alireza rahat dahmardeh

Electrolyte imbalance is one of the influential causes in determining the outcome of traumatic patients. One of the electrolytes that get less attention from healthcare providers is magnesium. Therefore, this study investigated the frequency of hypomagnesemia in trauma patients hospitalized in the intensive care unit.

The descriptive-cross-sectional study was conducted after approval at Zahedan University of Medical Sciences on 118 patients with multiple traumas from 2021 to 2022. Patients were selected by convenience sampling method according to the inclusion criteria. Age, sex, weight, body mass index, level of consciousness, and level of blood serum electrolytes were measured and recorded on the first and fifth days after hospitalization. The data were analyzed and compared using descriptive statistics, chi-square, and independent t-test.

Of 118 patients studied, 81 (68.6%) were male, and 38 (31.4%) were female. On the fifth day after hospitalization, the mean serum magnesium level of the patients was 1.4 ± 0.81 mg/dL. 87 patients (73.7%) had normal magnesium serum levels, 27 patients (29.9%) had hypomagnesemia, and 4 patients (3.4%) had severe hypomagnesemia. No statistically significant relationship existed between hypomagnesemia and gender, age group, and comorbidity diseases. The level of other blood serum electrolytes on the fifth day after hospitalization, age, weight, body mass index, and status of consciousness was not statistically significant between the two groups of patients with hypomagnesemia and without hypomagnesemia.

Trauma and the subsequent treatment measures lead to decreased magnesium serum levels in intensive care patients. Therefore, the normal serum level of other electrolytes should not be considered a diagnostic indicator for the normality of magnesium serum level. Magnesium should be measured along with other electrolytes to make a timely decision to replace magnesium supplements in a patient with hypomagnesemia.

Tube feeding is one of the supportive feeding methods for patients admitted to intensive care units (ICUs). However, tube feeding used in ICUs has received less attention compared to other care procedures. Therefore, assessing nurses’ perceptions and performance is essential, as they play a vital role in the correct practice of tube feeding and the prevention of its complications for patients.

The present study examined ICU nurses’ performance and perceptions of tube feeding in teaching hospitals affiliated with Zahedan University of Medical Sciences in 2023.

This descriptive study was conducted on 83 nurses working in the ICUs of hospitals affiliated with Zahedan University of Medical Sciences in 2023. The participants were selected through convenience sampling. Data were collected using a demographic information questionnaire, the Nurses’ Perceptions of Tube Feeding Scale, and the Tube Feeding Performance Evaluation Checklist. Data analysis was performed with SPSS-21 software using descriptive statistics and independent samples t -test.

The findings showed that the average work experience of ICU nurses was 6.28 ± 4.59 years. The mean overall performance score of the nurses was 59.62 ± 4.17, and the overall score of the nurses’ perception of tube feeding was 10.43 ± 1.66 out of 14, confirming the ICU nurses’ positive perception of tube feeding.

The findings suggested that ICU nurses’ perception of tube feeding was positive and higher than average, but their performance was lower than average. Given the importance of nutrition for patients admitted to the ICU and the crucial role of nurses, it is essential that ICU nurses perform tube feeding optimally and in compliance with pertinent procedures and standards.

Pulmonary bullae typically occur either idiopathically or in the context of chronic obstructive pulmonary disease and pulmonary infections. Clinical manifestations of pulmonary bullae include cough, shortness of breath, and chest pain. In some cases, they may be asymptomatic. Differentiating between pneumothorax and pulmonary bullae can be challenging when they coexist. Therefore, obtaining a detailed patient history, conducting a physical examination, performing laboratory tests, and utilizing radiology studies are essential diagnostic tools that should be employed simultaneously. In this case report, we present a patient who developed a wide pneumothorax due to a penetrating chest wound caused by a knife. Initially, the large lung cavity, which had already formed due to tuberculosis, was misdiagnosed as a loculated pneumothorax.

Disorders of consciousness, including the vegetative state (VS) and the minimally conscious state (MCS) following brain damage and various complications for the patient, also have economic and social consequences. However, there is still no definitive or effective treatment for this condition. However, there is still no definitive or effective treatment for this condition. Therefore, this study aims to investigate the effectiveness of zolpidem in improving consciousness in patients with acute brain injury.

The present quasi-experimental study was performed from 2020 to 2021 after obtaining the necessary permissions from Zahedan University of Medical Sciences, Iran. Eighty patients with acute brain injury who met the study inclusion criteria were recruited and randomized into zolpidem and placebo groups. In the zolpidem group, 10 mg zolpidem tablets were gavage twice daily. In the placebo group, a placebo tablet with the same appearance as zolpidem was gavage twice daily for 14 days. The consciousness level of patients was measured daily until the outcome (ICU discharge or expiration) was established. Eventually, a comparative data analysis was conducted to determine zolpidem's efficacy in enhancing consciousness, reducing mechanical ventilation duration, and improving patient outcomes.

The mean GCS score in the zolpidem group was 6.1±2.4 on admission and 11.6±3.8 at the end of the study, compared to 5.9±1.7 on admission and 11.3±2.8 at the end of the study, for the placebo group (p=0.154 and p=0.211, respectively). The mean duration of mechanical ventilation was 24.41±9.14 days in the zolpidem group and 23.16±10.72 days in the placebo group (P=0.529). Twenty-eight patients in the zolpidem group were discharged from ICU, and 12 expired. For the placebo group, 26 patients were discharged from ICU, while 14 were expired (p=0.87). No statistically significant difference was found in any of the measured variables between the two groups.

The results have shown that zolpidem administration had no statistically significant effect on improving the level of consciousness and reducing mechanical ventilation duration and clinical outcomes in acute brain injury patients.

The improved consciousness level reflects the patient’s recovery following acute brain injury. The medications that can regulate neurotransmitter levels, neural synaptic plasticity, and functional connectivity of consciousness networks might play a crucial role in improving the consciousness status of the patients. Thus, this study aims to evaluate the effectiveness of amantadine in improving consciousness in acute brain injury patients.

The present quasi-experimental study was performed from 2021 to 2022 after obtaining the necessary permissions from Zahedan University of Medical Sciences, Iran. Eighty patients with acute brain injury who met the study inclusion criteria were recruited and randomized into amantadine and placebo groups. The amantadine group was given a daily dose of 100 mg amantadine tablets, while the placebo group received a gavage of amantadine-like placebo tablets twice daily for 14 days. The consciousness level of patients was measured daily until the outcome (ICU discharge or expiration) was established. Eventually, a comparative data analysis was conducted to determine amantadine's efficacy in enhancing consciousness, reducing mechanical ventilation time, and improving patient outcomes.

The mean GCS score in the amantadine group was 5.5±1.4 on admission and 11.9±3.7 at the end of the study, compared to 6.6±1.5 on admission and 11.8±3 at the end of the study, for the placebo group (p=0.154 and p=0.211, respectively). The mean duration of mechanical was 28.87±11.34 days in the amantadine group and 24.13±14.93 days in the placebo group (P=0.329). Twenty-four patients in the amantadine group were discharged from ICU, and 16 were expired. For the placebo group, 21 patients were discharged from ICU, while 16 were expired (p=0.221). No statistically significant difference was found in any of the measured variables between the two groups.

The results demonstrate that amantadine administration had no statistically significant impact on improving consciousness status and clinical outcomes and reducing mechanical ventilation time in acute brain injury patients.

The intensive care unit is one of the most specialized hospital units that need nurses with a high level of skill and experience. The leave of experienced nurses from this unit reduces the quality of nursing care and imposes heavy costs on the health care system. This study aimed to investigate the reasons for nurses' intention to leave the ICU.

This cross-sectional study was performed on 247 nurses in the ICU affiliated with Zahedan, Tehran, and Mashhad University of Medical Sciences, Iran, from 2018 to 2021. Nurses were included in the study by Census sampling method based on inclusion criteria. They completed a four-part questionnaire including demographic variables, Job Satisfaction Survey (JSS), intention to leave, and reasons for intention to leave the ICU. Data were analyzed with SPSS software using descriptive-analytic statistics, Chi-square, independent t-test, one-way ANOVA, and Pearson correlation. The significance level was considered less than 0.05.

Out of 247 nurses studied, 183 (74.1%) were female and 64 (25.9%) were male. The mean age of participants was 32.47± 6.68 years. The mean score of job satisfaction was 115.45±58.20 and the mean score of intention to leave was 15.98±3.76. The mean score of the three areas of reasons for intention to leave had a negative correlation with job satisfaction and a positive correlation with the intention to leave the ICU, which was statistically significant in all cases (p= 0/001). The mismatch between the workload and legal benefits, shortage of nurses, forced overtime, the disproportion of nurse-patient ratio, and lack of welfare facilities had the greatest effect on nurses' intention to leave the ICU.

The results of the study showed that the most common reasons for the increase the intention to leave of nurses are related to the mismanagement of nursing managers and authorities of ICU. Therefore, reforming old management styles, observing justice among employees, involving nurses in decisions and the process of patient's treatment are among the things that can increase nurses' self-esteem, job satisfaction and reduce the leave of ICU without providing additional funding for the organization.

Traumatic brain injury (TBI) is one of the primary causes of trauma-related mortality and disability; while clinically important cases could be diagnosed by brain CT scan, high rates of false negative have raised cost-effectiveness controversies. To review the epidemiology of negative brain CT scans and their economic burden on healthcare systems.

This was a narrative review of literature, querying the online databases of PubMed, Science Direct, and Web of Science for cost-effectiveness studies of brain CT scan in mild TBI.

Based on our review, 12 studies were found to evaluate the cost-effectiveness of CT scans for mild trauma patients. Among the 6 studies with a study design of cost-effectiveness model, had more long time cost analysis based on the possibility of missing the diagnosis of an important CT scan finding for TBI patient and almost all of those studies revealed that requesting CT scan for all of the mild trauma patients is better than missing cases, even by costs. Some other studies compared conservative management versus early CT scan in the highest level of evidence, Norlund et al. revealed that CT scan of all patients is more cost-effective than observation of patients in ED. A high rate of false-positive results for the applied recommendations in most reviewed studies might address the weakness of existing guidelines in preventing unnecessary CT requests and also a high rate of true negative might show the incompatibility of clinicians with guidelines. These are all imposing high unnecessary costs on hospitals and the healthcare system. Traumatic brain injury if undiagnosed could lead to mortality and disability that contribute to much more economic losses than performing a negative CT scan. But, the exorbitance rate of these negative CT scans is not justifiable.

Due to the high cost of CT scan technologies and limited resources, there is an urgent need for systematic approaches to optimal allocation of CT requests for traumatic brain injury; but currently, requesting CT scans for most patients is favored over missing any important TBI; while further studies are needed to draw a conclusion.

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.

Correct endotracheal tube suction is one of the effective methods to prevent ventilator-associated infection. Many studies have reported that normal saline and N-acetylcysteine (NAC) in the trachea lead the translocation of bacteria to lower levels and increase the risk of pneumonia.

The present study sought to examine the effect of tracheal suction with NAC on the incidence of ventilator-associated pneumonia (VAP).

This single-blind randomized clinical trial study was conducted on 60 patients admitted to the intensive care unit (ICU) of the Khatam Al-Anbia Hospital in Zahedan, Iran, in 2020. The patients were selected using the convenience sampling method and assigned into two intervention and control groups by permutation block randomization. Before the intervention, the patients were evaluated using the Modified Clinical Pulmonary Infection Score (MCPIS), and the patients with scores < 5 on this scale were included in the study. Suctioning tracheal secretions in the intervention group was performed by pouring 2 cc of NAC into the tracheal tube during suction. The same suction procedure was performed for the patients in the control group by pouring 2 cc of normal saline into the tracheal tube in a standard way. The intervention was conducted for five days. After the intervention, the MCPIS scale was administered once more for the two groups. The collected data were analyzed using the independent samples t-test and chi-square test with SPSS software (version 25).

The independent samples t-test showed no significant difference between the intervention and control groups regarding the incidence of pneumonia (P = 0.31).

Despite the effect of NAC on the incidence rate of pneumonia in patients under mechanical ventilation, there was no significant difference between NAC and normal saline in reducing the incidence of pneumonia. However, since NAC leads to no specific complication in patients, it can be safely used in the suction of tracheal lobule secretions in patients under ventilators. In this regard, further studies should examine the use of NAC for suctioning during tracheal tube obstruction by secretions.

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.

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.

 Patients’ oral health is impaired in Intensive Care units (ICUs) due to loss of consciousness, open mouth, intubation, and mechanical ventilation.

 The current study aimed to compare the effects of comprehensive and combined programs on oral health in patients under mechanical ventilation.

 This single-blind clinical trial with three groups was performed on 90 patients with mechanical ventilation admitted to ICUs of medical centers affiliated to the Zahedan University of Medical Sciences, Iran, in 2020. Patients under mechanical ventilation were randomly divided into three groups, including those receiving a comprehensive program, those receiving a combined program, and controls through permutated blocks. In the two intervention groups, oral care was performed for 5 minutes, three times per day, during the 5 days of the study with a specific method. The control group received routine oral care. The patients’ oral health was measured once before the intervention and then every day until the fifth day of the intervention using the Beck Oral Assessment scale. The data were analyzed using the analysis of variance and chi-square in IBM SPSS Statistics software version 26.

 The mean oral health score in the three groups was not significantly different before the intervention and on the second day of the study (P > 0.05). However, on the third to fifth days of the study, the oral health score in the two intervention groups showed a significant decrease compared to the control group, indicating an oral health improvement in these groups (P = 0.001). The mean oral health score in the control group increased during the study days.

 Comprehensive care and combination methods can improve oral health in patients under mechanical ventilation. Nurses are recommended to use regular and codified oral care methods.

Inadequate oral care in ICU patients can lead to lethal complications such as ventilator-associated pneumonia (VAP).

The purpose of this study was to compare the effect of oral care using miswak and chlorhexidine mouthwash on the incidence of VAP in ICU patients.

This single-blind randomized clinical trial was carried out in 2018 on 70 patients undergoing mechanical ventilation in the intensive care units of Khatam-al-Anbia Hospital in Zahedan, Iran. The inclusion criteria were the insertion of endotracheal tube, scoring 10 or below based on Beck oral assessment scale (BOAS), scoring below 5 based on the modified clinical pulmonary infection score (MCPIS) at the beginning of the study, absence of chronic pulmonary disease, and no history of pulmonary aspiration. The subjects were selected through convenience sampling and randomly divided into the intervention (n: 35) and control (n: 35) groups. For five days, oral care was administered using miswak in the intervention group and chlorhexidine mouthwash in the control group. Data were collected through a demographic and clinical information questionnaire, MCPIS, and BOAS. After normality tests, the obtained data were analyzed in SPSS 22 using independent t-test, chi-square test, and Fisher’s exact test at the significance level of P < 0.05.

The two groups were similar in terms of age, gender, cause of hospitalization, level of consciousness, administered antibiotics, history of ICU admission, and smoking. After oral care with miswak, none of the patients in the intervention group developed VAP, but 6 patients in the control group (17.1%) were diagnosed with this condition. The results of Fisher’s exact test showed a significant difference between the two groups in terms of VAP incidence (P = 0.01).

In addition to promoting the oral health of ICU patients, miswak can mitigate the incidence of ventilator-associated pneumonia. Therefore, because of its availability, cost-effectiveness, and fewer side effects compared to chlorhexidine mouthwash, it is strongly recommended to be administered to ICU patients.

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.

The relationship of vitamin D3 with the duration of mechanical ventilation and mortality is still unknown. Therefore, this study aimed to determine the effect of using high-dose vitamin D on the duration of mechanical ventilation among the patients admitted to the intensive care unit. The current double-blinded clinical trial was performed on 44 mechanically ventilated, adult patients. Using permuted block randomization, the patients were recruited in intervention and placebo arms. In the placebo group, four patients were excluded due to death before 72 h. The vitamin D level was measured in both groups on entrance and 7th day of the study. The intervention and placebo groups received intramuscular injection of 300000 IU vitamin D and identical placebo, respectively. SOFA and CPIS score were evaluated daily for 7 days and on 14th and 28th days of the study. Also duration of mechanical ventilation and mortality rate were recorded. Fourteen males and 8 females were recruited in the intervention group, as well as 13 males and 5 females in the control group. There was no significant difference in baseline characteristics of the patients including gender and age. The mean duration of the mechanical ventilation was 17.63 ± 14 days in the intervention group versus 27.72 ± 22.48 days in the control group (p = 0.06). Mortality rate in control and intervention groups was 61.1% versus 36.3% (p = 0.00), respectively. Administration of high-dose vitamin D could reduce mortality in mechanically ventilated patients. Despite decrease of 10 days in duration of mechanical ventilation, the difference was not statistically significant. Larger studies are recommended.

Postoperative nausea and vomiting (PONV) leads to an increase in intraocular pressure (IOP) and its side effects, which should be controlled using the least complicated method. Therefore, the purpose of this study was to evaluate the effect of 80% supplemental perioperative oxygen on PONV in patients undergoing cataract surgery. The present double-blind clinical trial was conducted on 201 patients undergoing cataract surgery. The subjects were selected by convenience sampling method and randomly divided into two groups of oxygen 30% administration and oxygen 80% administration. The operation of patients was performed with the same surgical procedure and team. After the operation, the incidence rate of PONV was recorded in both groups and compared along with other variables by SPSS software using descriptive statistics and chi-square. There was no significant difference in age and sex between the two groups. The incidence rate of PONV was high in both groups, with statistically significant higher value in the group with 30% supplemental oxygen compared to the group with 80% supplemental oxygen (p=0.000). The use of 80% perioperative oxygen concentration could reduce the PONV severity.

Pneumonia is one of the most common hospital-acquired infections, where 86% is associated with mechanical ventilation, known as ventilator- associated pneumonia (VAP). Oropharyngeal decontamination reduces the incidence of VAP by medicinal agents. The aim of the present study was to determine the effect of oropharyngeal decontamination using topical antibiotics on oropharyngeal and tracheal colonization of trauma patients admitted to the intensive care unit (ICU). The present double-blind clinical trial was performed on trauma patients, who underwent endotracheal intubation during the first 24 hours, at the ICU of Khatam-al-Anbia Hospital, Zahedan, during years 2017 to 2018. The sample size was 100 individuals, who were selected using the convenience sampling method and randomly assigned to intervention and control groups. The study began with the start of intubation and lasted for five days. When oral and tracheal culture samples were sent to the laboratory during the first 24 hours after endotracheal intubation, the pre-mixed solution of nystatin, polymyxin B, and neomycin was rubbed to the mouth, lips, gingiva, and cheeks of the intervention group, using syringes and gloves, four times a day. The tracheal and oral secretions were cultured in the intervention and control groups at the beginning and the end of the study. Data analysis was carried out using the SPSS version 21 software. Independent t test and paired t test were used to compare the quantitative variables, and qualitative variables were compared using the chi-square test and Fisher's exact test. The significance level was considered at 0.05. When the final drop-out occurred, out of 44 remaining patients in the intervention group, the number of negative oral cultures increased from 31 cases (70.5%) in the pretest to 39 (88.6%) in the posttest. A total of 25 negative oral cultures were recorded in the control group in both the pretest and posttest stages. Also, the number of negative tracheal cultures in the intervention group increased from 38 cases (86.4%), in the first turn, to 44 (100%) cases in the second turn; while in the control group, the number of negative tracheal cultures was recorded as 39 (88.6%) in the first turn and increased to 40 cases (100%) in the second turn. Clinically, reduced colonization rate of invasive bacteria, as the main result of the present study, indicates a decrease in the incidence of inappropriate alterations in oral microbial flora that can subsequently be effective in reducing the incidence of diseases, such as pneumonia.

Treatment of acute pain and hemodynamic changes after surgery is extremely important. Various drugs for pain relief after surgery have been studied. The aim of this study was to evaluate the effect of a single dose of oral pregabalin on hemodynamic changes and duration of analgesia after spinal anesthesia in orthopedic surgeries of tibia fractures.
This clinical trial was carried out on 120 patients with fractures of the tibia bone in 2014 in the city of Zahedan. Sampling was conducted using randomized blocks and patients were placed into pregabalin (150mg PO 1 hour before anesthesia) and placebo groups. Duration of analgesia, severity of anxiety, mean arterial pressure and pulse rate were evaluated in both groups.
The mean age of the patients was 34.8 ± 21.7 years and 84 patients (70%) were male and 36 (30%) were female. There were no significant differences at baseline characteristics of the patients in two arms of the study. After surgery, mean arterial pressure, pulse rate and anxiety were significantly lower in intervention group. Also the duration of analgesia was significantly longer in intervention arm (185.3 ± 4.9 vs 36.9 ± 13.9, P

Pediatric tonsillectomy is associated with major complications such as severe postoperative pain. Hence, this study aimed to compare the effect of acetaminophen suppository administered before and after surgery on the pain severity of tonsillectomy.
The present double-blind clinical trial was performed on 100 children undergoing tonsillectomy, who were randomly divided into two groups of 50 receiving respectively rectal acetaminophen 40 mg/kg preoperatively (Group 1) and postoperatively (Group 2).
The first group consisted of 28 boys and 22 girls, and the second group had 26 boys and 24 girls. According to Chi-square test, there was no significant difference in terms of gender in the two groups (p=0.668). Comparison of pain scores with repeated measures ANOVA showed lower pain severity in the first group at all hours compared with the second group.
The preoperative use of acetaminophen suppository significantly controls the pain after tonsillectomy.

Weaning decision for the patients undergoing mechanical ventilation (MV) is often made based on personal judgments and experiences, which results in longer MV length of stay and higher costs. Therefore, the present study aimed to evaluate the effect of Burn’s wean assessment program on the success rate of weaning from ventilator in patients admitted to the Intensive care unit (ICU).
The present experimental study was carried out on 100 patients undergoing MV for more than 72 hours. The patients were selected by convenience sampling and randomly divided into two groups of 50 subjects. Burn’s wean assessment program was applied to the intervention group, while weaning was assessed by a physician in the control group.
35 patients in the intervention group were male and 15 were female. In the control group, 36 were male and 14 were female. Chi-square test showed no statistically significant difference between the two groups (P Using Burn’s scale for assessing patient readiness for weaning from mechanical ventilation is more useful.

Pain relief is one of the most important goals in patients undergoing surgery without using high-dose opioid analgesics due to their complications. The aim of this study was to evaluate the effect of using low-dose ketamine after spinal anesthesia on the severity of postoperative pain in the patients with orthopedic surgery.
The present double-blind clinical trial after obtaining approval was performed on 60 patients with lower limb fracture. The patients were selected by convenience sampling method and then divided into two equal (n=30) intervention and control groups using random number table. The patients in the intervention group after spinal anesthesia received 0.2mg/kg intravenous ketamine diluted with 10cc normal saline. The same amount of normal saline was injected intravenously in the control group. Then, the intensity of pain using VAS and the level of need for analgesics were measured in both groups at different times up to 24 hours after surgery.
The intervention group included 21 males and 9 females with a mean age of 30 ± 1.2 years and control group consisted of 19 males and 11 females with a mean age of 29 ± 4 years. There was no significant difference between the age and sex of the patients in the intervention and control groups (P=0.677), (P=0.589). In the intervention group with the VAS, the lowest pain score was found at the first turn of the assessment (2.4 ± 0.6), and the highest pain at 24 h (4.3 ± 2.6). The control group had the lowest pain score at the first turn of the assessment (3.6 ± 0.8) and the maximum pain at the first turn of the assessment (5.2 ± 1.7). According to independent t-test, there was a significant difference between the two groups at all times, except for the first turn of the assessment. In the intervention group, 12 (40%) patients did not receive analgesics within 24 hours. In the control group, 2 (6.7%) had no analgesics. Chi-square showed a significant difference between the two groups (P=0.002).
The present study showed that low-dose intravenous ketamine could relieve pain in patients and reduce postoperative analgesics.

Weaning from mechanical ventilation is one of the main stages of treatment as well as applying a tool that can predict the success in weaning is very important. This study aimed to evaluate the success rate of weaning from ventilator in patients admitted at the Intensive Care Unit (ICU) using Burn’s Wean Assessment Program (BWAP) checklist.
The present analytical cross-sectional study was carried out on 100 mechanical ventilation-dependent patients connected to the ventilator for more than 72 hours. All patients were selected by simple available sampling based on purposive sampling method and examined by BWAP checklist and were weaned from ventilator by obtaining scores over 18.
The total number of patients participating in the study was 100, 71 males and 29 females. There was no significant relationship between gender and success or failure of weaning process based on chi-square test (p Investigating preparation for weaning using Burn’s Scale is more useful for patients who had no prolonged hospitalization at ICU and ventilated through an endotracheal tube.