دکتر محمود شیخ فتح الهی

We sought to determine the frequency of postoperative pulmonary complications (PPCs) after cardiac surgeries in patients with obstructive, restrictive, and normal spirometry tests. 

This cohort study enrolled 623 patients who underwent cardiac surgeries at Rajaie Cardiovascular Medical and Research Center between 2017 and 2018 in 3 groups: obstructive, restrictive, and normal. The incidence of PPCs and their risk factors were noted. Associations between the incidence of PPCs and spirometry patterns and preoperative and intraoperative risk factors were evaluated statistically. 

Among all the PPCs evaluated in the patients, pulmonary edema/acute respiratory distress syndrome was much less common in the group with obstructive airflow limitations than in the groups with restrictive or normal lung patterns (P=0.010). The frequencies of other PPCs were not statistically significantly different between the 3 study groups (P>0.05). Among all the evaluated outcomes, the mean ventilation time was statistically different between the groups (P=0.059). Additionally, the incidence rate of pulmonary edema/acute respiratory distress was statistically significantly higher in the group with restrictive airflow limitations than in the other 2 groups. Operative mortality occurred in 15 cases (2.4%), and there were no significant differences in outcomes between the group with PPCs and those without them (P>0.05). 

Whereas there were no statistically significant differences concerning PPCs and in-hospital outcomes between the groups with obstructive, restrictive, and normal lung patterns, the 3 groups were meaningfully different regarding the estimated glomerular filtration rate, diabetes, thyroid-stimulating hormone, and history of morning fatigue. 

Postoperative pulmonary complications (PPCs) are among the leading causes of morbidity, mortality, and increased length of stay (LOS).

In a prospective cohort study, all adult candidates for all types of open-heart surgeries were enrolled and followed from admission to discharge for PPCs.

The study population consisted of 918 consecutive adult patients, including 574 (62.5%) males, at a mean age of 56.20±13.95 (mean ± standard deviation) years who underwent open cardiac surgery. Among them, 537 patients (58.5%) suffered PPCs, comprising pleural effusion in 293/916 (32.0%), atelectasis in 222 (24.2%), pneumonia in 68 (7.4%), diaphragm paralysis in 67 (7.3%), pulmonary edema and/or acute respiratory distress syndrome in 64/915 (7.0%), pneumothorax (in the right or left hemithorax) in 28/916 (3.1%), hemothorax in 7/915 (0.8%), subcutaneous emphysema in 11/913 (1.2%), and empyema in 2/918 (0.2) The independent risk factors for PPCs were age (OR, 1.010; 95% CI, 1.001 to 1.020; P=0.0326), female sex (OR, 1.375; 95% CI, 1.044 to 1.811; P=0.0235), and renal dysfunction (OR, 1.553; 95% CI, 1.001 to 2.409; P=0.0497). Twenty-three patients died within 30 days of cardiac surgery, accounting for a hospital mortality rate of 2.5%.

The cumulative incidence rate of PPCs was 58.5% in our center, with a mortality rate of 3.4%. The overall mortality rate among all the patients was 2.5%. The independent risk factors associated with PPCs were age, female sex, and renal failure. 

This paper presents the conditional relative survival rates of colorectal cancer (CRC) and associated prognostic factors in the Kerman province, the largest province in the south of Iran. Scince CRC is the fifth common cancer in this province, this study aimed to provide more detailed statistics on the survival rate of CRC patients.

This survival analysis study used the national population-based cancer registry data to estimate the survival rate in 1705 patients with CRC from 2007 to 2016. The Kaplan–Meier estimator and Log-rank test were used to plot survival curves and assess differences in survival rates. Univariate analysis and Cox proportional-hazards model were also used to determine association between CRC-related factors and patient survival.

The 5-year survival rate for patients with CRC was 51.9%. This rate was significantly higher in the stage with localized lesions compared with those of regional and distant (p<0.001). The survival rate in patients undergoing surgical treatment was higher than that of patients receiving chemotherapy (p<0.001). Increased age, low tumor differentiation, the stage with distant tumors, and right-sided colon cancer (RCC) were associated with lower survival (p<0.001).

The tumor stage was significantly correlated with the survival rate of patients. Despite advances in the diagnosis and treatment of CRC in Iran and worldwide, the survival rate of patients in this study was low. Since many factors affect this rate, further studies are needed to identify its prognostic factors in Kerman

Cardiovascular disease often leads to limitations in patient activities. Therefore, providing a valid and reliable tool to measure the level of participation and autonomy can be used for improving their health. This study aimed to determine the validity and reliability of the Persian version of a participation and autonomy scale (IPA-p) in patients with positive angiography.

This psychometric properties assessment study was conducted recruiting 202 positive angiography patients referred to a cardiovascular diseases clinic in Rafsanjan in 2017. Ten experts were also recruited to help assess the face and content validity. Criterion validity of the scale was assessed by calculating the correlation of the two sets of scores collected from patients and their relatives. To compute the construct validity, exploratory and confirmatory factor analysis were performed. Scale reliability was also evaluated.

The content validity index was 0.94. The correlation coefficient between the scores of the completed questionnaires by patients and their relatives ranged between 0.443 and 1.0. Exploratory factor analysis extracted 9 factors, explaining about 73% of the total variance of the scale. Confirmatory factor analysis confirmed the fitting of the model. The Cronbach's alpha coefficient was 0.962, the coefficient of Split-half was 0.825, the Intera-class correlation coefficient was 0.363, and the coefficient of Test-retest was 0.807.

Present findings the Persian version of the IPA scale to be a valid and reliable questionnaire for assessing participation and autonomy in patients with positive angiography. More investigation is recommended.

Acute pulmonary thromboembolism (PTE) is a common condition with an increasing incidence that causes severe complications and death. We herein describe the clinical profile of patients with PTE who were referred to a large tertiary university heart hospital.
 
In this retrospective cohort study, the demographic, clinical, and admission data of patients with PTE admitted to Rajaie Cardiovascular Medical and Research Center in 2 consecutive years were reviewed and analyzed. Based on echocardiography findings, clinical presentation, and pulmonary computed tomography findings, the patients were divided into massive, submassive, and minor PTE groups. The study variables, as well as in-hospital mortality, were compared between the groups.
 
The study population consisted of 328 patients with PTE: 210 patients (64.0%) with ordinary PTE, 88 (26.8%) with submassive PTE, and 30 (9.1%) with massive PTE. The patients with massive PTE were significantly younger (P=0.007) and had a higher rate of tachypnea (P=0.002), tachycardia (P=0.013), and hypotension (P<0.001) at presentation. The patients with submassive PTE were more likely to be male and had higher uric acid levels (P=0.002). Chest pain and hypertension were more frequent in the patients with ordinary PTE (P=0.019 and P=0.016, respectively). In pulmonary computed tomography angiography, the involvement of the left and right pulmonary arteries was more frequently observed in the patients with submassive PTE (P=0.013 and P=0.007, respectively). More patients in the massive PTE group received thrombolytic therapy (P<0.001) with a significantly higher mortality rate (P<0.001), a shorter ICU stay (P=0.001), and a shorter hospitalization period (P<0.001).
 
Patients with massive PTE have a higher risk of mortality and should be considered for more aggressive therapy. (Iranian Heart Journal 2022; 23(1): 95-105)

Measurement of pulmonary artery pressure (PAP) is important for therapeutic planning in most types of structural heart diseases. The standard route for measuring PAP is cardiac catheterization. Nevertheless, in some cases, abnormal cardiac structures do not allow for advancing the catheter into the pulmonary artery. Measurement of pulmonary venous wedge pressure is another way, but it is not possible in some cases. During cardiac surgery, it is possible to measure PAP by directly entering a small needle into the pulmonary artery. This study aimed to evaluate the accuracy of PAP measurement during cardiac surgery in patients in a surgical environment.
 

The study enrolled 105 consecutive patients with congenital heart defects in whom cardiac catheterization was done before cardiac surgery. Systolic and diastolic pressures of the aorta and the pulmonary artery were measured and recorded both during catheterization and during cardiac surgery, and their correlations were assessed.
 

Most of the pressures measured during cardiac surgery were lower than those measured during catheterization; nevertheless, no linear or other clear associations were found between them. There was no meaningful correlation concerning the amount of change between systemic and pulmonary pressures.
 

PAP significantly changes during general anesthesia and with an opened chest cage. PAP measured during surgery could not be relied upon for critical decisions such as univentricular approaches. (Iranian Heart Journal 2022; 23(1): 192-197)

Radiomorphometric indices obtained from panoramic radiography are used to quantitatively and qualitatively evaluate osteoporosis. Given the importance of early diagnosing osteoporosis.The present study was conducted to compare osteoporotic and healthy women in Rafsanjan, Iran in terms of mandibular radiomorphometric indices obtained from their panoramic radiographs.

This descriptive cross-sectional study examined 212 subjects, including 53 osteoporotic women and a control group comprising 159 women presenting to the Department of Oral and Maxillofacial Radiology, School of Dentistry, Rafsanjan University of Medical Sciences, Rafsanjan, Iran .The participants were investigated by performing radiographic imaging using a digital panoramic system (Planmeca Promax, Helsinki, Finland). The radiographic data recorded on each image included radiomorphometric indices such as mandibular cortical index(MCI),  antegonial index (AI) and gonial index(GI). The data collected from the checklists were analyzed in SPSS-22.

The osteoporotic patients were not significantly different from the controls in terms of AI. The mean GI was significantly higher in the osteoporotic women than in the women in the control group. Investigating MCI showed that category C1 was significantly higher in the controls than in the osteoporotic women, whereas category C2 was higher in the osteoporotic group than in the controls.

The present findings revealed that GI and MCI obtained from panoramic radiographs can be used to diagnose osteoporosis and differentiate osteoporotic patients from healthy individuals. Although the indices were affected by age in both groups, differences in the indices between the patients and controls were insignificant in the same age group.

Heart failure (HF) is the common result of most heart disorders. The quality of life (QoL) of these patients is severely impaired and they need continuous care. Spiritual care is a type of nursing care that may affect the QoL of patients. The present study aimed to determine the effect of spiritual care program on QoL in patients with HF. This randomized controlled trial was performed at Rajaie Cardiovascular Medical and Research Center, Tehran, Iran in August 2020. In total, 84 patients were selected through convenient sampling and randomly assigned to two groups using block balanced randomization. Iranian Heart Failure Quality of Life (IHF-QoL) questionnaire and Parsian and Dunning spirituality questionnaire were complemented by the two groups before and after 1-month follow-up. The intervention was performed for the intervention group in two virtual educational sessions (each 1.5 h) as well as a 1-month follow-up three times a week for 1 h per session via WhatsApp. Finally, the data of 74 patients were analyzed using SPSS software (version 22). The significance level was considered at P < 0.05. The groups were homogenous in terms of demographic characteristics. Dimensions of QoL in mental limitations (P<0.001) and self-care (P<0.01) were significant in the intervention group, compared to the control group. Therefore, the spiritual care program significantly increased the total score of QoL (P<0.01).Implications for Practice: Results of the study indicated that the spiritual care program greatly improved the total score of QoL and can be considered a part of the holistic care program.

Cisplatin is an important anticancer drug and despite its beneficial clinical effects in the treatment of cancer, it has toxic side effects owing to the production of free radicals. Pistachio is one of the plants having compounds with antioxidant properties and contains vitamins E and C, beta-carotene, various antioxidants, gamma tocopherol, quercetin, flavonoids, lutein, xanthine and minerals such as copper and selenium. Pistachio kernel extract contains multi-purpose phenolic compounds and can act as a free radical scavenger.

This experimental study was conducted on 36 male Wistar rats for 15 days. The rats were randomly divided into six 6-rat groups. Group 1 was the control group including healthy rats receiving DMSO (Dimethyl sulfoxide). Group 2 was healthy rats receiving 200 mg/kg body weight of ethyl acetate extract of pistachio kernel for 15 days. Group 3 was the healthy rats receiving 400 mg/kg body weight of ethyl acetate extract of pistachio kernel for 15 days. Group 4 was rats receiving cisplatin at a dose of 10 mg/kg body weight by intraperitoneal injection on the tenth day of untreated experiment. Group 5 was the rats receiving cisplatin at a dose of 200 mg/kg body weight from ethyl acetate extract of pistachio kernel for 15 days. Finally, group 6 included the rats receiving cisplatin at a dose of 400 mg/kg body weight from ethyl acetate extract of pistachio kernel for 15 days. After 15 days, blood samples were taken from the corners of the rats’ eyes and after isolating the serum was revived and concentration of Malondialdehyde (MDA), glutathione and the activity of enzymes including superoxide dismutase (SOD), catalase (Cat), glutathione peroxidase (Gpx) and total antioxidant capacity (TAC) was measured in the serum.

In groups 2 and 3 receiving only the extract, a significant decrease in serum levels of SOD and Cat and a significant increase in TAC were observed compared to that of the control group (P< 0.001). Moreover, in group 4 receiving only cisplatin, a significant decrease was observed in serum levels of Gpx, Cat, SOD and TAC, and a significant decrease was also observed in MDA compared to that of the control group (P< 0.001). In addition, the high dose of the extract in group 3 led to a significant decrease in MDA compared to that of the control group, yet the low dose of extract in group 2 caused a significant decrease in Gpx enzyme compared to that of the control group (P< 0.001).

The results of this study showed that the hydro-alcoholic extract of pistachio kernel has protective and modulating effects against cisplatin toxicity in rats and due to its antioxidant properties, it increased the activity of antioxidant enzymes.

Statement of the Problem:

 Dental caries is the most common chronic childhood disorders throughout the world. dmft (decayed, missing and filled primary teeth) and DMFT (decayed, missing and filled permanent teeth) are some of the most important epidemiological indices in dentistry. Evaluation of these two indicators in the population can help future planning to improve oral health status.

The aim of this study was to evaluate these indicators and the related factors in first-grade primary school students in Rafsanjan urban area to determine the current status for future health planning.

In this cross-sectional study, DMFT index of first permanent molar and dmft were evaluated by census method on 2031 first-grade primary school students in Rafsanjan urban area in 2018 (May-June). Dental examination was done using a mirror and probe under natural light according to World Health Organization criteria. The data were then analyzed using independent two-sample t-test, One-way ANOVA, Tukey's multiple comparisons test, Kolmogorov-Smirnov nonparametric test and Leven's test in SPSS version 21 software.

The mean and standard deviation of dmft index and DMFT index of first permanent molar were 6.37 ± 3.40 and 0.30 ± 0.72, respectively. The proportion of caries free students was 4.1%. A significant association was found between the values of these indices and school type, the level of education of parents, parental occupation, family size, frequency of brushing and the use of floss (p < 0.05). However, there was no significant association between these two indices with gender (p = 0.347 and p = 0.593, respectively).

The results of this study showed high prevalence of caries in first-grade primary school students in Rafsanjan. Therefore, to improve this situation, more attention is needed to the proper planning and education of families concerning oral hygiene and dental preventive measures.

Families of children with special needs face many problems. This study aimed to investigate happiness training on the pattern of parent-child relationships and the hope of parents with autistic children.

Twenty-six couples with autistic children who referred to Rafsanjan Autism Clinic, Rafsanjan City, Iran, were enrolled in the study by the census method. Informed consent was obtained from them. Then the parents completed the Schaefer and Edgerton Parent-Child Interaction Questionnaire (1985) and Miller Hope Scale (1988). Next, parents were randomly assigned to the intervention or control groups. Happiness training based on the Fordyce method was performed for eight 1.5-hour sessions per week for the intervention group. The parents of either group completed the questionnaires after training of the intervention group (about 2 months and 3 months later). The Chi-square test, independent t-test, and 2-way repeated-measures ANOVA were used for statistical analysis. The level of significance was set at 0.05.

The results of the analysis showed that the changes in the scores of communication (P=0.013), acceptance (P=0.008), control (P=0.005), independence (P=0.040), aggressive non-attachment (P=0.015), and hope (P=0.010) were significant between the two groups at stages of measurement. The scores of all variables increased but the aggressive non-attachment decreased.

The education of happiness in Fordyce style influenced the interactive pattern of communication and hope of parents with autistic children. Therefore, training of happiness along with other services available to parents of autistic children can also be considered.

Excessive use of mobile phones is addictive and causes many complications. The severity of these complications depends on the duration of the call and the frequency of using mobile phones. Therefore, this study aimed to determine the effect of mobile phone waves on salivary secretion.

This descriptive study was conducted on 120 dental students in Rafsanjan, Iran, in 2015. Using the call history of the mobile phones, the number and duration of each personchr('39')s daily calls were obtained. The spitting method was used to collect unstimulated saliva, and stimulated saliva was collected with the help of natural chewing gums without sugar and additive flavors. After sampling, the falcon tubes containing saliva were centrifuged at 2500 rpm for 10 minutes. Then the saliva volume was read from the tube and recorded. Independent two-sample t test, one-way ANOVA, and multiple linear regression model were used for data analysis.

Students who talked for more than 40 minutes or 20-40 minutes a day on their mobile phones had a mean unstimulated salivary secretion of 0.885 and 0.331 ml/min, respectively and mean stimulated salivary secretion of 0.702 and 0.708 ml/min, respectively more than students who talked less than 20 minutes a day on their cell phones (P<0.05).

The results showed that increased duration of cell phone calls was associated with increasing the amount of stimulated and unstimulated salivary secretion, which could decrease the risk of developing oral infections and tooth decay.

Cisplatin is an anticancer drug used for tumor treatment, causing free radicals and damaging the DNA. The higher doses of cisplatin induce toxicity in organs, such as the kidney and liver. Regarding antioxidant properties of Pistacia Atlantica gum containing flavonoid compounds, this study aims to investigate the protective effects of the gum on Wistar rat's liver and kidney cells against cisplatin toxicity.

Emulsion was made from Pistacia Atlantica gum using the self-emulsification method to facilitate rats' gavage. Then, 24 male Wistar rats were randomly divided into 4 groups, including the control group (CG), extract group (EG), gum & cisplatin group (GCG), and cisplatin group (CiG). Subsequently, the concentration of malondialdehyde (MDA), total protein (TP), total antioxidant capacity (TAC), the activity of catalase (CAT), superoxide dismutase (SOD), and glutathione peroxidase (GPX) were measured in rat's blood samples for 15 days. One-way ANOVA was used to demonstrate differences between groups by SPSS Ver.2018 software.

Pistachio Atlantica gum significantly halted the reduction effects of cisplatin on GPX, CAT, and SOD in group 3. It displayed a significant increase in TAC and a remarkable reduction in MDA.

Pistachio Atlantica gum appeared to have protective and moderate effects against cisplatin-induced toxicity on the liver and kidney. Moreover, its antioxidant attributes caused a reduction in free radicals.

One of the most important epidemiologic indices for the assessment and measurement of dental caries is the Decayed, Missing, and Filled Teeth (DMFT) index which is used as an important criterion for the evaluation of the oral and dental health status of individuals. Therefore, the present study was conducted to determine DMFT6 (DMFT of the first permanent molar) index and the related factors with the caries free status in students of 12 years of age in Larestan, Iran, in 2014.
The present cross-sectional survey was conducted on 2436 students. Data were collected using the National Oral Health Promotion Plan Checklist. If the features of decayed, missing, and filled were observed in any of the first permanent molars, they received a score of 1. Data were analyzed using chi-square test, chi-squared test for trend, independent two-sample t-test, and multiple logistic regression model.
The mean and standard deviation of DMFT6 in all students was 1.00 ± 1.36. It was 1.07 ± 1.39 and 0.93 ± 1.33 in girls and boys, respectively, and this difference was statistically significant (P = 0.0080). In addition, more than half of the students (51.5%) were caries free. The variables of gender (P = 0.0007), mothers’ education (P It seems that the amount of the DMFT6 index in students of 12 years of age in Larestan was high compared to the World Health Organization (WHO) standards in 2010. Therefore, it is recommended that efficient plans be made to promote the oral and ýdental health of students.

The increase in the prevalence of cesarean section (C-section) in recent decades has become a public health problem worldwide. Studies of cesarean section in order to identify the causes and form policies and interventions to reduce the incidence of this health problem are necessary. This study was conducted with the aim to investigate the causes of C-sections performed at Niknafs and Ali-Ibn Abi Talib Hospitals in Rafsanjan, Iran, in the second trimester of 2014. In this cross-sectional study, 560 pregnant women were selected from among those referred to Niknafs and Ali-Ibn Abi Talib Hospitals in the second trimester of 2014 for cesarean delivery. Information was collected using a researcher-made checklist through interviews with patients and reviewing medical records. Data were analyzed using chi-square or Fisher's exact tests, as required. The mean and standard deviation of age of women was 29.46 ± 5.08 years and most of them (65.0%) were in the age range of 26-36 years and had a diploma (40.7%). Considering delivery history, the highest percentage of women had had a single delivery (38.9%) and over half of the subjects (52.9%) had experienced a previous C-section. The most common causes were repeated C-section (52.9%), elective C-section (on maternal request) (7.5%), meconial stained (6.1%), fetal distress (5.0%), and breech presentation (4.5%). Statistically significant associations were observed between C-section reasons, and age (P < 0.001), number of previous pregnancies (P < 0.001), and previous delivery method (P = 0.010). Repeated C-section, as the most common cause of cesarean, has had a major role in increasing cesarean. Vaginal delivery after cesarean, taking into account the clinical and legal circumstances and providing training programs to acquaint women to the negative consequences of C-section and vaginal delivery benefits would be effective in the choice of delivery and might help in reducing cesarean.

It seems that weight gain and body composition changes occur during the first year of college . The aim of this study was the comparison of body composition among freshmen medical sciences students one term after entering Rafsanjan University of Medical Sciences , South East of Iran.
All freshmen medicine (n = 73) and nursing- midwifery students (n = 57) of Rafsanjan University of Medical Sciences who had registered for the fall of 2013 were participated in this descriptive study. After obtaining written consents from the participants, their demographic information was collected. Then, using bioelectrical impedance analysis (BIA), body composition of all the students was measured and recorded. Data were analyzed using independent two-sample t-test, paired t-test, and Wilcoxon signed-ranks test.
The difference between medical and nursing/midwifery students in terms of changes in body fat percentage ( 1.92 ± 2.87 versus -0.29 ± 2.21, respectively ) ( P There was a statistically significant difference between medical and nursing/midwifery students in terms of fat percentage, fat free mass, and total body water content. It seems that the differences between the two groups might be because of being native or nonnative students.