Evaluation of biochemical parameters in operating room staff exposed to radiation and anesthetic gases.

Background: Exposure to ionizing radiations and other hazardous agents such as anesthetic gases pose serious risks to the health of healthcare workers. This study aimed to evaluate the changes in blood and biochemical parameters of the operating room staff exposed to ionizing radiations and remnants of anesthetic gas. Methods: This cross-sectional study was performed at (Ayatollah Taleghani Hospital). The control group was selected from different parts of the hospital that were not exposed to ionizing radiations and anesthetics, including the office, services, and treatment. The case group included all operating room personnel. Hematopoietic parameters such as complete blood count and WBC differential, and parameters of liver function such as serum activity of liver enzymes (ALT, AST, ALP, LDH) and serum bilirubin levels, fasting blood sugar, serum lipid profile, level of vitamin D and magnesium were measured for the exposed and referent subjects. Additionally, a checklist was used to gather data regarding the occupational variables and medical histories of the studied subjects. Results: The mean values of Hb, Hct, Vitamin D, and MCHC, as well as the RBC count, were significantly lower in the exposed individuals than in the referent subjects. In contrast, the proportion of smokers was significantly higher in the exposed group than in the referent group. No significant differences were noted between exposed and unexposed groups as far as other parameters were concerned. However, no significant differences were noted between the case and control groups as far as other measured parameters were concerned. Likewise, no significant differences were noted between exposed and referent groups as far as blood types, history of underlying diseases, work history, working hours per month, number of morning and evening shift hours, type of diet, consumption of a high-fat diet a day before blood sampling, X-ray in the recent year, history of radiotherapy, and therapeutic agents use was concerned. Conclusions: Exposure of operating room staff to ionizing radiations and waste anesthetics gases is associated with subtle, subclinical prepathologic decreases in some hematopoietic parameters such as hemoglobin, hematocrit and MCHC levels, RBC count as well as vitamin D levels.

Low back pain and its related risk factors in health care providers at hospitals: A systematic review.

BACKGROUND: Health care personnel are exposed to ergonomic hazards, musculoskeletal disorders, and other work-related injuries. Low back pain is the most common musculoskeletal disorder. The aim of this study was to determine the prevalence of low back pain and the risk factors in health care personnel at the hospital in a form of a systematic review and meta-analysis. METHODS: In this systematic review and meta-analysis, the articles published in international electronic databases including Web of Knowledge, Embase, Scopus, PubMed were searched until May 2019. We included cohort, case-control and cross-sectional studies estimate the prevalence and risk factors for low back pain in health personnel. Data were analyzed using Stata-14 software and random effect model at 95% confidence level. FINDINGS: 154 studies were included in the study for analysis. The estimated lifetime prevalence of lower back pain in health care personnel was 54.8%. The estimated odds ratios were as follows: age 1.23, female gender 1.11, BMI 1.17, lack of regular physical activity 1.56 occupational factors 1.12, patient related factors 1.24, body position at work 2.55, and stress 1.67. CONCLUSIONS: /application to practice: The prevalence of low back pain in health care personnel is high. Body position at work, stress and lack of physical activity were the strongest risk factors, respectively. Future studies and educational programs are required to reduce the incidence of low back pain in health care personnel.

A cross-sectional study on the prevalence of electrolyte abnormalities in multiple trauma patients in Hamedan, Iran.

INTRODUCTION: Evaluation of electrolyte status and homeostasis is one of the most important components of evaluation and treatment of critically ill patients, especially those with multiple trauma. Electrolyte imbalance can be associated with a bad prognosis and the need of specialized consultancy. AIM: The aim of this study was to evaluate and determine the electrolyte status of patients with multiple trauma and evaluate the relationship of electrolyte disorders with patient outcome. METHODS: In this cross-sectional study, 370 patients who were referred to the emergency department of Besat Hospital in Hamadan, Iran with multiple trauma were studied. Demographic parameters clinical characteristics such as blood pressure, heart rate, respiratory rate, consciousness score and body temperature, paraclinical characteristics including radiographic status, ultrasound, and electrocardiography and serum levels of sodium, potassium, creatinine, hemoglobin, hematocrit, and BUN and urine analysis was performed. Data regarding the discharge from emergency department or referral to other units were also complete in a questionnaire for each patient. Statistical analyses were performed using SPSSv24. RESULTS: Three hundred seventy patients with multiple trauma were studied where 73% of patients were men and 27% were women. One hundred ninety-six patients were discharged from the emergency department, and 174 patients were referred to other units of the hospital. The most common electrolyte abnormalities were hypotension (62.7%), hypernatremia (9.5%), hypokalemia (6.8%), and hypercreatinine (4.6%). The results of independent t-test showed that heart rate and potassium level were significantly higher in patients referred to other units than in patients discharged from the emergency department and respiratory rate and hematocrit were significantly lower in patients referred to other units. CONCLUSION: Hypotension, hypernatremia, hypokalemia, hypercreatinine, and abnormal urine analysis were more frequent in patients referred to other units than in patients discharged from the emergency department. These variables can be considered in predicting patient status for referral to other units and delayed hospital discharge.

Evaluation of Allergic Reactions Following Intravenous Infusion of Polyvalent Antivenom in Snakebite Patients.

BACKGROUND: Antivenom is a gold-standard treatment for snakebite envenoming. However, adverse reactions to snake antivenom are common in many parts. OBJECTIVE: The aim of this study was to evaluate the allergic reactions following intravenous administration of antivenom sera. METHODS: This was retrospective study conducted on snakebites patients referred to the Rahimi Hospital in Khorramabad. The files of these patients were accessed for demographic data, snakebite-related data, treatment provided, clinical presentation and allergic reaction status as a result of antivenom treatment. RESULTS: 141 cases were investigated, including 73.8% male and 26.2% female patients. The mean age of the patients was 38.1±17.1 years. Age group 30-39 years accounted for the highest number of snakebite cases (24.1%). A majority of victims (89.4%) were from rural areas. Most of the patients (51.8%) were bitten in the spring and highest number of snakebite were reported in May (39.1%). The most common site of snakebite was lower extremities (50.4%) and upper extremities (44.7%). Among clinical feature of snakebite, pain was the most prevalent in 135 cases (95.7%) followed by swelling (83.7%). The mean antivenom vials used were 6.5±3.7 vials. Allergic reactions occurred in 6 patients (4.26%); reactions were mild in 5 patients and severe in 1 patient. The commonest presentation was maculopapular rash (1.4%) and the least common were headache (0.71%), nausea (0.71%), fever (0.71) and hypotension (0.71%). CONCLUSION: Snakebite is one of the significant life-threatening environmental events. Immediate antivenom treatment can reduce mortality however, patients should be carefully monitored for adverse allergic reactions.

Comparison of efficacy nebulized fentanyl with intravenous ketorolac for renal colic in patients over 12 years old.

OBJECTIVES: Acute renal colic is one of the common causes of referral to the hospitals. The aim of this study is to compare the efficacy of nebulized fentanyl with that of intravenous ketorolac in renal colic patients. MATERIALS & METHODS: This double-blinded clinical study included 186 patients with acute renal colic who were referred to the emergency department of Besat Hospital, Iran. PATIENT SELECTION: After selecting patients, according to study inclusion and exclusion criteria, they were divided into 2 groups of 93 using random block allocation method. The patients in the groups were treated with either nebulized fentanyl or intravenous ketorolac. The severity of pain was measured using the Numeric Pain Rating Scale (NPRS) of pain. The severity of pain at different times and demographic data were recorded. RESULTS: One hundred and thirty four males and 52 females with a mean age of 42.95 ± 13.13 years were included in the study. The two groups were matched in terms of age, sex, and the severity of the pain before the treatment. Fifteen minutes following the treatment, the severity of pain was decreased in the ketorolac group but did not change in the nebulized fentanyl group. Thirty minutes after the administration of the drug, the severity of pain in the nebulized fentanyl group decreased. At any time, the severity of pain in the ketorolac group was lower than that of the nebulized fentanyl group. CONCLUSION: Intravenous ketorolac had better analgesic effects in renal colic patients compared with nebulized fentanyl. Further studies that include complications and combinational therapy are required.

Pneumonia severity index compared to CURB-65 in predicting the outcome of community acquired pneumonia among patients referred to an Iranian emergency

OBJECTIVE: To compare the prognostic value of the pneumonia severity index and the severity score for community-acquired pneumonia (CURB-65) in predicting mortality and the need for ICU admission of patients with community-acquired pneumonia referred to our emergency department. MATERIALS AND METHODS: This prospective study was performed on patients with community-acquired pneumonia admitted to the emergency department of Imam Hossein Medical Center, Tehran, Iran. A questionnaire with demographic information, clinical signs and symptoms, laboratory and radiographic findings was completed for each patient. The information required for calculating the pneumonia severity index and CURB-65 were extracted from the medical records. The patients' clinical outcome was also recorded within a month after admission. RESULTS: We studied 200 patients with community-acquired pneumonia (122 men, 78 women). The sensitivity and specificity of CURB-65 in predicting mortality were 100% and 82.3%, respectively. As for pneumonia severity index, the rates were 100% and 75%, respec tively. The sensitivity and specificity rates of CURB-65 and pneumonia severity index in predicting mortality and need for ICU admission were 96.7% and 89.3%, and 90% and 78.7%, respectively. CONCLUSION: CURB-65 seems to be the preferred method to predict mortality and need for ICU admission in patients with community-acquired pneumonia. Despite their comparable specificity and sensitivity, CURB-65 is much easier to implement.

Pneumonia severity index compared to CURB-65 in predicting the outcome of community acquired pneumonia among patients referred to an Iranian emergency department: a prospective survey.

OBJECTIVE: To compare the prognostic value of the pneumonia severity index and the severity score for community-acquired pneumonia (CURB-65) in predicting mortality and the need for ICU admission of patients with community-acquired pneumonia referred to our emergency department. MATERIALS AND METHODS: This prospective study was performed on patients with community-acquired pneumonia admitted to the emergency department of Imam Hossein Medical Center, Tehran, Iran. A questionnaire with demographic information, clinical signs and symptoms, laboratory and radiographic findings was completed for each patient. The information required for calculating the pneumonia severity index and CURB-65 were extracted from the medical records. The patients' clinical outcome was also recorded within a month after admission. RESULTS: We studied 200 patients with community-acquired pneumonia (122 men, 78 women). The sensitivity and specificity of CURB-65 in predicting mortality were 100% and 82.3%, respectively. As for pneumonia severity index, the rates were 100% and 75%, respectively. The sensitivity and specificity rates of CURB-65 and pneumonia severity index in predicting mortality and need for ICU admission were 96.7% and 89.3%, and 90% and 78.7%, respectively. CONCLUSION: CURB-65 seems to be the preferred method to predict mortality and need for ICU admission in patients with community-acquired pneumonia. Despite their comparable specificity and sensitivity, CURB-65 is much easier to implement.