فهرست مطالب مهران کوچک

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.

Some mortality due to stroke occur outside the hospital. Therefore, the pre-hospital emergency medical services (EMS) plays an important and vital role in the management of stroke patients. The present study evaluated the knowledge of prehospital emergency medical services (EMS) personnel in the diagnosis of stroke patients.

This cross-sectional study was conducted in hospitals and pre-hospital EMS affiliated to Ilam University of Medical Sciences, Ilam, Iran in 2022. In order to measure the knowledge and awareness of pre-hospital EMS personnel regarding stroke, a researcher-made questionnaire containing 20 questions, as well as demographic data such as age, gender, field of study was collected.

The mean age of 109 pre-hospital EMS personnel was 32.4±6.6 years old. Most of them were graduates of associate degree in emergency medicine. The mean score of knowledge obtained by the pre-hospital EMS personnel was 16.9±3.5 out of 20, which according to the grading, the knowledge level was estimated to be very good. Of course, very weak and weak level of awareness was recorded in 0.9% (n=1) and 1.8% (n=2) of pre-hospital EMS personnel, respectively. No significant relationship was recorded between the mean level of knowledge and field of study.

The findings of the present study showed that the level of knowledge of Ilam pre-hospital EMS personnel in the field of stroke is favorable, however, the knowledge of a very small percentage of them was at a weak or very weak level. It is recommended conducting more studies in this field.

Occupational stress in the Intensive Care Unit (ICU) has a serious impact on the health and quality of life of nurses. Paying attention to the quality of life of nurses and reducing occupational stress can lead to better provision of medical services in the ICU and hospital. Therefore, the present study was conducted to determine the relationship between occupational stress and quality of life in ICU nurses in selected naval hospitals.

In this descriptive-analytical study, 76 ICU nurses in selected naval hospitals in the south of Iran in 2019 participated. Sampling was done by census and available methods. The research tools included the 26-question quality of life (WHOQOL-BREF) and occupational stress questionnaires, which were completed by nurses, and then data were analyzed.

The mean score of occupational stress and quality of life in ICU nurses in selected naval hospitals were estimated as 42.9±1.7 and 62.3±19.1 respectively, both of which are at a moderate level. Occupational stress has an inverse and significant relationship with quality of life in ICU nurses. Occupational stress and quality of life had no significant relationship with any of the ICU nurses' demographic variables.

The findings of the present study demonstrated that there is a significant and inverse relationship between the quality of life and occupational stress in ICU nurses, so the increase in occupational stress of ICU nurses has a negative effect on their quality of life, and this can affect the quality of providing clinical care in hospital. Therefore, improving the quality of life and reducing occupational stress should be on the agenda of health officials.

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.

Thrombocytopenia is common in ICU patients. The objective of this study was to evaluate possible links between platelet counts and survival in ICU patients. All patients who were admitted to the Imam Hossein Medical Center ICU for at least 2 days and were 18 years or older with absence of thrombocytopenia at the time of admission were included in this retrospective study. A multivariate logistic regression model was used to examine thrombocytopenia and ICU mortality as the outcome variable. From 565 patients admitted in that ICU during the study period, 394 matched the inclusion criteria. The incidence of thrombocytopenia was 57.5% and mortality was 61.4%. Mortality rate was 28.5 % in thrombocytic patients vs. 9.2% in non-thrombocytic patients (p‹0.001). Patients with ICU acquired thrombocytopenia had statistically significant lower baseline, minimum and 4th day platelet counts. Female sex, longer ICU stay, admission platelet counts, and albumin levels were significantly associated with occurrence of thrombocytopenia. Higher platelet counts on admission were associated with significantly reduced risk of thrombocytopenia (P=0.00). On multivariate regression analysis age, ICU acquired thrombocytopenia, higher INR, higher mean APACHE II score, renal replacement therapy, and mechanical ventilation were significantly associated with mortality. The incidence of thrombocytopenia and subsequent mortality in ICUs is considerably high and is a real medical concern. In patients, who spend ≥ 2 days in the ICU and have normal platelet counts at ICU admission, a decline in platelet counts to less than 150,000/mL is an indicator of poor prognosis.

Venous Thromboembolism is one of the most serious conditions in ICU that might complicate patient’s general condition. This descriptive study was delivered to assess the cumulative incidence of VTE amongst ICU Patients in a general university hospital in Tehran in a one year period. We reviewed all the files from patients admitted to ICU for a one year period from May 2005 to May 2006. Patients who had an episode of venous thromboembolism were selected and their age, gender, preliminary disease, prophylaxis regimen for venous thromboembolism, treatment approach, and their outcome were recorded. There were 14 cases of venous thromboembolism among 339 patients admitted. Out of these 14 patients 5 had pulmonary thromboembolism and 3 patients expired (2 general surgery and 1 neurosurgery cases). 5 out of 14 patients had received prophylaxis for venous thromboembolism while none of the 3 expired patients had received it. Based on the underlying disease, there were 4 general surgery patients, 6 neurosurgery, 3 orthopedic surgeries, and 1 internal medicine patient. Treatment approach in all cases was heparin and enoxaparin administration while one case had IVC filter. ‍ It can be concluded that the incidence of VTE in ICU patients and the mortality rate is predictable; therefore correct and effective DVT/VTE prophylaxis can prevent massive PE and death amongst high risk patients.

Backgraound: Sodium disturbances are among the most common electrolyte disturbance in Intensive Care Unit (ICU) patients. The aim of the present study was to determine the frequency of hypernatremia, hyponatremia and their comparison in relation to their mortality impact on patients admitted to a general ICU.

In a cross sectional fashion we studied 273 patients hospitalized in an ICU of a large teaching hospital in Tehran, Iran between 2004 and 2006. Age, sex, reasons for hospitalization, hyponatremia (serum sodium < 135 mEq/L) and hypernatremia (serum sodium > 145 mEq/L) during ICU stay were recorded and their effects on ICU mortality of the patients were assessed.

We observed hypernatremia in 39.5% and hyponatremia in 60.5% of our patients. The mean age of patients with serum sodium imbalance was significantly higher as compared to those without it 52±21 vs. 44±20 years for hyponatremics and 56±20 vs. 49±22 years for hypernatremics respectively. Hyponatremia occurred more frequently in surgical patients than those with medical causes, 72% vs. 22% respectively. Mortality of patients with hyponatremia (34% vs. 15% with odds ratio of 5.7 and 95% CI from 2.9 to 11.30) and hypernatremia (55.2% vs. 17.8% with odds ratio of 2.8 and 95%CI from 1.4 to 5.5) were significantly higher than patients without sodium imbalance. 55%with hypernatremia died vs. 34% with hyponatremia, (95% CI from 7.7% to 33.9%, p value = 0.0034).

Serum sodium imbalances are frequent in ICU patients, occurring more frequently in older individuals and are associated with an unacceptably high mortality. Mortality was significantly higher in patients with hypernatremia compared to those with hyponatremia.

Anesthetic procedure is an important factor in the extent of blood loss during operation and can determine pre and post-operative complications. Finding an anesthetic procedure to reduce the extent of blood loss is a major goal for most surgeons. This study was undertaken to compare two anesthetic procedures and their extent of blood loss in patients undergoing endoscopic sinus surgery. 46 ASA I patients, who referred to ENT ward of Rasoul-e-Akram Hospital for endoscopic sinus surgery, were selected and then randomly assigned into two groups of 23 patients each. In the first group the induction of anesthesia was accomplished by propofol and remifentanil and cis-atracarium. Maintenance of anesthesia in this group was accomplished by using propofol and remifentanil infusion. In the second group the induction of anesthesia was accomplished by using propofol and remifentanil and cis-atracurium. Maintenance of anesthesia in this group was accomplished by using isoflouran and infusion of remifentanil. All patients received 7 ml/kg crystalloid solution before induction of anesthesia and their systolic blood pressure was maintained at 90 mmHg using TNG if needed. Blood loss determinants were: the extent of blood loss in suction(per bottle), the extent of blood in the surgical field, pre and post-operation hemoglobin levels, and surgeon’s satisfaction of blood loss extent describing as: very extensive, obvious but acceptable and mild. The obtained results showed that there was no significant statistical difference in the extent of blood loss between two groups. There was also no significant statistical difference in pre and post-operation hemoglobin levels between two groups. In summary, the two procedures remarkably reduced the extent of bleeding(28cc±6), but this extent is not statistically different between the two groups.