (29.1%), and 28 (32.6), respectively. This complication was lower in the H1% group during these weeks (P < 0.05). CONCLUSION: Alpha ointment is more effective than H1% in relieving pain and burning, preventing complications except itching. It seems using an alpha ointment or combining it with H1% is an appropriate strategy to reduce the rate of injuries and skin complications of radiotherapy.

Coronavirus disease 2019 (COVID-19) can predispose young to Intracerebral hemorrhage: a retrospective observational study.

BACKGROUND: The respiratory system involvement is the most common presentation of Coronavirus disease 2019 (COVID-19). However, other organs including the central nervous system (CNS) could be affected by the virus. Strokes, seizures, change in mental status, and encephalitis have been reported as the neurological manifestation of the disease. We hypothesized that COVID-19 could predispose younger patients to spontaneous intracerebral hemorrhage (ICH). The present study aimed to investigate whether COVID-19 has any relationship with the occurrence of spontaneous ICH in young or not. METHODS: We retrospectively evaluated all the patients with spontaneous ICH who were referred to our center between 20 Feb and 1 Sep 2020. The demographic, clinical, radiological, and laboratory test data were evaluated. Patients were divided into two groups. The COVID-19 positive patients and COVID-19 negative ones. All the variables including age, sex, history of hypertension, diabetes mellitus, smoking, Glasgow Coma Scale (GCS), hematoma volume and location, the presence of intraventricular hemorrhage and hydrocephalus on admission, the length of hospital stay, the lab test results and the clinical outcome at last visit or discharge as Glasgow Outcome Scale (GOS) were compared between the two groups. RESULTS: There were 22 COVID-19 positive patients (20.8%) and 84 COVID-19 negative ones (79.2%). The mean age of the patients in the case group (54.27 ± 4.67) was significantly lower than that in the control group (69.88 ± 4.47) (p < 0.05). Meanwhile, our results showed a significant difference between the two groups based on the presence of chronic arterial hypertension (p < 0.05). There were no significant differences between the two groups based on gender, diabetes mellitus, smoking, Glasgow Coma Scale (GCS), hematoma volume, need for surgery, the presence of intraventricular hemorrhage and hydrocephalus on admission, White Blood Cell (WBC) count, platelet count, Prothrombin Time (PT), and Partial Thromboplastin Time (PTT) (p > 0.05). CONCLUSIONS: Our results show that COVID positive patients with ICH are younger and with less predisposing factors than COVID negative subjects with ICH.

Validation of the Persian version of the Compassionate Care Assessment Tool.

OBJECTIVES: The present study aimed to translate and determine the psychometric properties of the Persian version of the Compassionate Care Assessment Tool (CCAT) ©. METHODS: The study was carried out to translate and validate of the CCAT©. After securing permission from the designer of the tool and translating it, the psychometric properties were determined through examining face validity, construct validity, internal consistency, and test/retest reliability. With regard to construct validity, confirmatory factor analysis was used so that 300 patients in internal and surgery wards were selected by a simple random sampling method from three hospitals. Data were analyzed using SPSS (v.24.0) and LISREL statistical software version 8.8. RESULTS: The results of the confirmatory factor analysis supported the validity and reliability of the Persian version of the CCAT© and its four factors. The reliability of the tool and internal consistency were confirmed through test/retest method with two weeks' interval. At the two areas of importance and provision of compassionate care, Cronbach's α coefficient equaled to 0.918 and 0.933 and intraclass consistency equaled to 0.848 and 0.907 respectively. CONCLUSION: The results showed that the Persian version of the CCAT© was adequately valid and reliable for Iranian patients. Given the acceptable psychometric parameters of the tool, using it in future studies to measure importance and provision of compassionate nursing care to Iranian patients at internal and surgery wards is recommended.

Predictors of the failure of conservative treatment in patients with a thoracolumbar burst fracture.

BACKGROUND: There is a controversy about the management of patients with a thoracolumbar burst fracture. Despite the success of the conservative treatment in most of the cases, some patients failed the conservative treatment. The present study aimed to evaluate risk factors for the need for surgery during the follow-up period in these patients. METHODS: We retrospectively evaluated 67 patients with a traumatic thoracolumbar burst fracture who managed conservatively at our center between May 2014 and May 2019. Suggested variables as potential risk factors for the failure of conservative treatment including age, gender, body mass index (BMI), smoking, diabetes, vertebral body compression rate (VBCR), percentage of anterior height compression (PAHC), Cobb angle, interpedicular distance (IPD), canal compromise, and pain intensity as visual analog scale (VAS) were compared between patients with successful conservative treatment and those with failure of non-operative management. RESULTS: There were 41 males (61.2%) and 26 females (38.8%) with the mean follow-up time of 15.52 ± 5.30 months. Overall, 51 patients (76.1%) successfully completed conservative treatment. However, 16 cases (23.9%) failed the non-operative management. According to the binary logistic regression analysis, only age (risk ratio [RR], 2.21; 95% confidence interval [95%], 1.78-2.64; P = 0.019) and IPD (RR 1.97; 95% CI 1.61-2.33; P = 0.005) were the independent risk factors for the failure of the non-operative management. CONCLUSIONS: Our results showed that older patients and those with greater interpedicular distance are at a higher risk for failure of the conservative treatment. As a result, a closer follow-up should be considered for them.

The impact of extended adjuvant temozolomide in newly diagnosed glioblastoma multiforme: a meta-analysis and systematic review.

Surgical resection followed by concurrent radiation therapy and temozolomide (TMZ) chemotherapy is the current standard treatment for glioblastoma multiforme (GBM). The present metaanalysis investigated the impact of prolonged TMZ maintenance therapy (more than 6 cycles) in comparison with standard TMZ maintenance therapy (exactly six cycles) on overall survival (OS) and progression-free survival (PFS) of patients with GBM. A meta-analysis of the literature was conducted using Medline, PubMed, EMBASE and the Cochrane Library in accordance with PRISMA guidelines. Seven articles involving 1018 patients were included. The overall survival was higher in the case group (>6 cycles TMZ) compared to the control group (6 cycles TMZ) (Z=2.375, P=0.018). The lower and upper limits were between 1.002-10.467 months. The case group had higher progression-free survival compared with the control group (Z=3.84; P<0.001). The lower and upper limits were between 2.559-7.894 months. Evidence from this meta-analysis suggests that prolonged TMZ therapy compared to the standard 6-cycle TMZ therapy was associated with higher survival in patients with glioblastoma.

Carpal tunnel surgery: predictors of clinical outcomes and patients' satisfaction.

BACKGROUND: Carpal tunnel syndrome (CTS) is the most common peripheral neuropathy. Moreover, carpal tunnel release (CTR) surgery generally has excellent results. The present study aimed to investigate the predictors of clinical outcomes and satisfaction in patients with CTR. METHODS: In this observational prospective cohort study, 152 patients with open carpal tunnel release surgery were investigated. Complete clinical examinations were performed and recorded before the surgery, two weeks after the surgery and 6 months after the surgery. The Boston Carpal Tunnel Questionnaire (BCTQ) were assessed on admission and at last follow-up visits to evaluate clinical outcomes. Patients' satisfaction was determined by a 10-point verbal descriptor nominal scale (1 = very poor, 5 = fair and 10 = excellent) and recorded during the last follow -up visits. RESULTS: Among 152 patients who were investigated, there were 118 (77.6%) females and 34 (22.36%) males. Overall, surgery improved the outcomes based on Symptom Severity Scale (SSS) and Functional Status Scale (FSS) (P < 0.05). Most of the considered variables did not show significant effects on clinical outcomes and patients' satisfaction. However, duration of symptoms and electrophysiological severity were the predictors of the change score in SSS(P < 0.05). As well as, age was the only predictor of the change score in FSS (P < 0.05). Finally, according to the linear regression model, the pre-operative grip strength and age were the independent predictors of post-operative satisfaction (P < 0.05). CONCLUSIONS: Results of the present study revealed that there was a significant improvement in clinical outcomes after CTS surgery. Stronger pre-operative grip strength and younger age were independent predictors of higher post-operative satisfaction. These results can be used in pre-operative counseling and management of post-operative expectations.

Correction to: Prognostic factors in patients with glioblastoma multiforme: focus on the pathologic variants.

Unfortunately, the third author name was incorrectly published in the original publication. The complete correct name should read as follows.

Prognostic factors in patients with glioblastoma multiforme: focus on the pathologic variants.

The aim of this study was to offer predicting factors for survival in adult patients with glioblastoma multiforme. 153 consecutive patients with high-grade glioma (WHO grade IV) were studied in Imam Reza hospital, Kermanshah University of Medical Science, Kermanshah, Iran, between April 2003 and April 2017. All patients treated with surgical resection and standard postoperative radiotherapy (54 Gy). Using the patients' charts and electronic medical records system, the following data were obtained: gender, age, Karnofsky performance status (KPS) score on admission, primary vs. secondary type, extent of surgery, tumor location, tumor size, necrosis size, use of Temozolomide (TMZ), pathology subtype, and immunohistochemistry results. Patients were followed from the time of the surgery until the death occurred. Overall survival (OS) and progression-free survival (PFS) were calculated by the Kaplan-Meier method. Survival time curves for various subgroups were compared by the log-rank test. The impact of the suggested prognostic factors on survival was evaluated by univariate and multivariate analyses. Age, gender, KPS, extent of surgery, tumor location, necrosis size, and reoperation in recurrence had not any statistically significant effect on survival. Univariate analysis revealed a significant impact on outcome for pathology subtype (PFS: P < 0.001, OS: P < 0.001), tumor type (primary vs. secondary) (PFS: P = P < 0.001, OS: P < 0.001), tumor size (PFS: P = 0.044, OS: P = 0.04), TMZ therapy (PFS: P < 0.001, OS: P < 0.001), P53 (PFS: P < 0.001, OS: P < 0.001), and Ki67 (PFS: P < 0.001, OS: P < 0.001). In multivariate analysis, independent favorable prognostic factors for survival were pathology subtype (PFS: P < 0.001, OS: P < 0.001), type (PFS: P < 0.001, OS: 0.012), TMZ (PFS: P < 0.001, OS: P < 0.001), P53 (PFS: P < 0.001, OS: P < 0.001), and Ki67 (PFS: P < 0.001, OS: P < 0.001). The results suggest that pathology subtype, primary vs. secondary type, TMZ therapy, P53, and Ki 63 may play an important role in the survival of patients with glioblastoma multiforme. There is no relationship detected between age, gender, KPS, tumor size and location, necrosis size, extent of surgery, reoperation in recurrence, and patient survival.

Global longitudinal strain as an Indicator of cardiac Iron overload in thalassemia patients.

BACKGROUND AND OBJECTIVE: Cardiac involvement due to iron overload is the most common cause of morbidity and mortality in patients with thalassemia, and many patients remain asymptomatic until the late stages. Therefore, early detection of heart problems in such patients at subclinical stages can improve the prognosis of these patients. We investigated the role of speckled tracking (SI) and tissue Doppler echocardiography (TDI) in early detection of iron overload in these patients. METHODS: 52 thalassemic patients who were receiving regular blood transfusion with normal global LV function were examined by two- and three-dimensional echocardiography. Cardiac MRI was done and T2* images were considered as the non-invasive gold standard for evaluating cardiac iron deposition. Serum ferritin level was assessed and the relationships between serum ferritin levels and echo finding with cardiac MRI T2* was investigated. RESULTS: No significant relationship was seen between serum ferritin levels and cardiac MRI T2*. Among the echocardiographic findings, septal systolic myocardial velocity (P = 0.002 and r = 0.43) and global strain (GLS) (P = 0.000 and r = 0.60) were significantly associated with T2*. A GLS < 19.5 could predict a T2* level below 20 by 82.14% sensitivity and 86.36% specificity (area under the curve = 0.87; p < 0.0001). CONCLUSION: While serum ferritin level and ejection fraction are not useful candidates, GLS may be used as a valuable marker to screen thalassemia patients for myocardial iron deposition, using a cut off value below - 19.5. This approach may facilitate the cardiac follow up, reduce the costs, and contribute to preventing deterioration of cardiac function in countries with limited availability of cardiac MRI.

Efficacy of Implementing Home Care Using Eye Movement Desensitization and Reprocessing in Reducing Stress of Patients with Gastrointestinal Cancer.

Background: Gastrointestinal cancer is the third most common types of cancer in the world which leads to a lot of stress among sufferers. Pharmacological and non-pharmacological approaches are used to treat stress induced by serious diseases. Eye movement desensitization and reprocessing (EMDR) technique is considered as one of non-pharmacological method for decreasing patient's stress. Objective: This study was conducted to determine the effect of home care using EMDR technique on the stress of patients with gastrointestinal cancer. Materials and Methods: The current semi-experimental study was performed on patients with gastrointestinal cancer residing in Ilam, Iran. The patients were randomly divided into two groups of intervention (n=30) and control (n=30). Home care was provided for intervention group in patients' homes which included 2 sessions (a total of 60 sessions for all patients). Each session lasted for 45 to 60 minutes according to EMDR protocol. The data were analyzed using SPSS (version 16). Results: The findings of this study showed that most of patients were male (36, 60%), had diploma degrees (44, 73.3%), had a monthly income less than 500 thousand (38, 63.3%), were married (39, 65 %). The mean age of the patients was 69.18 ± 11.58 years. No statistically significant difference was observed between two groups before the intervention in terms of patients' perceived stress (P>0.05). However, efficacy and perceived distress of the intervention group significantly was decreased following the intervention (P<0.05). Conclusions: According to the findings regarding the impact of home care using EMDR technique on reducing stress in patients with gastrointestinal cancer, the implementation of this intervention and provision of education for patients are recommended to expand the nursing duty to community health wards as well as to improve the health status of patients.

Adjacent segment disease after posterior lumbar instrumentation surgery for degenerative disease: Incidence and risk factors.

PURPOSE: To identify risk factors for occurrence of symptomatic adjacent segment disease (ASD) after posterior lumbar instrumentation surgery. METHODS: This retrospective study evaluated 630 patients who underwent posterior lumbar transpedicular instrumentation for degenerative lumbar disorders between April 2008 and April 2012. On the basis of developing ASD at follow-up, patients were categorized into two groups: the ASD group and the non-ASD (N-ASD) group. These two groups were compared for patient characteristics, surgical variables, and radiographic parameters to investigate the possible predictive factors of ASD. RESULTS: Of the 630 individuals participated in the study, 76 (12.1%) patients had ASD. Mean and standard deviation of age were 61.37 ± 4.12 years for the ASD group and 62.37 ± 3.9 for the N-ASD group ( p = 0.79). The average follow-up period was 51 ± 2.2 months in the ASD group and 52 ± 2.3 months in the N-ASD group ( p = 0.691). There were no significant differences between the two groups in terms of gender, diabetes mellitus (DM), hypertension, smoking, and osteoporosis, with all p > 0.05. The logistic regression analysis demonstrated that higher preoperative body mass index (BMI; odds ratio (OR) 1.233, p = 0.005), preoperative disc degeneration (OR 1.033, p = 0.024), decreased postoperative lumbar lordosis (OR 3.080, p = 0.011), fusion at more than four levels (OR 4.280, p = 0.014), and intraoperative superior facet joint violation (OR 7.480, p = 0.009) were independently associated with ASD. CONCLUSIONS: Patients with higher preoperative BMI, preoperative disc degeneration, decreased postoperative lumbar lordosis, fusion at more than four levels, and intraoperative superior facet joint violation have a statistically significant increased risk of developing ASD.

Epidemiology of Colorectal Cancer and the Risk Factors in Kermanshah Province-Iran 2009-2014.

INTRODUCTION AND OBJECTIVE: Colorectal cancer is the fourth prevalent cancer in the world and there are several factors effective on development of the disease. These factors vary based on geographical distribution. The present study is aimed at surveying epidemiology of colorectal cancer and its risk factors in Kermanshah-Iran between 2009 and 2014. METHODOLOGY: A descriptive cross-sectional study was carried out on all colorectal cancer cases in two Kermanshah-based hospitals Imam Reza and Taleghani between 2009 and 2014. Demographic and epidemiological information was collected from the medical files and interviewing the patients. The collected data was analyzed in SPSS. FINDINGS: Totally, 336 patients had been registered from 2009 to 2014. Mean and standard deviation of age was 59.98 ± 15.26. Fifty-four subjects (16.05%) had a history of colorectal cancer among their relatives and 253 (62.5) had no history of physical activity. In addition, 81 subjects (24.1%) had a history of digestive diseases. In terms of diet, 205 subjects (61%) used less than 6 unit/day of grains and bread, and meat consumption in 150 subjects (44.6%) was less than 2 unit/day. CONCLUSION: The results showed that the prevalence of colorectal cancers was growing in Kermanshah. To change the rate, changes in lifestyle and screening tests for more susceptible age groups are recommended.

Accuracy of pulse oximetry in detection of oxygen saturation in patients admitted to the intensive care unit of heart surgery: comparison of finger, toe, forehead and earlobe probes.

BACKGROUND: Heart surgery patients are more at risk of poor peripheral perfusion, and peripheral capillary oxygen saturation (SpO2) measurement is regular care for continuous analysis of blood oxygen saturation in these patients. With regard to controversial studies on accuracy of the current pulse oximetry probes and lack of data related to patients undergoing heart surgery, the present study was conducted to determine accuracy of pulse oximetry probes of finger, toe, forehead and earlobe in detection of oxygen saturation in patients admitted to intensive care units for coronary artery bypass surgery. METHODS: In this clinical trial, 67 patients were recruited based on convenience sampling method among those admitted to intensive care units for coronary artery bypass surgery. The SpO2 value was measured using finger, toe, forehead and earlobe probes and then compared with the standard value of arterial oxygen saturation (SaO2). Data were entered into STATA-11 software and analyzed using descriptive, inferential and Bland-Altman statistical analyses. RESULTS: Highest and lowest correlational mean values of SpO2 and SaO2 were related to finger and earlobe probes, respectively. The highest and lowest agreement of SpO2 and SaO2 were related to forehead and earlobe probes. CONCLUSION: The SpO2 of earlobe probes due to lesser mean difference, more limited confidence level and higher agreement ration with SaO2 resulted by arterial blood gas (ABG) analysis had higher accuracy. Thus, it is suggested to use earlobe probes in patients admitted to the intensive care unit for coronary artery bypass surgery. TRIAL REGISTRATION: Registration of this trial protocol has been approved in Iranian Registry of Clinical Trials at 2018-03-19 with reference IRCT20100913004736N22. "Retrospectively registered."

Surveying the effect of a self-care education program on severity of nausea and emesis in colorectal cancer patients under chemotherapy.

BACKGROUND AND OBJECTIVE: Colorectal cancer is one of the main causes of mortality in both developed and developing countries, including Iran. One of the treatments available for colorectal cancer is chemotherapy, of which nausea and emesis are the side effects. Owing to problems in controlling the side effects, a combination of medicine and non-medicine interventions is usually used. Self-care is one of the non-medicine interventions in this regard. The present study was aimed at surveying the effect of a self-care education program on severity of nausea and emesis in colorectal cancer patients under chemotherapy. METHODS: A semi-experimental study was carried out in Imam Reza Hospital of Kermanshah, Iran. The sample group comprised 52 patients with colorectal cancer under chemotherapy. Data gathering tools included a demographics questionnaire and Morrow Assessment of Nausea and Emesis. To control intensity of nausea and emesis, a package of self-care measures including muscular progressive relaxation, music, and education on nutrition was used. Afterward, the collected data were analyzed using statistical tests such as Shapiro-Wilk test (to check normal distribution of the data), Mann-Whitney U test, Wilcoxon test, and chi-square test with the help of SPSS 20. RESULTS: The results showed a considerable decrease in intensity and frequency of nausea and emesis after the intervention. The p-value of Mann-Whitney U test results with regard to intensity of nausea in the experiment and control groups after the intervention was 0.029; this figure for intensity of emesis was 0.009, which indicated effectiveness of the self-care program. CONCLUSION: As the results showed, using self-care program could be effective in attenuating intensity of emesis and nausea in colorectal cancer patients under chemotherapy. So, it can be concluded that the use of this program can increase the patient's self-care ability to control vomiting and nausea, which can be considered as a complementary approach to the antiemetic medications.

Agreement and Correlation between Arterial and Central Venous Blood Gas Following Coronary Artery Bypass Graft Surgery.

INTRODUCTION: Arterial blood sampling, used to assess patients in acute conditions, may result in complications such as thrombosis and embolism. However, it can be replaced by venous blood sampling, but there is a dearth of information on this. AIM: To assess the correlation and agreement between the arterial and central venous blood gases analyses in patients undergoing elective Coronary Artery Bypass Graft (CABG) surgery. MATERIALS AND METHODS: In this cross-sectional study, 100 ICU patients undergoing elective CABG surgery were recruited. 2 mm arterial and a 2 mm venous blood samples were obtained from each patient's arterial and central venous lines, respectively. To predict Arterial Blood Gas (ABG) values based on central Venous Blood Gas (VBG) values, the linear regression analysis was used and for evaluating their agreement Bland-Altman method was used. RESULTS: In total of 200 samples were obtained. The mean and Standard Deviation (SD) of age was 58.9±9.1 years and 51% of the participants were female. There was a strong correlation between ABG and central VBG values regarding pH, partial Pressure of Carbon Dioxide (PCO2), Bicarbonate (HCO3) and Base Excess (BE) (r= 0.73, r=0.74, r=0.67 and r=0.71, respectively; p<0.001); however, the correlation between the arterial and venous Partial Pressure of Oxygen (PO2) and Oxygen Saturation (SO2) was moderate (r=0.29, p=0.005 and r=0.27, p=0.006, respectively). The Bland-Altman analysis showed an excellent agreement between all the variables (p<0.001). CONCLUSION: Central VBG analysis cannot replace ABG analysis in measuring exact PO2 status, necessitating arterial sampling in some matters, but with respect to the accuracy of pulse oximetry measurements in determining the exact PO2 status, for the rest of the indices a central VBG rather than an ABG can be utilised for determining patient's acid-base status. Particularly in patients who are hospitalised for a long time and have a central venous catheter in place like patients who have undergone CABG, thus reducing the risk and need for invasive arterial sampling.