The Roles of the Nurses in Family Physician Team: A Qualitative Systematic Review.

Background: There are various approaches in primary health care regarding the key role of nurses. This systematic review investigates the roles of nurses, as part of the family medicine team. Materials and Methods: All published articles related to the role of nurses in the family medicine team from January 2000 to March 2022 were the subjects of this study. The eligibility criteria included original articles published in English or Persian in the last two decades. International credible scholarly databases (PubMed, Scopus, Magiran, IranMedex, and SID) were searched using keywords and syntax. Some of the keywords included "Family Health Nurse," "Nurses in Primary Care," "Family Medicine," "Family Physician Care Program," "General Physician Program," "Role," and "Nurse." Data were extracted based on Sample, Phenomenon of Interest, Design, Evaluation, Research type (SPIDER) technique and reported based on the structure of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Results: Of 147 identified publications by the search strategy, eight eligible empirical studies were included. The results showed that besides providing nursing care, nurses play vital roles in communication and teamwork, assessment, securing health services relevant to communities' needs, education, empowerment, clinical practice, health promotion, prevention, reflective research practice, and counseling. Conclusions: This study identified different roles nurses could play in providing primary health care. These findings are helpful for the replanning or reform of primary health care in countries, which aimed to expand the Family Physician Program (FPP) in their countries, including Iran.

Referral System Challenges of the Family Physician Program in Iran: A Systematic Review.

Background: Iran has implemented the Family Physician Program (FPP) in 2005 in 4 provinces. This program was supposed to be expanded across the country; however, it faced various challenges. Considering the impact of the referral system on the quality of the FPP implementation, different studies were conducted to evaluate the performance of this system. Therefore, this systematic review of the literature was conducted to investigate the challenges of the referral system of the FPP in Iran. Methods: All published original articles, reviews, or case studies published in English or Persian related to the challenges in the referral system FPP in Iran from 2011 to September 2022 were included in this study. International credible scholarly databases were searched. The search strategy was defined based on keywords and the search syntax. Results: Out of 3910 articles identified by the search strategy, considering the inclusion and exclusion criteria and relevance of the study, and accreditation of the studies, 20 studies were included. The referral system suffers from different challenges in the areas associated with policy and planning, management, referral process, and health service recipients. Conclusion: The inefficient gatekeeping role of family physicians was one of the most important challenges of the referral system. The referral system should be improved by having evidence-based guidelines and policy documents, unified stewardship, integrated insurance schemes, and effective communication between different levels of care.

Synthesis of chemically-crosslinked multi-arm star-shaped polyurethane with triple-shape memory effect.

In this study, chemically-crosslinked multi-arm star-shaped polyurethanes (SPUs) were prepared using three, four, and six-arm polycaprolactone, hexamethylene diisocyanate, and 1, 4-butanediol. The hydrogen bonding indices of soft and hard segments were calculated using Fourier transform infrared spectra. The results indicated that the phase separation among hard and soft segments increased with the increment of PCL arm numbers. Moreover, the results of X-ray diffraction and differential scanning calorimetry showed that the crystallization ability of the three and four-arm SPUs were lower than that for six-arm SPU (6SPU), which is due to their higher crosslinking densities. In addition, the results of the mechanical studies showed that the crosslinking density and degree of crystallinity are the main effective parameters controlling the mechanical properties, by which 6SPU showed higher Young's modulus and lower elongation at break compared to other SPUs. Cyclic shape memory studies showed that 6SPU could fix approximately all the temporary shapes during three cycles and recover 100% of its original shape. Moreover, 6SPU could show triple-shape memory effect (TSME) by which it could fix two different temporary shapes. These results show that 6SPU has a high potential for practical applications due to its good mechanical properties, shape memory fatigue resistance, and TSME.

Chronic Kidney Disease in Isfahan Province, Action Plan for Screening in A Population-based Study.

INTRODUCTION: We intended to explore the prevalence of chronic kidney disease (CKD) and its different stages, as well as CKD associated variables in the adult population in Isfahan province, Iran. METHODS: Adults aged ≥ 18 were recruited in a cross-sectional study from 2017 to 2019. Data including demographics, anthropometrics, and laboratory findings were collected from each subject. The equation of chronic kidney disease- Epidemiology Collaboration (CKD-EPI) was used to estimate glomerular filtration rate (eGFR), and eGFR and UACR values were utilized to determine the stages of CKD. RESULTS: Data from a total of 3374 subjects was analyzed. The mean age of participants was 49.3 ± 14.09 years and 59.3% were female. The prevalence of CKD was 18.5%. Only 0.25 and 3.5% of the population were in CKD stage 3 and 4, while most of the patients were in CKD stage 2 (7.6%) and stage 1 (7.1%). CKD patients were mostly on refined grains diet and used lesser dairy products compared to healthy participants. Variables including systolic blood pressure (OR = 1.018; P < .001), diastolic blood pressure (OR = 1.005; P < .05), fasting blood sugar (OR = 1.011; P < .001), female sex (OR = 1.319; P < .05), body mass index (OR = 1.030; P < .05), married status (OR = 1.335; P < .05), and smoking (OR = 1.529; P < .05) were significantly associated with increased risk of CKD in the logistic regression analysis. CONCLUSION: According to our results, the prevalence of CKD, especially stages 1 and 2, is quite high in central part of Iran. These findings help us to improve the screening for CKD patients and perform larger scale studies to identify the challenges ahead.  DOI: 10.52547/ijkd.7201.

Isfahan COVID cohort study: Rationale, methodology, and initial results.

Background: The Isfahan COVID Cohort (ICC) study was designed to investigate the short- and long-term consequences of patients with COVID-19 in Iran. This report presents the rationale, methodology, and initial results of ICC. Materials and Methods: ICC is a 5-year multicentric prospective cohort study that is ongoing on two groups including 5000 patients hospitalized with moderate or severe and 800 nonhospitalized patients with mild or asymptomatic COVID-19 in Isfahan. The ICC endpoints are morbidity, mortality, incident cases, or worsening of underlying noncommunicable diseases (NCDs) and their risk factors. In the current analysis, we examined the persistent symptoms and incident NCDs or risk factors in 819 previously hospitalized patients who completed 1-year follow-up. Results: The two most common symptoms were joint pain/myalgia (19.7%) and dry cough/dyspnea (18.7%). Around 60% of patients had at least one symptom which was more common among women than men and in middle aged than younger or older patients. Female (odds ratio [OR] =1.88, 95% confidence interval [CI]: 1.39-2.55) and highly-educated patients (OR = 2.18, 95% CI: 1.56-3.04) had higher risk of having any symptom in 1-year follow-up. New cases of hypertension followed by diabetes then coronary heart disease (CHD) were the most common incident NCDs. Conclusion: During 1-year follow-up after hospital discharge, about 60% of patients experienced persistent symptoms. Incident hypertension, diabetes, and CHD were the most common events seen. Close monitoring and extensive health services with integrative approaches are needed to improve the health status of these patients.

Effective hospital readmission prediction models using machine-learned features.

BACKGROUND: Hospital readmissions are one of the costliest challenges facing healthcare systems, but conventional models fail to predict readmissions well. Many existing models use exclusively manually-engineered features, which are labor intensive and dataset-specific. Our objective was to develop and evaluate models to predict hospital readmissions using derived features that are automatically generated from longitudinal data using machine learning techniques. METHODS: We studied patients discharged from acute care facilities in 2015 and 2016 in Alberta, Canada, excluding those who were hospitalized to give birth or for a psychiatric condition. We used population-level linked administrative hospital data from 2011 to 2017 to train prediction models using both manually derived features and features generated automatically from observational data. The target value of interest was 30-day all-cause hospital readmissions, with the success of prediction measured using the area under the curve (AUC) statistic. RESULTS: Data from 428,669 patients (62% female, 38% male, 27% 65 years or older) were used for training and evaluating models: 24,974 (5.83%) were readmitted within 30 days of discharge for any reason. Patients were more likely to be readmitted if they utilized hospital care more, had more physician office visits, had more prescriptions, had a chronic condition, or were 65 years old or older. The LACE readmission prediction model had an AUC of 0.66 ± 0.0064 while the machine learning model's test set AUC was 0.83 ± 0.0045, based on learning a gradient boosting machine on a combination of machine-learned and manually-derived features. CONCLUSION: Applying a machine learning model to the computer-generated and manual features improved prediction accuracy over the LACE model and a model that used only manually-derived features. Our model can be used to identify high-risk patients, for whom targeted interventions may potentially prevent readmissions.

Retraction Note: The Effect of COVID-19 Vaccination on Reducing the Risk of Infection, Hospitalization, and Death in Isfahan Province, Iran.

[This retracts the article on p. 188 in vol. 51, PMID: 35223640.].

Electrospun POSS integrated poly(carbonate-urea)urethane provides appropriate surface and mechanical properties for the fabrication of small-diameter vascular grafts.

This study developed a platform for fabricating small-diameter vascular grafts using electrospun poly(carbonate-urea)urethane bonded with different concentrations of POSS nanocage. The characteristics of electrospun POSS-PCUUs were investigated by ATR-FTIR, 1HNMR, EDS, SEM, AFM, WCA, and DSC analyses. Besides, mechanical attributes such as tensile strength, modulus, elastic recovery, and inelastic behaviors were monitored. The survival rate and cellular attachment capacity were studied using human endothelial cells during a 7-day culture period. The results showed that electrospun nanofibers with 6 wt.% POSS-PCUU had better surface properties in terms of richness of POSS nanocage with notable improved mechanical strength and hysteresis loss properties (p < 0.05). The surface roughness of electrospun 6 wt.% POSS-PCUU reached 646 ± 10 nm with statistically significant differences compared to the control PCUU and groups containing 2, 4 wt.% POSS-PCUU (p < 0.05). The addition of 6 wt.% POSS increased the ultimate mechanical strength of nanofibers related to control PCUU and other groups (p < 0.05). The expansion of human endothelial cells on the 6 wt.% POSS-PCUU surface increased the viability reaching maximum levels on day 7 (p < 0.05). Immunofluorescence imaging using DAPI staining displayed the formation single-layer endothelial barrier at the luminal surface, indicating an appropriate cell-to-cell interaction.

The Effect of COVID-19 Vaccination on Reducing the Risk of Infection, Hospitalization, and Death in Isfahan Province, Iran.

BACKGROUND: We aimed to evaluate the effect of COVID-19 vaccines in preventing infection, hospitalization, and mortality due to COVID-19 in Isfahan Province, Iran. METHODS: Following a retrospective cohort design, data of all vaccinated individuals since the rollout of vaccination of the general population are analyzed, Mar 2020 to Aug 13, 2021. Moreover, the data of all non-vaccinated people were collected by the census method for this period. The two groups were compared concerning hospitalization and mortality using the Chi-square test. Kaplan-Meyer was also used to calculate the median interval between receiving a vaccine and outcome (hospitalization and death). RESULTS: Overall, 583434 people have received a second dose of a vaccine from Mar 2020 to Aug 2021, which 74% (n=433403) was Sinopharm, 18.2% (n=106027) AstraZeneca, 3.6% (n=21216) Sputnik, and 3.9% (n=22,788) Barekat. In contrast, 2,551,140 people living in the Isfahan Province did not receive a vaccine. The median interval between injection of the first dose and the hospitalization for those who received Sinopharm, AstraZeneca, Sputnik, and Barekat was 22, 61, 19, and 19 days, respectively. For unvaccinated cases, the rates of infection, hospitalization, and mortality (per 1000 population) were 69.7, 12.1, and 1.04, respectively. In contrast, for vaccinated individuals, these rates were 3.9, 1.08, and 0.09, two weeks after the second dose, respectively. CONCLUSION: The highest and lowest reduction in relative risk was for those who received AstraZeneca and Sputnik, respectively.

Preparation and characterization of polycaprolactone/chitosan-g-polycaprolactone/hydroxyapatite electrospun nanocomposite scaffolds for bone tissue engineering.

Chitosan (CS) and poly (ε-caprolactone) (PCL) are two most usable polymers in biomedical applications. In this study, chitosan has been modified and incorporated with poly (ε-caprolactone) to fabricate bone tissue engineering scaffold. Moreover, hydroxyapatite nanoparticles were added to enhance bioactivity and mechanical properties of scaffold. Bulk and fibrous comparative results showed significant effect of fiber diameter and distribution on mechanical properties. Moreover, the incorporation of chitosan-g-poly (ε-caprolactone) (CS-g-PCL) significantly decreases fiber diameter of pure PCL scaffold. Furthermore, both CS-g-PCL and nHA enhance mineralization and degradation of the scaffold soaked in simulated body fluid (SBF) and phosphate buffered saline (PBS), respectively. In vitro cytocompatibility assays also confirmed high cell viability and proliferation on the samples. Taken together, the results suggest that the microfabricated nanocomposite scaffolds could be used in bone tissue engineering.

Relationship between CT Severity Score and Capillary Blood Oxygen Saturation in Patients with COVID-19 Infection.

Background: COVID-19 pneumonia is responsible for the latest pandemic. Usage of pulmonary computed tomography (CT) scan is known to be an important method in the diagnosis of COVID-19. Here, we aimed to evaluate the relationship between CT severity score and capillary blood oxygen saturation in patients with COVID-19 infection. Methods and material: This is a cross-sectional study performed in 2020 on patients with COVID-19 infection. All patients underwent pulmonary CT scan and CT severity score was calculated. The initial capillary oxygen saturation by the time of admission was also collected. Data were collected and analyzed. Results: A total number of 270 patients diagnosed with COVID-19 infection entered the study. The initial mean capillary oxygen saturation was 89.65 ± 8.09%. The mean score in patients was 15.16 ± 8.08. We also indicated that 27 patients had hypoxia by the time of admission and these patients had significantly higher CT severity scores (p = 0.001). Diabetes mellitus (p = 0.001), hypertension (p = 0.001), and chronic obstructive pulmonary disease (COPD) (p = 0.03) and totally having an underlying disease (p < 0.001) were significantly associated with decreased capillary oxygen saturation. Patients with hypertension (p = 0.001) and patients with the previous medical disease (p = 0.01) had significantly higher CT severity scores than others. There was a significant reverse relationship between CT severity score and capillary oxygen saturation (r = -0.44, p < 0.001). Conclusions: We showed that there was a significant reverse relationship between CT severity score and capillary oxygen saturation which has great clinical importance. Furthermore, we indicated that previous medical history could also play an important role in CT severity score. How to cite this article: Aalinezhad M, Alikhani F, Akbari P, Haji Rezaei M, Soleimani S, Hakamifard A. Relationship between CT Severity Score and Capillary Blood Oxygen Saturation in Patients with COVID-19 Infection. Indian J Crit Care Med 2021;25(3):279-283.

Physical and thermo-mechanical properties of shape memory polyurethane containing reversible chemical cross-links.

Orthodontic chains are one of the main parts of orthodontic braces. In this study, in order to obtain a suitable polymer for this application as well as troubleshoot the main drawbacks such as stress relaxation and water absorption, thermoplastic polyurethane (TPU) elastomers with various compositions were synthesized and characterized by Fourier-transform infrared spectroscopy (FTIR), differential scanning calorimetry (DSC), and X-ray diffraction (XRD) analyses. Mechanical properties of samples were evaluated by tensile, elasticity, and stress relaxation tests. According to the required properties for orthodontic chain application, PU2000-311 which contains reversible crosslinks, was selected as the most favorable sample among other pure samples. Moreover, to reduce the water absorption content of PU2000-311, its nanocomposite containing 1 wt% of silica nanoparticles was prepared via solution casting method. As water content angle and field emission scanning electron microscopy (FESEM) images illustrate, incorporation of 1 wt% of modified silica nanoparticles has increased PU2000-311-1S hydrophobicity. In vitro oral environment study showed crystability of samples has recovered great portion of relaxed force. Stress relaxation study indicated samples are applicable in oral temperature range and temperature changes have assisted recovery of relaxed force and reduced treatment period. Finally, shape memory study showed that optimum samples could recover 100% of their original shape.

Differentiating solid breast masses: comparison of the diagnostic efficacy of shear wave elastography and magnetic resonance imaging.

OBJECTIVES: Shear wave elastography (SWE) quantitatively determines the nature of the breast lesions. Few previous studies have compared the diagnostic value of this modality with other imaging techniques. The present study aimed to compare the diagnostic value of SWE with that of magnetic resonance imaging (MRI) in detecting the nature of the breast masses. METHODS: In this cross-sectional study, 80 patients with breast lumps who had Breast Imaging Reporting and Data System (BI-RADS) score of three or higher based on mammography and/or screening ultrasonography, underwent 3D SWE and MRI. The lesions were classified according to MRI BI-RADS scoring; Mean elasticity (Emean) and elasticity ratio (Eratio) for each lesion were also determined by SWE. The results of these two modalities were compared with histopathologic diagnosis as the gold standard method; diagnostic value and diagnostic agreement were then calculated. RESULTS: Of the masses, 46.2% were histopathologically proven to be malignant. The Emean for benign and malignant masses was 34.04 ± 19.51 kPa and 161.92 ± 58.14 kPa, respectively. Both modalities had diagnostic agreement with histopathologic results (p<0.001). Kappa coefficient was 0.87 for SWE and 0.42 for MRI. The sensitivity of both methods was 94.59% (95% CI: 81.81-99.34), while the specificity and accuracy were 48.84% [95% CI: 33.31-64.54] and 70.0% [95% CI: 58.72-79.74] for MRI, and 93.02% [95% CI: 80.94-98.54] and 93.75% [95% CI: 86.01-97.94] for SWE. CONCLUSIONS: SWE has better diagnostic value in terms of determining the nature of the breast masses. SWE can increase the diagnostic function of differentiating benign masses from malignant ones.

Coronavirus Disease-2019 Pneumonia and Pulmonary Embolism: Presentation of Four Cases.

Since the beginning of the Coronavirus Disease-2019 (COVID-19) outbreak, elevated D-dimer levels as an acute-phase reactant have been reported in some patients. Additionally, the patients with pneumonia are at increased risk of developing thromboembolic events. Diagnosing acute pulmonary embolism and deep vein thrombosis can be challenging in SARS-CoV2-positive patients. Here, we report four patients with COVID-19 pneumonia to highlight the possibility of acute thromboembolism in these patients. The physicians should be aware of this complication and even consider prophylactic anticoagulant therapy in proper clinical settings. How to cite this article: Alikhani F, Aalinezhad M, Haji Rezaei M, Akbari P, Hashemi M. Coronavirus Disease-2019 Pneumonia and Pulmonary Embolism: Presentation of Four Cases. Indian J Crit Care Med 2020;24(9):873-876.

Radiographic Image Radiomics Feature Reproducibility: A Preliminary Study on the Impact of Field Size.

RATIONALE AND OBJECTIVES: Radiomics is an approach to quantifying diseases. Recently, several studies have indicated that radiomics features are vulnerable against imaging parameters. The aim of this study is to assess how radiomics features change with radiographic field sizes, positions in the field size, and mAs. MATERIALS AND METHODS: A large and small wood phantom and a cotton phantom were prepared and imaged in different field sizes, mAs, and placement in the radiographic field size. A region of interest was drawn on the image features, and twenty two features were extracted. Radiomics feature reproducibility was obtained based on coefficient of variation, Bland-Altman analysis, and intraclass correlation coefficient. Features with coefficient of variation ≤ 5%, intraclass correlation coefficient ≤ 90%, and 1% ≤ U/LRL ≤30% were introduced as robust features. U/LRL is upper/lower reproducibility limits in Bland-Altman. RESULTS: For all field sizes and all phantoms, features including Difference Variance, Inverse Different Moment, Fraction, Long Run Emphasis, Run Length Non Uniformity, and Short Run Emphasis were found as highly reproducible features. For change in the position of field size, Fraction was the most reproducible in all field sizes and all phantoms. On the mAs change, we found that feature, Short Run Emphasis field 15 × 15 for small wood phantom, and Correlation in all field sizes for Cotton are the most reproducible features. CONCLUSION: We demonstrated that radiomics features are strongly vulnerable against radiographic field size, positions in the radiation field, mAs, and phantom materials, and reproducibility analyses should be performed before each radiomics study. Moreover, these changing parameters should be considered, and their effects should be minimized in future radiomics studies.

Radiographic Texture Reproducibility: The Impact of Different Materials, their Arrangement, and Focal Spot Size.

BACKGROUND: Feature reproducibility is a critical issue in quantitative radiomic studies. The aim of this study is to assess how radiographic radiomic textures behave against changes in phantom materials, their arrangements, and focal spot size. METHOD: A phantom with detachable parts was made using wood, sponge, Plexiglas, and rubber. Each material had 1 cm thickness and was imaged for consecutive time. The phantom also was imaged by change in the arrangement of its materials. Imaging was done with two focal spot sizes including 0.6 and 1.2 mm. All images were acquired with a digital radiography machine. Several texture features were extracted from the same size region of interest in all images. To assess reproducibility, coefficient of variation (COV), intraclass correlation coefficient (ICC), and Bland-Altman tests were used. RESULTS: Results show that 59%, 50%, and 4.5% of all features are most reproducible (COV ≤5%) against change in focal spot size, material arrangements, and phantom's materials, respectively. Results on Bland-Altman analysis showed that there is just a nonreproducible feature against change in the focal spot size. On the ICC results, we observed that the ICCs for more features are >0.90 and there were few features with ICC lower than 0.90. CONCLUSION: We showed that radiomic textures are vulnerable against changes in materials, arrangement, and different focal spot sizes. These results suggest that a careful analysis of the effects of these parameters is essential before any radiomic clinical application.

Investigation of the effects of polycaprolactone molecular weight and graphene content on crystallinity, mechanical properties and shape memory behavior of polyurethane/graphene nanocomposites.

In the following work, different shape memory polyurethanes (SMPUs) were synthesized using polycaprolactone (PCL) with various molecular weights, hexamethylene diisocyanate (HDI), and 1,4-butanediol (BDO). Afterward, polyurethane (PU)-based nanocomposites were prepared with different graphene nanosheets contents via solution casting method. Hydrogen nuclear magnetic resonance (1H-NMR) was used to confirm the chemical structure of PCLs and calculate their actual molecular weights. The chemical structure and hydrogen bonding content of PUs and their nanocomposites were investigated by Fourier-transform infrared spectroscopy (FTIR). According to the results, the hydrogen bonding contents of nanocomposites were reduced by graphene nanosheets inhibition from the formation of hydrogen bonds between polyurethane chains. Thermal properties and crystalline morphology of samples were studied using differential scanning calorimetry (DSC) and X-ray diffraction (XRD). The results indicated that the transition temperature and crystallinity of samples were changed by variation of the molecular weight of the PCL component and of the concentration of the graphene nanosheets. Graphene nanosheets dispersion in polyurethane matrix was investigated using the field emission scanning electron microscope (FE-SEM). The mechanical and shape memory properties of different PUs and their nanocomposites were determined at both 75 °C and room temperature. It can be deduced from the results that the modulus of the samples increased due to the rigidity of nanosheets. Furthermore, the restricted mobility of PCL chains, due to the presence of nanosheets, led to higher shape fixity ratio. Moreover, the nanosheets prevented the stress transfer on the hard segments which increased the shape recovery ratio.

Streptococcal Pharyngitis in a Two-Month-Old Infant: A Case Report.

INTRODUCTION: Group A ß-hemolytic Streptococcus is the most common cause of bacterial pharyngitis among 5 - 15-year-old children, but it is uncommon in children less than three years old and rarely happens in infants less than one year old. CASE PRESENTATION: The patient was a 62-day-old female infant who presented with fever and poor feeding since two days before admission. At the time of admission, the patient was febrile and ill. Upon examination, a rectal temperature of 38.5°C, multiple right-sided submandibular lymphadenopathies, pharyngeal erythema, and tonsillar exudates were detected. Twenty-four hours after the throat swab was collected and cultured, Streptococcus pyogenes grew on a sheep blood agar medium. The patient's mother, who also experienced similar symptoms, had a positive throat swab culture for S. pyogenes. CONCLUSIONS: Although Streptococcal pharyngitis is rare in children less than three years old and the necessity of treatment is not well clarified, in case of streptococcal infection in parents and the occurrence of similar signs and symptoms in their child, considering S. pharyngitis as a possible differential diagnosis seems rational.

Preemptive Analgesic Effects of Transcutaneous Electrical Nerve Stimulation (TENS) on Postoperative Pain: A Randomized, Double-Blind, Placebo-Controlled Trial.

BACKGROUND: Transcutaneous electrical nerve stimulation (TENS) is a non-pharmacological analgesic method used to control different types of pain. OBJECTIVES: The aim of this study was to evaluate the effects of preoperative TENS on post inguinal hernia repair pain. PATIENTS AND METHODS: This randomized, double-blind, placebo-controlled clinical trial was performed on 66 male patients with unilateral inguinal hernias who were admitted to the Shahid Beheshti hospital in Kashan, Iran, from April to October 2014. Participants were selected using a convenience sampling method and were assigned to intervention (n = 33) and control (n = 33) groups using permuted-block randomization. Patients in the intervention group were treated with TENS 1 hour before surgery, while the placebo was administered to patients in the control group. All of the patients underwent inguinal hernia repair by the Lichtenstein method, and pain intensity was evaluated at 2, 4, 6, and 12 hours after surgery using a visual analogue scale. Additionally, the amounts of analgesic administered by pump were calculated and compared between the two groups. RESULTS: The mean estimated postoperative pain intensity was 6.21 ± 1.63 in the intervention group and 5.45 ± 1.82 in the control group (P = 0.08). In the intervention group pain intensity at 2 and 4 hours after surgery were 3.54 ± 1.48 and 5.12 ± 1.41 (P < 0.001), respectively. In the control group these values were 4.0±1.5 and 4.76 ± 1.39 (P = 0.04), respectively. No significant differences were observed in mean pain intensities at 6 and 12 hours. CONCLUSIONS: TENS can reduce postoperative pain in the early hours after inguinal hernia repair surgery.

Photocatalytic activity enhancement of anatase-graphene nanocomposite for methylene removal: Degradation and kinetics.

In the present research, the TiO2-graphene nanocomposite was synthesized by an eco-friendly method. The blackberry juice was introduced to graphene oxide (GO) as a reducing agent to produce the graphene nano-sheets. The nanocomposite of anatase-graphene was developed as a photocatalyst for the degradation of methylene blue, owing to the larger specific surface area and synergistic effect of reduced graphene oxide (RGO). The UV spectroscopy measurements showed that the prepared nanocomposite exhibited an excellent photocatalytic activity toward the methylene blue degradation. The rate of electron transfer of redox sheets is much higher than that observed on GO, indicating the applicability of proposed method for the production of anatase-RGO nanocomposite for treatment of water contaminated by cationic dye. The prepared materials were characterized with Fourier transform infrared spectroscopy, X-ray diffraction, Brunauer-Emmett-Teller surface area measurement, scanning electron microscopy and transmission electron microscopy. A facile and rapid route was applied for the uniform deposition of anatase nanoparticles on the sheets. The resulting nanocomposite contained nanoparticles with a mean diameter of 10nm. A mechanism for the photocatalytic activity of nanocomposite was suggested and the degradation reaction obeyed the second-order kinetics. It was concluded that the degradation kinetics is changed due to the reduction of GO in the presence of blackberry juice.