فهرست مطالب علیرضا راحت دهمرده

A better understanding of the mechanism and / or pathophysiology of shoulder pain syndrome after laparoscopic gynecological surgery leads to an increase in the number of clinical trials to prevent this complication. Therefore, the present study was conducted with aim to define the mechanism and prevention methods of shoulder pain syndrome after laparoscopic gynecology surgeries.

In this narrative review study, to find the articles related to shoulder pain syndrome after laparoscopic gynecology surgeries, the published articles from 2000 including observational and clinical trials, descriptive and correlational studies were searched in the electronic databases of PubMed, Scopus, EMBASE, PEDro, Google Scholar, CINAHL , SID and Magiran with the keywords of shoulder pain syndrome, shoulder pain, surgery, laparoscopy, gynecology, postoperative and gynecology laparoscopy.

The main searched mechanisms included the pain mechanism, pain due to surgical incision, causes of shoulder pain syndrome after laparoscopic surgery in women, use of an alternative blowing gas to reduce shoulder pain syndrome, use of low pressure pneumoperitoneum to reduce the shoulder pain syndrome, gas-free laparoscopy and active gas excretion to reduce shoulder pain syndrome, use of heated or heated and humidified CO2 to reduce shoulder pain syndrome, use of sub-diaphragmatic intraperitoneal anesthesia or localized intraperitoneal anesthesia to reduce tip shoulder pain and use of pulmonary recurrence maneuvers in reducing shoulder pain syndrome.

Shoulder pain syndrome in laparoscopic gynecological surgeries can be minimized with preventive measures such as the use of hot and humid gas, intraperitoneal administration of local analgesics and pulmonary recovery maneuver.

Predicting the final outcome of patients with traumatic brain injury is crucial for making the right clinical decision and determining the course of treatment. The aim of this study was to compare the ability of Marshall and Rotterdam scoring systems to determine the prognosis in patients with traumatic brain injury.

The present study is cross-sectional. The statistical population of the study consisted of patients with traumatic brain injury admitted to the intensive care unit of Khatam al-Anbia Hospital in Zahedan from 2021 to 2022. 287 patients were selected by convenience sampling method based on inclusion criteria. Patients were first evaluated by an intensive care physician to determine the prognosis with the APACH II Scale. The Marshall and Rotterdam scores of each patient were then determined by a radiologist based on a brain CT scan, and the patients were evaluated for the entire period of hospitalization until the final outcome (discharge or death) was determined. Finally, the data were compared to determine the ability of the two scales to predict outcomes.

Out of 287 patients, 33(11.5%) died and 254 (88.5%) survived. The mean score of the Marshall Scale in deceased patients was 4.69±1.01 and in survived patients was 2.03±1.3. The mean score of the Rotterdam Scale in deceased patients was 5.33±0.95 and in survived patients was 2.14±0.89. In both cases, this difference was statistically significant (P=0.001). The mean score of APACH II scale was 24.04±8.2 in deceased patients and 16.08±7.3 in survived patients. The correlation between Rotterdam and Marshall Scales in determining the outcome of patients, with APACH II was positive and high. The agreement between the APACH II and Rotterdam scales was greater in predicting mortality. The results of regression model showed that gender with (OR=2.91), head injury due to accident with (OR=3.04), Marshall Score above 4 (OR=1.97), Rotterdam score above 4 (OR=2.84) and Apache II score above 15 (OR=1.97) have a significant relationship with patient mortality.

Both the Marshall and Rotterdam scales can determine the prognosis of patients with traumatic brain injury.

The composition of the oral and pharyngeal microbial flora of patients admitted to the intensive care unit within 48 hours after admission easily changes from gram-positive streptococci to dominant gram-negative pathogens and this can increase the incidence of infection and death of patients. Therefore, the aim of this study was to evaluate the efficacy of salvadora presica (Miswak) against chlorhexidine on Gram-negative oral bacteria.

In this clinical trial study, patients were selected by available sampling and divided into two groups by simple random sampling. Patients in the intervention group received oral care with a Miswak and the control group received chlorhexidine mouthwash. Colony status of Gram-negative bacteria in patients' mouths before the intervention and finally on the fifth day of the study were evaluated by sampling oral secretions and the obtained information were compared using Fisher's exact test.

The mean and standard deviation of age were 34.2±13.6 years which did not differ significantly (P=0.72). There was no statistically significant difference between the two groups regarding gender (P=0.28). As the main target, no significant difference was observed between the two groups before treatment (P=0.16). However, after treatment the two groups had a statistically significant difference in the Gram-negative bacteria colonies (P<0.0001).

Salvadora presica (Miswak) had more effect on oral bacteria than chlorhexidine.

Inadequate oral care in intubated patients leads to decreased salivation, dry mouth, dental plaque, gingivitis and accumulation of pathogenic bacteria in the mouth and throat and aspiration of the contents of the mouth into the trachea and subsequently causes ventilator associated pneumonia. Two mechanical and chemical methods have been recommended for oral care, and contradictory results have been reported regarding its effects on ventilator associated pneumonia. Therefore, the aim of this study was to compare the effect of comprehensive oral care program and combination of toothbrush and mouthwash with 0.2% chlorhexidine on the incidence of ventilator-associated pneumonia in intubated patients under mechanical ventilation.

Materials: 

The current study is a clinical trial that was performed in the intensive care unit of Khatam Al-Anbia Hospital in Zahedan in 2020. 90 ventilated patients who met the inclusion criteria were selected and then randomly allocated by permutation block into three groups of comprehensive oral care program, combined toothbrush program and chlorhexidine and control groups. Data collection tools were demographic information form, Modified Clinical Pulmonary Infection Score (MCPIS) and Beck Oral Assessment Scale (BOAS).

The incidence of ventilator-associated pneumonia was lower in the intervention groups than in the control group, But there was no significant difference in the incidence of pneumonia between the three groups. (P=0.168)

The incidence of ventilator-associated pneumonia in the use of a comprehensive oral care program, a combined program of toothbrush and chlorhexidine 0.2% and the control group were not different from each other and in fact these methods were not superior to each other in this regard. However, considering that clinically the incidence of pneumonia was lower in the intervention groups than in the control group, it indicates that a special care program or instruction should be used, while training health care workers based on specific instructions in the oral care is recommended.

Oral health in patients in need of intensive care is important because it can improve the health and clinical outcomes of these patients and one of the main duties of nurses in the care of patients admitted to intensive care units is to provide oral hygiene to patients; Therefore, the aim of this article was to comparing the effect of  Salvadora persica chewing stick (miswak) and chlorhexidine mouthwash on oral health in patients  hospitalized in intensive care units.

This clinical trial study was performed on 70 patients admitted to the intensive care unit of Khatam Hospital who had endotracheal intubation and no sensitivity to herbal compounds in the age range of 18 to 65 years in spring 1398.patients with inclusion criteria were selected by convenience sampling and were randomly divided into two groups of intervention (miswak) and control (chlorhexidine). Data collection tools were demographic checklist and oral health assessment checklist which were completed by interview and observation. Data were analyzed using SPSS software version 22 and independent t-test.

The patients in both intervention and control groups were homogeneous in terms of demographic and clinical characteristics. There was no significant difference between the oral health status of patients in the first day (P = 0.2), but in the second to fourth days, the patients in the intervention group received significantly higher scores on oral health than the control group. The miswak group improved significantly; in other words, the effect of miswak on oral health was more than chlorhexidine mouthwash.

Comparing the efficacy of Salvadora persica and chlorhexidine mouthwash on oral health status of patients showed that miswak was more effective in promoting oral health than chlorhexidine mouthwash. Therefore, due to the advantages of herbal compounds, Salvadora persica can be a suitable alternative to chlorhexidine.