alireza khalesi

This study assessed the effect of four doses of N-acetylcysteine %20 and probiotics on the variety of the oropharyngeal microbial flora of intubated ICU patients.  

 In this study, 60 ICU patients under mechanical ventilation were randomly assigned to three groups and treated with N-acetylcysteine %20 mouth rinse, probiotic, or routine care (chlorhexidine). A culture sample was obtained from the oropharyngeal zone before and 24 hours after mouth rinse.

 The colonized bacterial count of the sample was not significantly different before intervention among the N-acetylcysteine, probiotic, and routine care groups (P>0.05). 

The probiotics and N-acetylcysteine increased the variety of bacterial groups in the oropharyngeal zone. These florae can compete for nutritional items and growth conditions with pathogenic bacteria.

Opium has been used for thousands of years for medical and analgesic purposes, and its misuse has also increased in recent years. Methadone, a synthetic opioid, has been used as an analgesic and to help patients quit opium addiction. However, some evidence suggests that long-term use of opioids can affect the hypothalamic-pituitary-adrenal axis.

We aimed to evaluate the serum cortisol level and response to the cosyntropin stimulation test in opium addicts on methadone treatment.

The study was conducted in November 2019 at Imam Reza Hospital Rehab Center, Birjand, Iran. Thirty-eight methadonetreated opium addicts participated in the study. A blood sample was initially obtained, then 250 g intramuscular cosyntropin was injected. After 30 and 60 minutes, two other blood samples were obtained. The data were analyzed using SPSS.

There was a significant difference between serum cortisol levels and the normal value in methadone users (9.46 ± 5.42 vs. 14 g/dL) (P < 0.001). The mean response to the cosyntropin stimulation test in methadone users was 9.34 ± 8.11 g/dL. Also, 55% of the participants had adrenal insufficiency.

Serum cortisol levels significantly differed from normal values in methadone-treated patients. Therefore, we recommend measuring serum cortisol levels in methadone-treated patients before major medical procedures to consider the stress doses of corticosteroids.

To investigate the effect of using nano-chelate zinc and iron ratios on yield and yield components of maize and cowpea seeds, a factorial experiment was conducted by using randomized completely block design with three replications in the south of Kerman, Iran, during 2018-2020. Experimental treatments consisted of five levels of mixed culture of corn and beans (100% beans, 75% beans + 25% corn, 50% beans + 50% corn, 25% beans + 75% corn, and 100% corn) and four levels of iron and zinc nanoclates combination (iron nanoclate, zinc nano-chelate, iron nano-chelate + nano-chelate zinc and control). Number of seeds per ear row, 1000-seed weight, seed yield and harvest index were measured. The results showed that the effect of planting ratios on number of seeds per ear, 1000-seed weight and harvest index were statistically significant at 1% and on grain yield at 5% level of probability while it was not significant on number of seeds per ear row and number of rows per ear. The highest number of seeds per ear (707.8), seed yield (12787 kg.ha-1) and 1000-seed weight of corn (253 g) were obtained from 25% bean + 75% corn crop ratio. The highest harvest index (52%) was obtained from pure culture. Simultaneous application of nano-chelate iron and zinc increased the quantitative and qualitative properties of corn. Intercopping of 25% cowpea + 75% corn with nano-chelate application produced the highest proein percent (22.3 %). The highest value of land equality ratio (total) (2.12) was obtained by using a mixed cultivation treatment of 75% bean + 25% corn and the lowest (1.57) by 25% of beans were +75% of corn and zinc combinations. Finally, the highest grain yield of 12,993 kg.ha-1 was obtained from a intercropping of 75% corn + 25% bean and application of iron and zinc.

This study aimed to evaluate the correlation of the Brain Function Index (BFI) with three criteria of consciousness (Glasgow, Richmond, and FOUR score) in the intensive care unit.

We enrolled patients aged over 15 years who required no muscle relaxants and had no hearing and visual impairment, mental retardation, mental disorder, hemodynamic instability (MAP < 60 mmHg), and hypoxia (SpO2 < 90%), as well as patients with no brain electrical activity disorders such as epilepsy and focal brain disease, and those who had not undergone anesthesia and surgery for the past 24 hours.

All ICU patients were enrolled in the study in the autumn and winter based on inclusion and exclusion criteria (n = 85). During 24 hours, BFI and three clinical criteria of sedation and consciousness including RASS, GCS, and FOUR score were assessed three times with a minimum of four-hour intervals. Among the patients, 45 (52.9%) were males, and 40 (47.1%) were females; 24 (28.2%) patients were under 40 years of age, 13 (15.3%) patients were between 41 and 60 years old, and 48 (56.5%) patients were over 61 years old. There was a significant positive relationship between the BFI score of ICU patients and the score of patient consciousness based on RASS, FOUR score, and GCS. The correlation of BFI with the FOUR score was higher than those with the other two criteria.

Objective criteria for assessing the consciousness level such as BFI are sufficiently accurate and can be used instead of clinical criteria to assess the level of consciousness in special wards.

Coronavirus, coronavirus disease 2019 (COVID-19), in humans, mainly causes respiratory and gastrointestinal manifestations that can range from a simple cold to severe clinical symptoms or death. On the other hand, COVID-19 patients’ hospitalization in the intensive care unit (ICU) have serious problems, which can affect their mortality; therefore, the awareness of these problems has a main role in decision-making in the early stages.

This study aimed to evaluate the clinical features and outcomes of patients with COVID-19 admitted to the ICU.

This cross-sectional (descriptive-analytical) study was conducted on patients with COVID-19 pneumonia admitted to the ICU of Valiasr Hospital, Birjand, Iran, in 2020. A total of 111 patients, including 51 female and 63 male subjects, were enrolled in this study using convenience sampling. Demographic data, comorbidities, signs and symptoms, radiological findings, supportive methods of oxygen therapy, and clinical outcomes were collected using a checklist and compared between two groups (i.e., survivors and nonsurvivors).

Among 111 patients (including 59 nonsurvivors and 52 survivors), the numbers of mortalities within the age ranges of ≥ 75 and ≤ 44 years were the highest and lowest, respectively. In the survived patients, hypertension (50.8%), diabetes mellitus (47.5%), heart disease (44.1%), and chronic obstructive lung disease (23.7%) were the most common comorbidities. Moreover, dyspnea (81.1%), fever and chills (73%), cough (64.9%), muscle pain (45%), and weakness, and lethargy (42.3%) were the most common symptoms of the patients. Based on the comparison of survived and nonsurvived groups, diarrhea (P < 0.001), sore throat (P < 0.001), nausea (P < 0.001), and vomiting (P < 0.0001) were significantly higher in the group of survived patients. Among the radiological findings (i.e., chest X-ray and high-resolution computed tomography), bronchoalveolar markings (P = 0.05) and pleural effusion (P = 0.02) were higher in the nonsurvived patients. The average Acute Physiology and Chronic Health Evaluation II (APACHE II) score≥ 16 was reported with a higher mortality rate.

Risk factors, including dyspnea, older age, comorbidities, and high APACHE II score, could increase the risk of poor clinical outcomes and help identify ill patients with a poor prognosis at the beginning of ICU admission.

 The outbreak of coronavirus disease 2019 (COVID-19) pandemic has led to public panic and psychological problems. In this regard, few studies have reported the post-discharge mental health status of COVID-19 survivors.

 This study aimed to evaluate the mental health status of COVID-19 survivors and determine the risk factors of adverse psychological outcomes.

 This cross-sectional study consisted of 188 COVID-19 survivors discharged from hospital. Data were recorded using social media applications. To evaluate the mental health status, Hospital Anxiety and Depression Scale (HADS) and Depressive Anxiety and Stress Scale 42 (DASS-42) were used. Ordinal regression with a logit link was used to assess the simultaneous effect of variables.

 The mean age of participants was 56.4 ± 9.6 years, and the majority of patients were male (62.2%). According to HADS, 81 (43.1%) and 24 (12.8%) patients suffered from anxiety and depression, respectively. Using DASS-42, we reported at least a mild degree of depression [23 (12.2%)], anxiety [20 (10.6%)], and stress [74 (39.4%)] among the discharged patients. Depression, anxiety, and stress were significantly associated with length of hospital stay (P < 0.05). In addition, there was a direct association between stress and patients’ number of children (β = 0.38, P = 0.02).

 Depression, anxiety, and stress are relatively high among COVID-19 survivors. Length of hospital stay and number of children were identified as the predisposing factors for adverse psychological outcomes.

The current study compared the amount of bleeding in propofol and isoflurane anesthesia in patients undergoing lumbar disc and cerebral hemorrhage surgery in Birjand teaching hospitals within 2017-2018.

This retrospective quasi-experimental study was conducted based on a nonequivalent group design. It was performed on patients within the age range of 18-75 years undergoing spinal surgery and cerebral hemorrhage who were referred to Imam Reza (AS) and Razi hospitals in Birjand within 2017-2018. Patient information was retrospectively collected using their medical records. The data were analyzed in SPSS software (version16) using the independent t-test, paired t-test, and Mann-Whitney test. A p-value less than 0.05 was considered statistically significant.

A number of 36 and 35 patients underwent propofol and isoflurane anesthesia, respectively. Both groups were individually matched on gender, and the propofol patients were not significantly younger than the isoflurane patients (P=0.006). There was no significant difference between the two groups in terms of pre- and postoperative bleeding, hemoglobin level, systolic blood pressure, and diastolic blood pressure. Preoperative hemoglobin, systolic blood pressure, and diastolic blood pressure in the propofol group were reported as 13.8±1.69 g/dl, 127.2±15 mmHg, and 80±8 mmHg, respectively. These values decreased to 13.03±2.01 g/dl (P=0.0001), 122.3±12.8 mmHg (P=0.079), and 76.5±9.7 mmHg (P=0.034) postoperatively. On the other hand, in the isoflurane group, preoperative hemoglobin, systolic blood pressure, and diastolic blood pressure were obtained at 13.7±1.62 g/dl, 128.4±18 mmHg, and 78.5±12.6 mmHg, respectively. These values also decreased to 12.8±1.9 g/dl (P=0.0001), 124.1±15.8 mmHg (P=0.217), and 76.0±11.9 mmHg (P=0.365) postoperatively.

Based on the obtained results, the amount of bleeding is similar in patients undergoing central nervous system surgery under either propofol or isoflurane anesthesia. Nevertheless, hypotension was higher in propofol-anesthetized patients. Inhaled anesthesia is advantageous over propofol anesthesia due to the possibility of metabolic acidosis in patients with controlled hypotension.

Systematic inflammatory syndrome causes death in many conditions. Inflammation and anti-inflammation parameters variation monitoring were done by different clinical and lab methods, however, determining the progression of inflammation is very important for on time interference, gaining best results, and cost controlling. In this condition, adrenal insufficiency’s variation causes water and electrolyte disorders, circulatory failure, and uncontrolled progression of inflammatory response, which is very important. Routine serum total cortisol level monitoring for SIRS is not advised as yet, and corticosteroid was used blindly according to hemodynamic condition and physician diagnosis.

In this pilot study, the ability of first three days monitoring serum total cortisol level in SIRS of burned ICU traumatic patients was studied for outcoming improvement.

A total of 60 patients, 15 - 70 years old, < 80% burn, with systemic inflammatory response syndrome, during first three days of admission in the ICU, that weren’t included in the exclusion criteria (patients with history of clinical adrenal insufficiency or corton usage, or recent drug history of etomidate or ketoconazole), were divided randomly between two groups with 30 patients. The first group considered under the routine clinical treatment and in the second group, besides the routine methods cortisol daily measurement at 8 o’clock, was done during three days to find the cortisol level under 15 ug/dL, and replacement therapy with 50 mg hydrocortisone IV, four times a day.

None of the patients had a cortisol drop during their first three days. Among patients with cortisol more than normal, 20% (6 patients) died.

Despite the fact that total serum cortisol drop during systemic inflammatory response syndrome may happen, it is not prevalent, however, it is wise to consider it as an effective parameter on monitoring of treatment measures.