Intraluminal extension of papillary thyroid carcinoma into the Internal Jugular Vein; a case report.

BACKGROUND: Papillary thyroid carcinoma (PTC), being the most common thyroid malignancy, is a slow-growing tumor and is usually limited to the thyroid. Extra thyroid extension is uncommon; besides, invasion to the vasculature seems to be extremely rare and usually indicates aggressive nature of the disease. CASE PRESENTATION: We present a case of a 40-year-old lady who referred with a palpable neck mass a month after total thyroidectomy which its histopathologic examination revealed follicular variant of PTC; the same variant as prior thyroidectomy. Preoperative ultrasonography failed to comment on the intravascular component of the mass. Surgical procedure confirmed a mass attaching and infiltrating to the internal jugular vein, which turned out to be persistent disease. CONCLUSIONS: Awareness of this entity is important for surgeons, oncologists and radiologist as it can influence patient management.

Characteristics of Traumatic Patients Referring to the Emergency Department and their Association with Mortality and Incidence of Surgery Performance.

Objective: To identify the distinctive features of acutely injured patients who were presented to the emergency department (ED) and their association with mortality and surgical intervention outcomes. Methods: This cross-sectional study was conducted on all trauma patients resuscitated in the ED of Shahid Rajaee (Emtiaz) Trauma Hospital (Shiraz, Iran) from May 2018 to June 2019. Demographic information, the mechanism of trauma, trauma type, injured body regions, criteria of abbreviated injury scale (AIS) score, injury severity score (ISS), and surgical intervention were all taken into consideration. The items related to the mortality and surgical performance outcomes among the patients were analyzed. Results: Of all 1281 cases, 82.9% were men, and the mean age of the patients was 37.9±19.1 years. The most common mechanism of injury was a car accident, and the thorax was the most prevalent injured area of the body. The majority of the patients had moderate blunt trauma. The mechanism of trauma, ISS, and the severity of head trauma were all significantly correlated with operation interventions. Moreover, age, the mechanism and type of trauma, ISS, and the necessity for the surgery were significantly associated with death occurrence. Additionally, head, thorax, and abdomen trauma were significantly related to a high mortality rate. Conclusion: Age, trauma mechanism and type, ISS, and the necessity for surgery were significantly associated with the mortality rate of injured patients. The severity of the trauma, particularly head injuries and the mechanism of damage were important determinants in concern for surgery the necessity.

Design, development, implementation, and evaluation of a severe drug-drug interaction alert system in the ICU: An analysis of acceptance and override rates.

BACKGROUND AND OBJECTIVE: The override rate of Drug-Drug Interaction Alerts (DDIA) in Intensive Care Units (ICUs) is very high. Therefore, this study aimed to design, develop, implement, and evaluate a severe Drug-Drug Alert System (DDIAS) in a system of ICUs and measure the override rate of this system. METHODS: This is a cross-sectional study that details the design, development, implementation, and evaluation of a DDIAS for severe interactions into a Computerized Provider Order Entry (CPOE) system in the ICUs of Nemazee general teaching hospitals in 2021. The patients exposed to the volume of DDIAS, acceptance and overridden of DDIAS, and usability of DDIAS have been collected. The study was approved by the local Institutional Review Board (IRB) and; the ethics committee of Shiraz University of Medical Science on date: 2019-11-23 (Approval ID: IR.SUMS.REC.1398.1046). RESULTS: The knowledge base of the DDIAS contains 9,809 severe potential drug-drug interactions (pDDIs). A total of 2672 medications were prescribed in the population study. The volume and acceptance rate for the DDIAS were 81 % and 97.5 %, respectively. The override rate was 2.5 %. The mean System Usability Scale (SUS) score of the DDIAS was 75. CONCLUSION: This study demonstrates that implementing high-risk DDIAS at the point of prescribing in ICUs improves adherence to alerts. In addition, the usability of the DDIAS was reasonable. Further studies are needed to investigate the establishment of severe DDIAS and measure the prescribers' response to DDIAS on a larger scale.

Investigating the prevalence of and predictive and risk factors for pulmonary embolism in patients with COVID-19 in Nemazee Teaching Hospital.

Background: Pulmonary thromboembolism (PTE) is a significant contributing factor to vascular diseases. This study aimed to determine the prevalence of pulmonary thromboembolism and its predisposing factors in patients with COVID-19. Methods: This cross-sectional study included 284 patients with COVID-19 who were admitted to Nemazee Teaching Hospital (Shiraz, Iran) between June and August 2021. All patients were diagnosed with COVID-19 by a physician based on clinical symptoms or positive polymerase chain reaction (PCR) test results. The collected data included demographic data and laboratory findings. Data were analyzed using the SPSS software. P≤0.05 was considered statistically significant. Results: There was a significant difference in the mean age between the PTE group and non-PTE group (P=0.037). Moreover, the PTE group had a significantly higher prevalence of hypertension (36.7% vs. 21.8%, P=0.019), myocardial infarction (4.5% vs. 0%, P=0.006), and stroke (23.9% vs. 4.9%, P=0.0001). Direct bilirubin (P=0.03) and albumin (P=0.04) levels significantly differed between the PTE and non-PTE groups. Notably, there was a significant difference in the partial thromboplastin time (P=0.04) between the PTE and non-PTE groups. A regression analysis indicated that age (OR, 1.02; 95% CI, 1.00‒1.004; P=0.005), blood pressure (OR, 2.07; 95% CI, 1.12‒3.85; P=0.02), heart attack (OR, 1.02; 95% CI, 1.28‒6.06; P=0.009), and albumin level (OR, 0.39; 95% CI, 0.16‒0.97; P=0.04) were all independent predictors of PTE development. Conclusion: Regression analysis revealed that age, blood pressure, heart attack, and albumin levels were independent predictors of PTE.

Epidemiology of Burns in Pediatric and Adolescent Patients of Fars Province between 2017 and 2018.

Objective: According to the reports of the World Health Organization approximately 300,000 deaths occur yearly worldwide due to burns or burn-associated injuries. This study aims to review the epidemiology of burns in pediatrics and adolescents in Fars province between 2017 and 2018. Methods: This is a cross-sectional study that investigated all people ≤18 years old who suffered from burn injuries in Fars province between 2017 and 2018. We use data from the file of burn patients which was provided by pre-hospital emergency services of Fars province. This data comprises demographic information (age and gender), burn-related information (type, degree, and severity of burns), mode of transfer (outpatient surgery or transfer to hospital) and the outcome of the disease (death before arrival to the hospital or alive). Results: The average age of the subjects of this study was 5.8±8.9. We also categorized the subjects into four age groups, 1-4, 5-8, 9-13 and 15-18 years. The number of boys who suffered from burn injuries is significantly more than the girls (p=0.011). Also, there is a remarkable correlation between burn with age (p<0.001) and burn with disease outcome (p=0.01). The Most common cause of burns in boys was nonchemical hot objects and liquids (28.5%). Likewise, the possibility of mortality in burn patients who faced an electric shock was 22.66%. ([95%CI=2.32-220.63], p<0.001 OR=22.66). Conclusion: This study shows that pediatrics and adolescents ≤ 4 have the most burn injuries, and boys have twice as many burn events as girls. More importantly, the most common cause of burns in both genders was burning with non-chemical hot objects and liquids, in particular, in the age group of 1-4 years, in which event happens at home.

Incidence and pattern of traumatic spine injury in a single level I trauma center of southern Iran.

PURPOSE: Spine injury is one of the leading causes of death and mortality worldwide. The objective of this study was to determine the incidence, pattern and outcome of trauma patients with spine injury referred to the largest trauma center in southern Iran during the last 3 years. METHODS: This is a cross-sectional study conducted between March 2018 and June 2021 in the largest trauma center in the southern Iran. The data collection form included the age, sex, injury location (cervical, thoracic, and lumbar), cause of injury (traffic accidents, falls, and assaults), length of hospital stay, injured segment of spine injury, severity of injury, and outcome. Statistical analyzes were performed using SPSS software version 24. RESULTS: Totally 776 cases of spine injury were identified. The spine injury rate was 17.0%, and the mortality rate was 15.5%. Cervical spine injury (20.4%) more often occulted in motorcycle accident, and thoracic spine injury (20.1%) occulted in falls. The highest and lowest rates of spine injurys were related to lumbar spine injury (30.2%) and cervical spine injury (21.5%), respectively. There was a statistically significant relationship between the mechanism of injury and the location of spine injury (p < 0.001). And patients with lumbar spine injury had the highest mortality rate (16.7%). Injury severity score (OR= 1.041, p < 0.001) and length of stay (OR = 1.018, p < 0.001) were strong predictors of mortality in trauma patients with spine injury. CONCLUSION: The results of the study showed that the incidence of traumatic spine injury rate was approximately 17.0% in southern of Iran. Road traffic injury and falls are the common mechanism of injury to spine. It is important to improve the safety of roads, and passengers, as well as work environment, and improve the quality of cars. Also, paying attention to the pattern of spine injury may assist to prevent the missing diagnosis of spine injury in multiple trauma patients.

Development of a Mobile App for Self-Care Against COVID-19 Using the Analysis, Design, Development, Implementation, and Evaluation (ADDIE) Model: Methodological Study.

BACKGROUND: Mobile apps have been shown to play an important role in the management, care, and prevention of infectious diseases. Thus, skills for self-care-one of the most effective ways to prevent illness-can be improved through mobile health apps. OBJECTIVE: This study aimed to design, develop, and evaluate an educational mobile-based self-care app in order to help the self-prevention of COVID-19 in underdeveloped countries. We intended the app to be easy to use, quick, and inexpensive. METHODS: In 2020 and 2021, we conducted a methodological study. Using the ADDIE (analysis, design, development, implementation, and evaluation) educational model, we developed a self-care management mobile app. According to the ADDIE model, an effective training and performance support tool is built through the 5 phases that comprise its name. There were 27 participants who conducted 2 evaluations of the mobile app's usability and impact using the mobile health app usability and self-care inventory scales. The study design included pre- and posttesting. RESULTS: An Android app called MyShield was developed. The results of pre- and posttests showed that on a scale from 0 to 5, MyShield scored a performance average of 4.17 in the physical health dimension and an average of 3.88 in the mental well-being dimension, thereby showing positive effects on self-care skills. MyShield scored highly on the "interface and satisfaction," "ease of use," and "usefulness" components. CONCLUSIONS: MyShield facilitates learning self-care skills at home, even during quarantine, increasing acquisition of information. Given its low development cost and the ADDIE educational design on which it is based, the app can be helpful in underdeveloped countries. Thus, low-income countries-often lacking other tools-can use the app as an effective tool for fighting COVID-19, if it becomes a standard mobile app recommended by the government.

Effect of COVID-19 Pandemic on Incidence and Mortality Rate Due to Road Traffic Injury in Shiraz.

Objective: To evaluate the effect of COVID-19 pandemic on the incidence and mortality rate of road traffic injuries in Shiraz, Iran. Methods: This cross-sectional study was performed on the data of patients who admitted by road traffic accidents 18 months before the outbreak of COVID-19 and 18 months after COVID-19 in the largest provider of trauma level 1 care services in southern Iran. SPSS 19 software was used to analyze the data. Results: A significant decrease of 12.8% was observed in the number of patients admitted by road traffic accidents during the COVID-19 pandemic period compared to the same period before the pandemic (p<0.0001). But the death toll from road traffic accidents has increased significantly during the COVID-19 pandemic period compared to the same period before the pandemic (p=0.01). Conclusion: Due to the COVID-19 restrictions, it seems that factors such as restrictions on suburban travel, closure of public and recreational spaces, reduction of intra-city traffic, people staying at home and a significant reduction in injuries caused by traffic accidents, is reasonable. On the other hand, these restrictions, quarantines, and COVID disease itself can lead to confusion, anxiety, fear of infection, and thus avoid or delay the search for health care and increase mortality. Therefore, planning and policy-making is essential in order to prepare the correct guidance for seeking treatment.

The effect of information technology intervention on using appropriate VTE prophylaxis in non-surgical patients: A systematic review and meta-analysis.

Introduction: Clinical decision support systems (CDSSs) play an important role in summarizing the best clinical practices, thereby promoting high standards of care in specific medical fields. These systems can serve as tools for gaining knowledge and mediating between clinical guidelines and physicians thereby providing the right information to the right person at the right time. Objective: This review aims to evaluate the effect of CDSSs on adherence to guidelines for venous thromboembolism (VTE) prophylaxis and VTE events compared to routine care without CDSSs in non-surgical patients. Methods: In order to conduct a systematic literature review, the published studies were identified through screening EMBASE, the international clinical trials registry, OVID, Cochrane database, PubMed, ISI Web of Science, and Scopus databases, from 1982 to March 2021. The included studies were reviewed by two independent reviewers; the proportion of patients that correctly received VTE prophylaxis has been next extracted for further analysis. Additionally, patients were divided into two groups: CDSS-recommended VTE prophylaxis and routine care without using a CDSS. Results: Twelve articles (three randomized controlled trials, seven prospective cohort trials, and two retrospective cohort trials) were in fine analyzed. The use of CDSSs is found to be associated with a significant increase in the rate of using the appropriate prophylaxis for VTE (p < 0.05) and a significant decrease in the incidence of VTE (p < 0.05). Conclusion: Implementation of CDSSs can help improving the appropriate use of VTE prophylaxis in non-surgical patients. Further, evidence-based and interventional studies on the development of CDSSs can provide more in-depth knowledge on both this tool design and efficiency.

Usability of Venous Thromboembolism Prophylaxis Recommender System: A Pilot Study.

Poor usability of clinical decision support system impact negative on healthcare professionals, decrease usage and quality of clinical decision support system and result in a negative effect on patient outcome. Therefore, the objective of this study was the usability evaluation of the venous thromboembolism prophylaxis recommendation system. This study design is a pilot study. Totally seven individuals participate in the study that 4 out of 7 were ICU attending and 3 out of 7 were Residents in ICUs setting. System Usability Scale (SUS) was used to assess the usability of the clinical decision support system (venous thromboembolism prophylaxis recommendation system) integrated into the medication order entry system in the ICU setting. This study has shown that the mean System Usability Scale (SUS) score was 74.64. Summing up the results, it can be concluded that the usability quality of the venous thromboembolism prophylaxis recommendations system is good. Further research requires to evaluate the usability of the venous thromboembolism prophylaxis recommendation system by quantitative and qualitative methods in large scale.

Mortality Prediction from Hospital-Acquired Infections in Trauma Patients Using an Unbalanced Dataset.

OBJECTIVES: Machine learning has been widely used to predict diseases, and it is used to derive impressive knowledge in the healthcare domain. Our objective was to predict in-hospital mortality from hospital-acquired infections in trauma patients on an unbalanced dataset. METHODS: Our study was a cross-sectional analysis on trauma patients with hospital-acquired infections who were admitted to Shiraz Trauma Hospital from March 20, 2017, to March 21, 2018. The study data was obtained from the surveillance hospital infection database. The data included sex, age, mechanism of injury, body region injured, severity score, type of intervention, infection day after admission, and microorganism causes of infections. We developed our mortality prediction model by random under-sampling, random over-sampling, clustering (k-mean)-C5.0, SMOTE-C5.0, ADASYN-C5.5, SMOTE-SVM, ADASYN-SVM, SMOTE-ANN, and ADASYN-ANN among hospital-acquired infections in trauma patients. All mortality predictions were conducted by IBM SPSS Modeler 18. RESULTS: We studied 549 individuals with hospital-acquired infections in a trauma hospital in Shiraz during 2017 and 2018. Prediction accuracy before balancing of the dataset was 86.16%. In contrast, the prediction accuracy for the balanced dataset achieved by random under-sampling, random over-sampling, clustering (k-mean)-C5.0, SMOTE-C5.0, ADASYN-C5.5, and SMOTE-SVM was 70.69%, 94.74%, 93.02%, 93.66%, 90.93%, and 100%, respectively. CONCLUSIONS: Our findings demonstrate that cleaning an unbalanced dataset increases the accuracy of the classification model. Also, predicting mortality by a clustered under-sampling approach was more precise in comparison to random under-sampling and random over-sampling methods.