Efficacy of topical gabapentin in women with primary macular amyloidosis: A side-by-side triple-blinded randomized clinical trial.

BACKGROUND: Primary cutaneous macular amyloidosis (PCMA) is a chronic pruritic cutaneous disease characterized by heterogeneous extracellular deposition of amyloid protein in the skin. AIMS: This study aimed to evaluate the efficacy of topical 6% gabapentin cream for the treatment of patients with PCMA. MATERIALS AND METHODS: In this triple-blind clinical trial, a total of 34 patients, who were diagnosed with PCMA, treated using two different strategies of topical gabapentin as the active group and vehicle cream as the control group. RESULTS: Pruritus score reduction in both groups was statistically significant compared with the baseline value (p < 0.001). There was a significant pigmentation score reduction in intervention group compared with control group after 1 month of the study (p < 0.001). The differences of pigmentation score changes between the groups were not significant at month 2 (p = 0.52) and month 3 (p = 0.22). CONCLUSIONS: The results of this study suggest that topical gabapentin cream may be effective as a topical agent in the treatment of pruritus associated with PCMA without any significant adverse effects. It is recommended to perform similar studies with a larger sample size and longer duration in both sexes.

Comparison of the effect of mint extract and chamomile drops on the gastric residual volume of traumatic patients under mechanical ventilation and nasogastric tube feeding in the intensive care unit: A triple -blind, randomized, crossover trial.

Objective: Mint and chamomile can effectively reduce the gastric residual volume (GRV). This study aimed to determine the effect of mint extract and chamomile drops on the GRV of trauma patients under mechanical ventilation and nasogastric tube feeding in the intensive care unit. Materials and Methods: This study was a triple-blinded randomized clinical trial with a 2×2 crossover design. Eighty patients were randomly divided to receive mint extract and chamomile drops. Five drops of mint extract and 11 drops of chamomile were gavaged every 6 hr. GRV was measured using a syringe-aspiration method before and 3 hr after each intervention. After a 24-hour washout period, the two groups changed places. Results: In the first phase of the study, before the interventions, the GRV in the mint and chamomile groups was 14.60±7.89 and 13.79±7.12 ml, and after the interventions were 8.13±6.31 and 6.61±4.68 ml, respectively. In the study's second phase, before the interventions, the GRV in the mint and chamomile groups was 10.03±4.93 and 11.46±7.17 ml and after the interventions, GRV was 4.97±4.05 and 6.98±4.60 ml, respectively. The difference in the GRV before and after the intervention was not significantly different between the two groups. Both herbal drugs effectively reduced the GRV (p=0.382). Conclusion: Mint extract and chamomile drops are similarly effective in reducing the GRV in trauma patients under mechanical ventilation and nasogastric tube (NGT) feeding in the intensive care unit.

Depression and Suicidal Ideation among Patients Receiving Opioid Maintenance Treatments Considering Cognitive Flexibility.

Objective: Cognitive flexibility is associated with psychiatric disorders. Drug addicts experience more psychiatric disorders. This research aimed to examine depression and suicidal ideation among those receiving opioid maintenance treatment (OMT), taking into account the mediating role of cognitive flexibility. Method : This cross-sectional research was conducted on patients who were enrolled in the OMT program in Semnan in 2021 and abstained from opioid use for at least one year. 126 participants (115 males and 11 females) were randomly selected from among patients in three therapeutic groups (42 from each of the methadone, buprenorphine, and opium tincture groups). The main data collection tools were the Beck Scale for Suicide Ideation (BSSI), Cognitive Flexibility Inventory (CFI), and Beck Depression Scale (BDI-II). Data analysis was done through logistic regression models. Results: Correlation analysis between depression scores, suicidal ideation, and cognitive flexibility showed a significant correlation between each of them. Adjusting for the type of treatment, the increase in cognitive flexibility was associated with a decreasing chance of depression (odds ratio [OR] = 0.87; 95% CI [0.82, 0.92]), and the use of buprenorphine (OR = 15.1) and opium tincture (OR = 9.3), compared to methadone, were associated with a depression increase. Yet, multivariate analysis did not show an independent and significant association between cognitive flexibility and the risk of suicide. Conclusion: Based on the results, patients receiving maintenance treatments are in different conditions in terms of depression and suicide, and psychological flexibility is in correlation with depression and suicidal thinking and behavior in them. This suggests that these patients seem to benefit from cognitive training, at least in reducing their depression.

Global clinicoepidemiological pattern of childhood vitiligo: a systematic review and meta-analysis.

BACKGROUND: Childhood vitiligo differs from adult vitiligo in many aspects. To the best of the authors' knowledge, there is no systematic review of different clinicoepidemiological patterns of vitiligo in children. This study aimed to review the characteristics of vitiligo among the paediatric population. METHODS: In June 2022, a comprehensive search was conducted using MeSh-based keywords on online databases including PubMed, Scopus and Web of Sciences. The papers were assessed, and the eligible articles were selected. The selection of articles followed three distinct steps. The extracted clinicoepidemiological data were then imported into the STATA software for meta-analysis. RESULTS: The meta-analysis of 17 studies with 4365 subjects yielded 2475 women (estimated=56.8%, 95% CI 54.45 to 59.22). The female-to-male ratio was determined to be 1.3:1. Meta-regression demonstrated a significant relationship between continents and gender (p=0.03). The most prevalent types of non-segmental vitiligo were vulgaris (42.49%), focal (27.21%) and acrofacial (17.8%). The pooled ratio of non-segmental to segmental was 4.6:1. The highest and lowest ratios were found in Africa with one study (estimated=11.56%, 95% CI -0.98 to 24.10) and America with two studies (estimated=3.02%, 95% CI 1.54 to 4.50), respectively. Using meta-regression, the relationship between continents and vitiligo type was found to be insignificant (p=0.47). Positive family history was recorded in 657 patients (estimated = 16.88%, 95% CI 13.37 to 20.39). Positive family history varied by country of study from 13.91% (Asia with 11 studies) to 27.01% (Europe with two studies) (p=0.11). Kobner phenomena and leukotrichia were noted in 687 (25.47%) and 461 (18.52%) patients, respectively. CONCLUSION: The review indicated that childhood vitiligo is more prevalent in women. Non-segmental forms of childhood vitiligo were the most common, including vulgaris, focal and acrofacial. The clinicoepidemiological pattern of childhood vitiligo is variable in different geographic areas.

Perceived professional identity and related factors in Iranian nursing students: a cross-sectional study.

BACKGROUND: Professional identity, an important process in the development and expansion of the nursing profession, is built over time and includes gaining insight into professional performances and fostering ideals and values for the profession. Several factors influence the formation of professional identity. This study investigates the level of professional identity in nursing students and its predictors using a localized tool. METHODS: This cross-sectional study recruited 195 nursing students at Semnan University of Medical Sciences, Semnan, Iran, who were selected by census sampling in 2020. Data were collected using a researcher-made professional identity questionnaire and were then analyzed in SPSS-18 using descriptive and inferential (logistic regression) statistics. RESULTS: The mean total score of the students' perceived professional identity was 316.72, indicating a strong professional identity. The students' professional identity had a significant relationship with variables including GPA above 16 (OR = 2.65, P = 0.002), choosing the field out of interest (OR = 2.15, P = 0.015), and having work experience while studying (OR = 3.10, P = 0.006). CONCLUSION: The findings showed that selecting the field of nursing out of interest, having a GPA above 16 and work experience while studying are associated with a higher perception of professional identity among nursing students. The professional identity of nursing students can be enhanced through reinforcing the mentioned factors and further attention to their role in the promotion and consolidation of professional identity. The researchers recommend that educational directors, nursing professors, and clinical nursing educators make greater efforts to develop and promote the professional identity of nursing students.

Working conditions and stressors data during Covid-19 and mental well-being in Iranian healthcare workers.

The current Covid-19 pandemic has affected the physical and mental stressors of hospital-based healthcare workers, but the extent of such effects are required to be quantified. This survey looked at data on nurses' perception across teaching hospitals to assess the impacts of Covid-19 on working conditions, exposure to stressors, and mental health symptoms. We implemented a population survey with a cross-sectional design in teaching hospitals affiliated with Medical Sciences Universities in Iran from April to November 2021. Participants were about 1200 health care workers, including hospital nursing staff, assistants, and technicians. Final data were assembled from 831 hospital nurses across surgery, dialysis, intensive care, emergency care, cardiac care, internal medicine, gynecology, and pediatric wards. Self-reported data were collected directly from survey participants. We collected information on variables including gender, marital status, employment status, occupational health training, evaluation of work environment stressors, fear of Covid-19, and occupational burnout constructs, specifically reflecting emotional exhaustion, depersonalization, and personal accomplishment. Focus groups of faculties evaluated and edited items to test the content wording and to define the content that are valid measures of the variables. The questionnaires were assessed for their reliability. Manual data entries were double-checked for errors. Data were recorded and categorized consistently to ensure the replicability of the data in the future. Statistical descriptive and analytical analyses were performed on the data. Data reported on the frequencies and mean values of responses and the variations of mental health in terms of worktime schedules. Chi- square, ANOVA, and correlation analyses determined relations between variables. The compiled data shed light on the exposure and response to physical and psychosocial factors and mental health symptoms among nurses during the pandemic. The data files detailed in this article can be further reused to inform workplace determinants of health in hospital settings. The obtained scores and existing dataset on mental health outcomes can help future studies to consider resilience strategies that should be provided among nurses.

Occupational Burnout Symptoms and Its Relationship With Workload and Fear of the SARS-CoV-2 Pandemic Among Hospital Nurses.

Introduction: The pandemic has intensified physical and psychological work demands experienced by nurses in a hospital environment. The purpose of this study was to examine personal and work environmental risk factors associated with occupational burnout among hospital nurses. Methods: We conducted a cross-sectional from April to November 2020. Data from 831 nurses who worked professionally in four educational hospitals were compiled through survey questionnaires to report the prevalence of burnout, occupational and individual factors. Independent t-test and Mann-Whitney test measured the link between the scopes of occupational burnout and risk factors. Results: About half of the participants indicated moderate symptoms of burnout. The fear of the nurses correlated significantly with emotional exhaustion (r = 0.71, p = 0.001), depersonalization (r = 0.67, p = 0.02), and personal accomplishment (r = 0.63, p = 0.05). Mental demand (r = 0.74, p = 0.01) and effort at work (r = 0.68, 0.001) correlated significantly with emotional exhaustion (r = 0.51, p = 0.03). Conclusion: The findings indicated a high prevalence of burnout symptoms, particularly emotional exhaustion, among hospital nursing professionals. Occupational health services should consider burnout as an occupational-related condition and provide interventions to reduce workplace chronic stressors and burnout in hospitals.

Clinical and Epidemiological Features of Patients with Drug-Induced Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in Iran: Different Points of Children from Adults.

BACKGROUND: Different epidemiologic aspects of drug-induced Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) in children are scarce. AIM: To compare the clinical and epidemiological features of patients with drug-induced SJS and TEN in children and adults. METHOD: This retrospective study was conducted at two academic referral centers (Isfahan, Iran) over 5 years. SJS and TEN were clinically diagnosed and confirmed by skin biopsy as needed. RESULTS: One hundred one patients (31 children and 70 adults) with a female to male ratio of 1.1 : 1 was identified in the present study. SJS was more commonly diagnosed in both pediatric and adult patients. The most frequent reason for drug administration identified was the infection (45.2%) and seizure (45.2%) in children and infection (34.3%) and psychiatry disorder (27.1%) in adults (P = 0.001). The most common culprit drugs in the pediatric were phenobarbital (9/31), cotrimoxazole (4/31), and amoxicillin (4/31); however, in the adult group, the most common drugs were carbamazepine (11/70) and lamotrigine (9/70). Fever was significantly more common in adults (44.3%) compared to pediatric patients (22.6%) (P = 0.03). Multiple logistic regression models showed that pediatric patients had significantly lower odds of hospitalization (OR [odds ratio]: 0.14; 95% CI 0.02, 0.67). In addition, patients with SCORTEN 1 had significantly higher odds of hospitalization (OR: 6.3; 95% CI: 1.68, 23.79) compared to patients with SCORTEN 0. CONCLUSIONS: The present study showed several differences between the pediatric and adult patients with SJS and TEN, including the reason for drug administration, culprit drugs, length of hospital stay, presence of fever, and final diagnosis of disease.

The prophylactic effect of betaxolol 0.5% versus brimonidine 0.2% on IOP elevation after Nd:YAG laser posterior capsulotomy.

CLINICAL RELEVANCE: Posterior capsule opacification is a common late complication of cataract surgery. Posterior capsule opening with Nd:YAG laser, which is the standard treatment, may cause transient elevation of intraocular pressure (IOP). BACKGROUND: To evaluate the efficacy of betaxolol 0.|5% compared to brimonidine 0.2%, in prevention of intraocular pressure increase after Nd:YAG Laser posterior capsulotomy. METHODS: In a double masked randomised clinical trial, 38 eyes from 38 pseudophakic patients over 21 years of age who had significant posterior capsule opacification after phacoemulsification were randomly assigned to receive either betaxolol 0.|5% (18 eyes) or brimonidine 0.|2% (20 eyes) one hour before Nd:YAG Laser posterior capsulotomy.| Exclusion criteria were: glaucoma or history of glaucoma surgery, active uveitis, active ocular infection, pregnancy, unstable cardiovascular condition and severe asthma and lung diseases. Intraocular pressure was measured by Goldmann applanation tonometry, 1 hour before applying the laser and 4 hours after the laser application. RESULTS: There was no statistically significant difference between the two groups regarding the baseline mean IOP and the 4-hour post-laser mean IOP. There was a statistically significant decrease in the 4-hour post-laser mean IOP as compared to the baseline mean IOP in each group. The mean IOP change in the betaxolol group, was -2.39 ± 1.79 mm Hg and in the brimonidine group was -4.25 ± 2.20 mm Hg. The difference was statistically significant (P = 0.007). None of the patients experienced clinically significant IOP increase (≥5 mm Hg) in either group. CONCLUSION: Use of a single topical dose of betaxolol 0.5% and brimonidine 0.2%, 1 hour before laser treatment, can prevent significant acute IOP increase after Nd:YAG laser posterior capsulotomy, and betaxolol may provide a new alternative for prophylactic use.

Compliance of imipenem and meropenem administration with the national antimicrobial stewardship program in a referral teaching hospital in Iran.

INTRODUCTION: Considering the great significance of antimicrobial resistance, implementation of antimicrobial stewardship programs (ASPs) in healthcare facilities is of particular importance. This study aimed to evaluate the compliance of imipenem and meropenem administration with the ASP guidelines in a referral teaching hospital in Iran. METHODS: In this retrospective cross-sectional study, the medical records of patients, who received either imipenem or meropenem at xx Hospital in Semnan, Iran, from 21 March 2017 until 20 March 2019, were reviewed using the developed ASP, according to the instructions issued by the Ministry of Health of Iran. The obtained findings were recorded in a checklist consisted of six items. If the action taken for the patient complied with the item requirement specified in the ASP, it would receive a score of one; otherwise, a score of zero. The sum of scores (range: 0-6) was reported and analyzed. Data were analyzed in SPSS version 23, using Chi-square, ANOVA, and independent t-test, and P < 0.05 was considered as significant. RESULTS: The mean duration of imipenem/meropenem administration was 9.2 ± 8.0 days. A total of 6,032 imipenem/meropenem vials (1 g/vial) were prescribed during the study (meropenem for 210 patients and imipenem for 87 patients). In 64.2% of the patients, there was no indication, and the mean score of the subjects was 1.55 ± 1.2. The obtained score was three in 53 (17.8%) records and four in 18 (6.1%) records. The mean score of ASP in the intensive care units was higher, while it was lower in the surgical ward as compared to the other wards (P = 0.002). DISCUSSION: Antibiotic prescription was inappropriate in our center, and compliance with the ASP guidelines was very low, especially in the surgical wards. It seems necessary to take effective steps for planning continuing education programs on rational antibiotic prescription and supervision of prescription patterns.

Knowledge, Attitudes, and Practices toward COVID-19 among Persian Birth Cohort Participants.

BACKGROUND: Knowledge, attitudes, and practices (KAP) toward COVID-19 play an important role in controlling the outbreak. The present study aimed to investigate the KAP of a group of women toward COVID-19 during the second wave of the outbreak in Iran. METHOD AND MATERIAL: A cross-sectional survey of 2862 women was conducted in May and June 2020 in two centers of Persian birth cohort. The survey instrument was a self-reported questionnaire Multivariable linear regression analysis to identify factors associated with knowledge and practice. toward COVID-19 and multinomial logistic regression analyses to identify factors associated with attitudes. Unstandardized regression coefficients (ß) and odds ratios and their 95% confidence intervals were used to quantify the associations between variables and KAP. RESULT: Good knowledge and optimistic attitudes toward the successful control of COVID-19 was seen among participants. Overall, about 57.3% (1640), 41.1% (1176), and 1.6% (46) of respondents were categorized as low (score <50%), moderate (score: 50%-80%), and high (score > 80%) proper practice, respectively. Eighty-five individuals with COVID-19 experience (3.0%) had lower knowledge score (79.91 ± 17.93 vs. 83.81 ± 13.88, P < 0.001) and lower proper practice score (40.22 ± 16.57 vs. 47.96 ± 16.15, respectively, P < 0.001) compared to those who were not infected. A higher level of knowledge was associated with appropriate practice in both groups of positive attitudes (χ2 = 32.23, P < 0.001) and negative attitudes (χ2 = 31.49, P < 0.001). CONCLUSION: This survey recorded good knowledge and relatively good attitudes among women. Special health policies plan should be taken for target populations among women during the COVID-19 pandemic.

Intima-Media Thickness Measurements of the Common Carotid Artery in Patients with Central Serous Chorioretinopathy: A Case-Control Study.

PURPOSE: To evaluate the intima-media thickness (IMT) of the left and right common carotid arteries (CCA) as an indicator of subclinical atherosclerosis in patients with central serous chorioretinopathy (CSCR). METHODS: This was a case-control study involving patients with CSCR and a matched healthy control group. The mean and difference of the left and right CCA IMT were determined and compared between the two groups using carotid duplex high-resolution B-mode ultrasound equipment. RESULTS: The study enrolled 32 CSCR patients (68.8% female, mean age 38.22 ± 5.42 years) and 32 controls (65.6% female, mean age 39.56 ± 5.33 years). The difference in common carotid IMT between the right and left sides was significantly greater in the CSCR group than in the control group (p < 0.001). Additionally, according to logistic regression analysis, patients with CSCR had a greater chance of having differences in IMT between the two sides when compared to the control group (OR: 1.29, 95% CI: 1.09-1.52). CONCLUSION: Our findings indicated that in the CSCR group, the difference between the right and left sides of CCA IMT was significantly greater than in the control group.

Pruritus Features in Children with End-Stage Renal Disease Underwent Dialysis: A Cross-Sectional Study.

OBJECTIVE: Evaluation of the pruritus features in children with end-stage renal disease (ESRD) who underwent dialysis at an academic tertiary pediatric dialysis center. METHODS: This cross-sectional study was conducted at an academic tertiary pediatric dialysis center, Isfahan, Iran. The reviewed medical records of the children included their characteristics, dialysis properties, and laboratory parameters. The 4-item itch questionnaire was utilized to assess distribution, severity, frequency, and associated sleeping disorders. RESULTS: Thirty ESRD patients with pruritus, including 23 males (76.7%) with a mean age of 11.7 ± 3.64 years, were recruited. The most common cause of CKD was nephronophthisis (23.3%). The median total score of pruritus was 5 (range: 3-15). The distribution score of pruritus was directly correlated with the age (Spearman's rho = 0.42, P = 0.02) and serum level of parathyroid hormone (PTH) (Spearman's rho = 0.42, P = 0.04). In the reduced multiple logistic regression model, the increasing level of serum calcium was associated with increased odds of having total pruritus score ≥ 5 (OR (odds ratio): 4.5; 95% CI 1.12 to 18.05). In addition, an increase in age for one year was found to be associated with 50% higher odds of having total pruritus score ≥ 5 (OR: 1.5; 95% CI 1.03 to 2.18). CONCLUSION: Increased level of serum Ca and higher age were associated with increased odds of having more severe pruritus score in children.

Moral distress and its contributing factors among emergency department nurses: A cross-sectional study in Iran.

BACKGROUND: Moral Distress (MD) is a common experience in nursing practice and constitutes one of the main reasons for professional burnout, job withdrawal, fatigue, and avoidance of patient care among nurses. The causes, frequency and severity of MD vary according to the ward and hospital of service. The present study was conducted to determine the frequency and severity of MD and its contributing factors among Emergency Department (ED) nurses in Iran. METHODS: This descriptive cross-sectional study was conducted in 2019.A total of 203 participants were selected by census sampling from the 248 nurses working in the EDs of hospitals in Semnan Province, Iran. Data were collected using Corley's Moral Distress Scale-Revised and analyzed using descriptive and inferential statistics. FINDINGS: The mean severity and frequency of MD were 1.36 ± 0.74 and 1.20 ± 0.68 out of 4, respectively. The MD levels were significantly higher in female nurses (p = 0.002), those under 30 years of age (p = 0.003), with less than ten years' work experience (p = 0.03), and with higher levels of education (p < 0.001). In addition, inverse and significant relationships were found between MD and the nurses' age (r = -0.202,p = 0.004) and work experience(r = -0.149, p = 0.034). CONCLUSION: According to the results, nurses had moderate levels of MD. Numerous factors, including age, gender, work experience, and education, were associated with the total MD score.To reduce MD and its negative effects on nurses, it is necessary to address these factors and appropriately plan to identify and manage MD so as to improve the quality of nursing care.

Exploration of mental health problems in association with health-promoting lifestyle profile in Iranian medical students: A cross-sectional study.

OBJECTIVE: The aim was to explore the relationship between mental health problems (MHPs) and health-promoting lifestyle (HPL) in the medical students. METHODS: This cross-sectional study was carried out on medical students in 2017 at Semnan University of Medical Sciences applying a stratified random sampling. The Symptom Checklist-25 and the HPL profile scales were used. Logistic regression models were used to analysis. RESULTS: Of the participants, 84 were male and 148 were female. The mean age was 22.69 years (±2.42). Most students (95.3%) were single and 40.1% were in the preclinical stage. The mean MHP score was 44.14 (±13.99), and 3% were in the severe category. The mean HPL score was 104.88 (±16.84); 95.7% and 4.3% of them had average and satisfactory lifestyles, respectively. The MHP score of the female (P < 0.001), younger (P < 0.001), single (P = 0.045), preclinical (P < 0.001), and who were away from home (P = 0.009) were significantly higher. The HPL score of female (P < 0.001), older (P = 0.041), and married students (P = 0.028) were significantly higher. The female gender (odds ratio [OR] = 4.45, P < 0.001) and studying in the clinical level (OR = 0.30, P < 0.001) were the most important associated factors with MHP. Adjusting for them, there was a significant relationship between an increase in the HPL score and a decrease in the likelihood of MHP (OR = 0.96, P < 0.001). CONCLUSIONS: The mental health of medical students was shown to be in association with lifestyle independent of other important determinants, including gender and academic level. It seems that modifying the lifestyle to a healthier way can improve students' mental health.

The Effect of the Open and Closed System Suctions on Pain Severity and Physiological Indicators in Mechanically Ventilated Patients with Traumatic Brain Injury: A Randomised Controlled Trial.

OBJECTIVE: Tracheal suctioning can cause pain and physiological indicator variations in patients with traumatic brain injury (TBI). The aim of the present study was to compare pain severity and physiological indicator variations during the closed tracheal suction system (CTSS) and open tracheal suction system (OTSS) in patients with TBI. METHODS: This study was a clinical trial. Samples included all ventilated patients with TBI. The patients were randomly divided into the OTSS and CTSS groups. In both groups, the Critical Care Pain Observation Tool (CPOT) and physiological indicators were recorded by three nurses prior to suctioning, the end of suctioning and 5 min after suction completion. Data were analysed using the independent t-test and repeated measurement tests. RESULTS: A total of 112 patients participated in the present study. Before the interventions, the mean value of the Glasgow Coma Scale was 6.45±1.13, blood pressure 128.33±20.54, saturated oxygen in arterial blood (SpO2) 96.74±2.76, respiratory rate (RR) 15.06±3.98, end-tidal CO2 (EtCO2) 36.2±21.98, heart rate 82.18±42.33 and CPOT-based pain 0.43±0.94 in the patients. Independent t-test was used to compare CTSS and OTSS, suggesting significant differences with respect to the mean values of SpO2, RR and EtCO2 immediately after suctioning. This test showed significant differences between the two groups with respect to pain intensity at all three points of measurement. The two groups were also found to be significantly different with respect to RR measured 5 min after suctioning (p<0.05). CONCLUSION: Compared to OTSS, CTSS can cause higher reductions in pain levels during and after suctioning in patients with head traumas and can also cause higher improvements in physiological indicators, such as RR, O2 saturation and EtCO2.

Estimating the Net Survival of Patients with Gastric Cancer in Iran in a Relative Survival Framework.

BACKGROUND: Iran is an Eastern Mediterranean region country with the highest rate of gastric cancer. The present study aimed to evaluate the 5-year net survival of patients with gastric cancer in Iran using a relative survival framework. METHODS: In a cross-sectional study, using life-table estimation of relative survival, we reported 1- to 5-year relative survival regarding age, sex, disease stage, pathology, and adjuvant therapies via modeling excess mortality. All the analyses were done applying Stata 11.2 with a confidence level of 95%. RESULTS: Data on 330 patients (aged 32-96 y), who were comprised of 228 (69.1%) men and 102 (30.1%) women with gastric cancer and were followed up for 10 years, were analyzed. Adenocarcinoma was the most common malignancy (281 [85.2%] patients), and 248 (75.1%) patients were at stage 3 or stage 4. The 1- and 5-year net survival rates after surgery were 67.96 (95% CI: 62.35-72.98) and 23.35 (95% CI: 17.94-29.28), respectively. Higher stages (P=0.001), older ages (P=0.007), and less use of adjuvant therapies (P<0.001) were independently associated with excess mortality. CONCLUSION: It is recommended to use the relative survival framework to analyze the survival of cancer patients as an alternative approach not only to eliminate biases due to competing risks and their dependencies but also to estimate the cure at the population level concerning the most important individual characteristics. Our findings showed that the survival rate of gastric cancer in Iran is lower than that in most developed countries in terms of net survival.

Injecting Drug Users Retention in Needle-Exchange Program and its Determinants in Iran Prisons.

BACKGROUND: Participation and to stay in a health program depends on many factors. One of these programs is Needle Exchange Program (NEP) in prisons. OBJECTIVES: The current study aimed to evaluate the retention of injecting drug prisoners and find the related factors in Iran. PATIENTS AND METHODS: This cohort study analyzed data about injecting drug male prisoners who were participated in NEP in three Iranian prisons. Data was collected from October 2009 to June 2010. A proper approach of survival analyses including Kaplan-Meier method, Log-Rank test, and Cox Proportional Hazard Model were used to evaluate Injecting Drug Users (IDUs) retention in NEP and its determinants. RESULTS: Out of 320 prisoners, 167 were from Isfahan Central Prison, 82 from Tehran-Ghezel-Hesar Prison, and 71 from Hamadan Central Prison. Two-hundred and fifty prisoners (78.4%) had history of drug injection; and drug injection was the most common choice for 115 persons (35.9%). Participants were followed up for 29 weeks, the mean (SD) time of retention in the program was 24.1 (0.6) weeks. There was a significant relationship between age, number of used needles per week, duration of addiction, age of addiction onset, as well as imprisonment age, main method of drug use, type of main using drug, Hepatitis B Virus (HBV) infection, job status, reason of arrestment, history of involvement in harm reduction programs, and the length of retention (P < 0.05). There was also significant relationship between the history of using harm reduction services (P = 0.007), tattooing (P = 0.01), longer durations of addiction (P = 0.048), and retention. CONCLUSIONS: Tattooing and longer duration of addiction were two important factors that significantly increased retention in the program. In contrast, history of using harm reduction services was the factor that decreased persistence. The risk of quitting the program may decrease about 68% in those who did not involve in harm reduction programs.