haniyeh sadat fayazi

 Adequate and effective dialysis can improve patients’ quality of life and reduce kidney failure complications and mortality in end-stage renal disease on hemodialysis.

 This study aimed to evaluate dialysis adequacy based on Kt/V and its related factors among patients undergoing hemodialysis.

 This cross-sectional, multi-center study was conducted during six months on hemodialysis patients referred to dialysis centers of the Guilan province in the north of Iran. Dialysis adequacy was evaluated using Kt/V (>1.2) criteria.

 The mean Kt/V was 1.24±0.36 with a median of 1.2. Adequacy of dialysis was desirable in 51.2% of the patients. There was a significant and inverse relationship between body mass index (BMI) and Kt/V (r=-0.139, P=0.013). The relationship between Kt/V criterion and pre-dialysis weight (r=-0.310, P=0.00) and post-dialysis weight (r=-0.314, P=0.00) were inverse. The Kt/V criterion was significantly associated with calcium (Ca) level and the patients with normal Ca level had a higher adequacy than those in the other levels of Ca [normal versus low level, mean difference (MD]: 0.19±0.06; normal versus high level, MD: 0.07±0.04, P<0.001). The Kt/V criterion was inversely related to blood pressure and temperature before and after dialysis (P<0.05).

 The present study showed a close correlation between blood pressure, Ca level and BMI with dialysis adequacy based on Kt/V criteria. The findings obtained here suggested treatment strategies based on correction of Ca levels, BMI and blood pressure prior to dialysis to increase the adequacy of dialysis.

Breaking Bad News (BBN) is a multidisciplinary and unpleasant task, and nurses play a vital role in this process as they are often exposed to such situations. It is a critical duty that has not been adequately addressed.

This study investigated the performance of nurses in academic hospitals affiliated with Guilan University of Medical Sciences (GUMS) regarding BBN.

During 2020, eligible nurses were interviewed, and a questionnaire containing 16 items about environmental and psychical support was filled out. The first 10 questions evaluated psychical support, and the next six assessed environmental support. Each question scored 10, "never," to 50, "always."

A total of 384 out of 410 nurses filled out the questionnaires, and a response rate of 93.65% was obtained. As shown, 346 (90.1%) responders were women, and 38 (9.9%) were men. Also, 289 (75.3%) had passed educational courses. A positive association was observed between psychical and environmental support and age (P = 0.007, P = 0.003) and years of experience (P = 0.013, P = 0.004). However, there was no significant difference respecting educational programs (P > 0.05).

This study revealed that the current educational programs are not practical and could not induce a significant difference in nurses’ answers. Effective interventions to improve nurses’ communication skills are strongly warranted.

 Diabetes is one of the most common chronic diseases with an increasing prevalence worldwide. On the other hand, the relationship between Uric Acid (UA) level and glycemic index in type 2 diabetic patients is not clear.

 This study aims to evaluate the UA level and glycemic status in patients with type 2 diabetes.

 In this cross-sectional study, participants were 230 patients with type 2 diabetes referred to Razi Hospital and Besat clinic in Rasht, Iran in 2020. A researcher-made checklist were used to collect demographic and clinical information includes age, gender, disease duration, body mass index, fasting blood sugar (FBS), Cholesterol, Triglyceride (TG), high density Lipoprotein(HDL), low density Lipoprotein(LDL), Hemoglobin A1C (HbA1c) level, UA level, Creatinine (Cr) level, history of heart disease, blood pressure, and smoking. The data were analyzed in SPSS v.26 software.

 There was a significant relationship between UA level and levels of HbA1C (r=0.318, P<0.001), Cr (r=0.351, P<0.001) and TG (r=0.174, P=0.008). 
Conclusion In patients with type 2 diabetes, serum UA level has an adverse effect on glycemic status.

Hyperglycemia during coronary artery bypass graft surgery (CABG) strongly predicts intra- and post-operative adverse consequences.

This study aimed to evaluate the quality of glycemic management during CABG in an academic center regarding peripheral blood and coronary sinus values.

This prospective descriptive study encompassed 55 eligible patients undergoing on-pump CABG surgery in 2020. Peripheral blood glucose (BG) was measured four times, before anesthesia induction (T0), before cardiopulmonary bypass pump (CPB) (T1), during CPB (T2), at the end of CPB (T3), and at the end of surgery (T4). The surgeon also took a sample of the coronary sinus BG.

The BG variations from T0 to T4 were statistically significant (P < 0.0001). The higher values detected in the ASA class III compared to ASA classes II were statistically significant at T1 (P = 0.01) and T2 (P = 0.025): patients with the higher BMI showed the higher levels of BG. In this regard, the differences were significant at T0 (P = 0.0001), T2 (P = 0.004), and T3 (P = 0.015). Regarding coronary sinus, the mean BG was 222.18 ± 75.74 mg/dL. It was also observed that the ASA class III (P = 0.001), longer duration of CPB (P = 0.021), higher IV fluid volume administrated during surgery (P = 0.023), higher BMI (P = 0.0001), and less urine volume at the end of surgery (P = 0.049) were significantly associated with the higher BG of the coronary sinus.

The existing glycemic management protocols on the CABG patients were acceptable in our hospital. However, the BG level of the coronary sinus was higher than the peripheral one.

 Inevitable prolonged fasting time before surgery leads to inflammatory reactions, surgery-related stress response, and consequently unfavorable outcomes; thus, developing strategies to mitigate these consequences is crucial.

In this study, we evaluated the effect of ascorbic acid on stress response reduction in abdominal hysterectomy following prolonged fasting time.

Eligible women candidates for abdominal hysterectomy following prolonged fasting time were enrolled in the study and divided into 2 groups of vitamin C [group C; 1 g intravenously (IV) before surgery] and placebo (group P). Before induction of anesthesia, C-reactive protein (CRP), mean arterial pressure (MAP), heart rate (HR), and blood sugar (BS) were measured and compared between the 2 groups at 4-point times, 24 and 48 hours immediately after extubation.

Finally, the data of 80 patients were included for the final analysis. A statistically significant difference was observed between the 2 groups in terms of CRP and BS values in T1 CRP serum levels; at the end of the study, CRP values were 0.5 ± 0.55 and 0.92 ± 0.69 in groups C and P, respectively (P = 0.012), and BS levels were 124.12 ± 18.11 and 152.0 ± 17.36 in groups C and P, respectively (P = 0.0001). However, this significant difference was not observed at T2 regarding CRP (P = 0.145) and BS (P = 0.135), as well as at T3 regarding CRP (P = 0.282) and BS (P = 0.213). However, according to both CRP and BS values, the trend of changes from T0 to T3 was significant in the 2 groups (P < 0.0001). Hemodynamic parameters were not significantly different between the 2 groups. No adverse event was reported in the 2 groups.

We found that ascorbic acid could induce short-term positive effects in abdominal hysterectomy following prolonged fasting time. Obviously, the optimal dosage, timing, and specific cases that benefit the most from this intervention should be investigated.

Despite the lack of conclusive and proven supporting epidemiologic data about the association between cell phone radiofrequency electromagnetic fields (RF-EMF) and the developing fetus complications, there are frequent discussions about this matter.

A medical student interviewed eligible pregnant women admitted to Al Zahra Hospital, an academic referral hospital in the North of Iran, to fill questionnaires intended to assess maternal demographic data and their attitude towards cell phone use during pregnancy in 2020.

A total of 322 pregnant women with the mean age of 30.12 ± 6.81 years enrolled in the survey, in which 3.1% of them were non-cell phone users, and 6.052% of all did not use a cell phone during the first trimester. Also, 38.81% of them mentioned healthcare providers as the main source of obtaining information, while 40.6% did receive any information. The mean years of cell phone use and the daily hours were 8.26 ± 4.1 and 2.66 ± 2.02, respectively. Also, 64.3% believed that cell phone use poses risks to the fetus, while 26.7% had no idea. A positive association was also found concerning maternal awareness from cell phones harmfulness to the fetus and maternal education, residency, and employment (P < 0.0001).

In this study, the majority of pregnant women believed that cell phone use during pregnancy could be harmful to the fetus; however, most of them were cell phone users with no special consideration even during the first trimester. It seems that the importance of the issue must be revealed to them by more healthcare providers’ interventions.

Bone loss is common in cirrhosis. However, the prevalence of osteopenia and osteoporosis has been heterogeneous in different reports. Reduction in bone formation with or without increase in bone resorption appears to be responsible for bone loss in these patients.. We aimed to investigate bone loss in patients with cirrhosis at different anatomical sites and key factors that might affect it..Patients and In this cross-sectional study, 97 patients with cirrhosis who were referred to Razi Hospital, Rasht, Iran, from 2008 to 2010, were studied. Cirrhosis was diagnosed using biopsy and/or clinical and paraclinical findings. Bone mineral densitometry was done in L2 through L4 lumbar spine (LS) and femoral neck (FN), using dual-energy X-ray absorptiometry (DEXA) (QDR 1000, Hologic DEXA Inc, Waltham, Massachusetts, the United States). Statistical analysis was performed using SPSS 18. A P value < 0.05 was considered statistically significant.. A total of 97 patients with cirrhosis (55.7% male) and the mean age of 51 ± 13 years and median body mass index (BMI) of 22.7 kg/m2 were recruited over a two-year period. Etiologies of cirrhosis were hepatitis C (40.2%), hepatitis B (26.8%), cryptogenic (21.6%), and other causes (11.4%). Child A, B, and C, were seen in 16.5%, 47.4%, and 36.1% of patients, respectively. The DEXA results were abnormal in 78.4% of our participants (osteopenia, 45.4%; osteoporosis, 33%). BMI and calculated glomerular filtration rate (GFRc) had moderate positive and Child score had moderate negative significant correlation with T score in both anatomical sites. There was no significant association between abnormal DEXA and the causes of cirrhosis. The univariate analysis showed that the risk of abnormal results in DEXA was significantly higher in those with low BMI, current smoking, higher Child score, and low GFRc; however, in multivariate analysis, the abnormal results were more frequent in those with lower vitamin D, higher Child score, and less GFRc.. Abnormal DEXA was highly prevalent among patients with cirrhosis. The risk of this finding was increased by lower vitamin D levels, advanced disease, and impaired renal function..