فهرست مطالب محمد سیستانی زاد

Hypertension is an important and controllable risk factor for heart diseases, stroke, renal failure and peripheral vascular disease. The aim of this study was to determine the level of awareness of patients with hemorrhagic stroke to control blood pressure and to provide solutions to improve patients’ awareness.

This study is a descriptive cross-sectional study that was conducted to evaluate the knowledge of patients with hemorrhagic stroke about the use of antihypertensives. The study population consists of all patients with hemorrhagic stroke, who were admitted to the intensive care unit of Imam Hossein Hospital in Tehran from September 2020 to March 2021. Data related to blood pressure awareness and drug history was completed by the researcher through the method of direct contact with the patients or their relatives. In this study, 17 patients diagnosed with hemorrhagic stroke due to hypertension who were admitted to the intensive care unit of Imam Hossein Hospital in Tehran, were included. The extent of the exact treatment adherence was assessed using the Morisky questionnaire.

In this study, the median of patients age was 67 and 10 (58.82%) of them were women. The median systolic and diastolic blood pressures were 170 and 95 mmHg on admission. 4(23.53%) subjects were not aware of the disease. Out of 13 people who were aware of their hypertension, 11(64.71%) were under the supervision of a physician. However, 7(63.64%) of the subjects, despite being under the supervision of a physician and acceptable drug adherence, did not have controlled blood pressure and expired.

This study is a warning for patients and health care providers to pay more attention to blood pressure control. Furthermore, educating the community as well as medical staff about the importance of timely diagnosis and accurate treatment of hypertension is highly recommended.

Mismatched-blood transfusions in the ABO-system may lead to severe of complications such as intravascular hemolysis.

Case report:

 A 49-year-old man suffering from a right lower limb injury due to accident was admitted to hospital. Vital signs were normal. X-ray showed a femoral neck fracture. Before surgery, all of lab tests were in normal values and B+ blood- group was reported. During surgery and due to blood loss, the patient underwent blood transfusion. At the end of transfusion, a mismatched blood bag was observed. The patient had received about 400 cc mismatched-blood. Transfusion was promptly terminated and the patient received extensive IV fluids in addition to a single dose of furosemide. The patient had stable status without signs of overt hemolysis. After 3 days stay at intensive care unit, he was transferred to the ward with a stable status.

In spite of mismatched blood transfusion, the patient did not experience severe adverse events. To prevent this problem, different steps of blood transfusion should be checked by anesthesiologist

Drug interactions, as one of the most important subsets of medication errors, can lead to adverse reactions in patients. Considering the increase in drug interactions and their consequences, this study aimed to evaluate the frequency and pattern of drug interactions in patients admitted to the emergency department of a university affiliatedhospital.

This was a cross-sectional study. The study population consisted of patients referring to the Emergency Department of Imam Hossein Hospital from Aprilto the end of September 2018. 552 patients hospitalized in the emergency department of Imam Hossein Hospital were selected via random sampling and the rate of drug interactions reported in their medical profile was evaluated.

The mean age of these patients was 58.51 ± 20.05 years. Sex distribution evaluation showed that 54.4% were male. Based on the number of patients-days recorded, 34.2% had no drug interactions. The total number of interactions recorded was 1139, the highest number of which belonged to group C and the lowest number belonged to group X and A. 50% of people experienced two or less drug interactions and 75% of people experienced 4 or less drug interactions. Mean hospitalization days were 7.63 ± 6.15 days. Finally, 90.8% of patients recovered and 9.2% died.

Based on the findings of the present study, only 34.2% of the patients had no drug interactions. The total number of interactions recorded was 1139, the highest number of which belonged to group C and the lowest number belonged to group X and A. There was a significant correlation between the number of administered drugswith duration of hospitalization, final outcome and the probability of drug interactions. In addition, there was a significant correlation between type D and X drug interactions with mortality rate in patients.

Disseminated intravascular coagulation (DIC) is a pathologic activation of the blood coagulation system in various organs of the body, which is one of the most common paraclinical disorders in intensive care unit (ICU) patients. In this study, the incidence of DIC-like syndrome and its effect on mortality rate and hospitalization days in patients in the intensive care unit were evaluated.
This study included a historical cohort in which demographic and clinical data of patients admitted to the ICU of the Imam Hossein Hospital between 2013 and 2017 years was collected from the ICU database. The incidence of DIC-like syndrome was calculated and reported 48 hours after the patient entered the ICU. Mortality rate or discharge was the primary outcome. Duration of hospitalization in the ICU was a secondary outcome and was recorded in all patients.
A total of 1257 patients admitted to the ICU were evaluated and the incidence of DIC-like syndrome in these patients was 5.7% (n=72). Of the 72 patients with DIC-like syndrome, 43 were men, 58 of whom were over 40 years of age. Most patients had an Apache score of 15-20. The mean number of hospitalization days were 22.8 days for patients with DIC syndrome (72 patients) and 18 days for other patients (1,185 patients) (P = 0.06), and most patients with DIC syndrome were admitted to the ICU for more than 28 days . Mortality was significantly higher in patients with DIC-like syndrome than in other ICU-treated patients. There was no significant relationship between DIC-like syndrome and age and sex variables, and APACHE scores. In other reported data, no significant difference was found between DIC-like syndrome patients and other ICU patients.
The incidence of DIC-like syndrome leads to an increase in mortality rates in ICU patients. This suggests that any coagulation disorder, even limited to laboratory results, should be immediately followed and treated.

Blood transfusion is commonly used for patients in intensive care units (ICU), and physicians usually decide to order blood transfusion according to the hemoglobin (Hb) level. In this regard, various strategies for blood transfusions, including liberal and restrictive transfusion strategies, are presented on the basis of Hb level threshold. Considering the importance of blood transfusions in the ICU, the current study aimed to appraise blood transfusion practices in the ICU of Imam Hossein hospital in comparison with international strategies during 2010-2014.
This retrospective cohort study was conducted in the ICU of Imam Hussein hospital. The medical files of all patients older than 18 years admitted to the ICU during 2010-2014 were examined. Patient's demographic and clinical information and data about the blood transfusion were collected in the checklist. Finally, by using appropriate statistical analysis, the patterns of blood transfusion in the ICU were determined and compared with international strategies.
In this study, 654 patients were hospitalized in the ICU, of which 327 patients did not receive any blood transfusion and 327 patients received blood transfusion. Among the 327 patients who received blood transfusion, 62 patients (19%) had a hemoglobin (Hb) less than 7, and were indeed transfused by restrictive strategy. Also, 220 patients (67.2 %) had Hb between 7 and 10, and 45 patients (13.8 %) had Hb more than 10. Patients who received blood transfusion were hospitalized significantly for more days in the ICU and had significantly more days under mechanical ventilation (p=0.001). In this study, 58 patients had anemia, all of whom had Hb less than 7. The death rate recorded in the study showed no significant difference between groups according to Hb level (p=0.56), although a higher percentage of deaths were recorded in patients with Hb less than 7.
In this study, 19% of the patients who received blood transfusion had Hb less than 7, and were transfused by the restrictive transfusion strategy. This is while the clinical outcomes of blood transfusion in patients with different Hb levels was not significantly different. Therefore, it seems that blood transfusion in Imam Hossein hospital is not according to the international strategy of blood transfusion. Given the importance of blood transfusions in the ICU, measurements to comply with standard strategies is necessary.