فهرست مطالب navid shafigh

This study aims to investigate the clinical and demographic features of underlying medical conditions and the potential relationship between underlying diseases and the increased rate of morbidity and mortality due to COVID-19.
This study was conducted on 350 COVID-19 patients hospitalized at the Masih Daneshvari Hospital from February-July 2021. All participants had confirmed COVID-19 diagnosis based on symptoms and/or positive PCR test or chest X-ray results. Data was collected from medical records on demographics, disease severity, symptoms, underlying conditions like diabetes, hypertension, coronary heart disease, obesity, renal disease/transplantation, and outcomes like hospital stay, ICU admission, and mortality. Relationships between age, underlying diseases, and mortality were analyzed using chi-square and Fisher's exact tests."
A total of 350 patients diagnosed with COVID-19 were included in the study, with an average estimated age of (60.8±15.4). The age group of 56 and above had the highest morbidity rate, which accounted for 50% of the total participants. Among the COVID-19 patients, diabetes was the most common underlying medical condition, accounting for 31.4% of the cases. High blood pressure was present in 27.1% of the patients, and 17.1% of the total participants had coronary heart disease (CHD). Additionally, 10.9% of the participants were overweight, and 30 of them had previously experienced kidney failure or transplantation. Moreover, the study found that 40% of patients with diabetes died, while the mortality rate was 38.3% in patients with CHD and 47.4% in overweight participants. High blood pressure patients had a mortality rate of 43.2%, and patients with renal failure or kidney transplantation had a significantly increased risk of mortality at 83.3%. The research also revealed a significant and direct relationship between mortality rate, age group, and underlying disease among the patients (P<0.05).
The findings of the present study hold significant implications for preventive interventions and policy adoption, particularly in relation to the use of calendar age as the key criterion for risk evaluation. These results underscore the need for a more precise and focused approach to prioritizing patients with identified risk factors.

The Arbaeen foot-pilgrimage in the Holy City of Karbala is one of the world's most significant religious events, attracting millions of pilgrims yearly. Health and hygienic issues in this gathering have always been a cause of concern for the communities involved.

The study aimed to examine the challenges Ehsan Field Hospital faced in the Arbaeen of 2022 and its approach to providing services to referring pilgrims.

The present study was a cross-sectional study with a 10-day interval conducted on 19,800 patients referred to Ehsan Field Hospital between the 9th and 19th of September, 2022. The research tool was a two-part checklist; the first part included the patients’ demographic information, and the second part included information about the disease (e.g., laboratory information, the disease symptoms, and the disease diagnosis). The SPSS software (version 26) was used for data analysis. Moreover, a brief qualitative investigation based on the experiences of the personnel working on-site was conducted to assess the challenges and their solutions in this foot-pilgrimage.

A total of 13,860 (70%) patients were male, 5,940 (30%) were female, and the majority of them were between the ages of 25-55 (63.8%). Most hospitalizations (58.5%) were related to problems caused by gastroenteritis.

Considering the importance of people's health and hygiene in gatherings similar to Arbaeen, the necessity of building and operating field hospitals and mobile treatment camps for serving people is crucial, starting a few days before and continuing after the gathering. Furthermore, universities of medical sciences can provide a platform to facilitate and carry out valid research projects and studies to clarify the health and treatment problems dealt with during the Arbaeen foot-pilgrimage. Furthermore, they can provide practical and efficient solutions to improve the level of health and hygiene.

Gastric residual volume (GRV) is considered an important parameter for gastric emptying and nutrition tolerance. This volume is measured before any nutrition and has a direct effect on the volume and timing of the next nutrition. The present study aimed to examine the GRV via ultrasound after receiving intravenous ondansetron, metoclopramide, and neostigmine. In the present study, 40 patients were included in the study, 10 patients were excluded from the study due to death during treatment, and 30 patients were divided into three groups of 10(10 patients in each group).The first, second, and third groups received 2.5, 10, and 8 mg neostigmine, metoclopramide, and ondansetron every 8 h, respectively. The drugs were infused as a micro set in 100 ml normal saline into patients within 30 min. The patients underwent ultrasound imaging and GRV measurement by an intensive care unit (ICU) subspecialty fellow, who was not aware of the drugs received by the patients, in the 1st h of hospitalization, 6 h after drug injection, and once daily for 4 days. A total of 40 patients entered the study based on inclusion and exclusion criteria. The effect of neostigmine on reducing GRV (Gastric residual volume) in ICU patients was better than those of the other two drugs, which was significant. The results of this study showed that neostigmine has a better and significant effect on reducing GRV in ICU patients, compared to those of ondansetron and metoclopramide.

neurosurgery reoperation that occurs for various reasons such as complications of primary surgery, planned reoperation, emergency or unplanned reoperation, and increase the financial burden of the hospital and the patient, poor prognosis, and increase the length of stay in hospital and intensive care unit for the patient. Neurosurgery patients are among the patients in whom reoperations need to be evaluated. Determining the factors leading to reoperations in the Neurosurgery Intensive Care Unit determines the causes and improves the quality of the system to prevent preventable reoperations.

In this cross-sectional retrospective study, the information of patients undergoing reoperation including the type of disease and initial surgery, reasons for reoperation were identified. The frequency of each of the three variables was examined in pairs. All reoperations and returns to the operating room during 5 consecutive years were reviewed. Information of all patients including demographic information, underlying disease, smoking and alcohol, cause of primary and reoperation surgery, medical history, type of operation, complications of the surgery, postoperative care were examined.

In this study, it was found that age, sex, initial diagnosis, the distance between surgery and readmission, underlying disease, ICU admission, were not associated with the occurrence of neurosurgery reoperation. Variables associated with the occurrence of neurosurgery reoperation include open surgery, surgical disease including Cerebrovascular, duration of the first surgery, first emergency surgery, duration of further anesthesia in the first operation, bleeding rate and need for a packed cell, Need to receive FFP, some hospital complications

Determining the factors that cause neurosurgery re-operation, prevent such surgeries if possible and reduce costs and hospital load, and also patients suffer fewer complications and mortality

Neurological Critical Care Unit is allocated for patients with critical conditions in the field of neurological diseases. ICU beds and their equipment are very expensive and there are some economic constraints for increasing the ICU beds. At the same time, the admission waiting time for patients in this unit is not favorable. Therefore, an initiative for better management of this ward was needed. The objective of this study was to examine an optimal program for allocating beds to patients, based on their required length of stay in the unit.

Methods and Materials:

 In this study, different categories of patients and their quantity was investigated in the Loghman Hakim hospital. Then, by using the design of experiments technique, optimal combinations were obtained. The obtained combinations were simulated for each of two criteria was calculated; patients' average waiting time and bed occupancy rate. Subsequently, a mathematical model with the objective function of minimizing the average waiting time for patients, as well as the average bed occupancy rate was presented using the linear response method.

According to the results of this study, an optimal combination of beds allocation to different categories of patients for the Neurological Critical Care Unit were respectively 6, 2, 3, 3, and 2 beds, and average waiting time was 1.4 hours and an average bed occupancy rate was 34.5%.

The present study demonstrated that optimization of bed allocation in ICU by using a combined approach of simulation and design of experiments, resulted in a decrease in average waiting time and increase in bed occupancy rate (bed productivity)

Similar to industrial units, hospitals comprise of production factors including capital, human resource, technology and management. Successful performance of hospitals depends upon the way in which resources and in particular beds are allocated to patients. Thus it is necessary to implement an effective bed management so that on-demand healthcare services are accessible. In the same vein, hospitals need business intelligence tools to increase productivity, predict resource and equipment capacity and upgrade the healthcare service level so that they can achieve an effective bed management. Thus present research aimed to design a business intelligence model for bed allocation based on patient prioritization and allocation of equipment and services.

First the primary model was provided for bed allocation based on prioritization in a business intelligence concept framework. Then according to the conceptual model, required data were collected from various databases of neurosurgical intensive care units (ICUs) of Loqhman Hakim hospital by using ETL process and building data warehouse. In the next step, data mining classification algorithms were used to classify patients and develop prediction model. Then, patient classes were prioritized and simulation model was used to identify the effect of this prioritization. At last, the final model was provided.

The primary model for bed allocation based on prioritization in business intelligence concept framework was tested by data collection from 420 patients, data mining to classify them using decision tree technique with %87.02accuracy, prioritization of patient classes using PROMETHEE technique and simulation of 14 ICU beds based on collected data. Finally, it was estimated that the monthly number of hospitalized patients with and without prioritization were 76 and 86 respectively, Discussion and

After observing the positive results of the primary model for bed allocation based on prioritization including a 13 percent increase in monthly admission numbers and in turn, increased productivity proving model effectiveness, the next step was to develop a comprehensive business intelligence model for bed allocation based on prioritization of patients. The model was designed in business intelligence framework using online data collected from patients. The information provided by this model cAan be an effective decision making support for physicians and healthcare service providers in choosing patients in admission process.

Inflammatory mediators are an important component in the pathophysiology of the coronavirus disease 2019 (COVID-19). This study aimed to assess the effects of reducing inflammatory mediators using hemoperfusion (HP) and continuous renal replacement therapy (CRRT) on the mortality of patients with COVID-19.

Twelve patients with confirmed diagnosis of COVID-19 were included. All patients had acute respiratory distress syndrome (ARDS). Patients were divided into three groups, namely, HP, CRRT and HP+CRRT. The primary outcome was mortality and the secondary outcomes were oxygenation and reduction in inflammatory mediators at the end of the study.

Patients were not different at baseline in demographics, inflammatory cytokine levels, and the level of acute phase reactants. Half of the patients (3 out of 6) in the HP+CRRT group survived along with the survival of one patient (1 out of 2) in the HP group. All four patients in the CRRT group died. Serum creatinine (SCr), Interleukin-1 (IL1), Interleukin-6 (IL6), Interleukin-8 (IL8), partial pressure of oxygen (PaO2), O2 saturation (O2 sat), and hemodynamic parameters improved over time in HP+CRRT and CRRT groups, but no significant difference was observed in the HP group (All Ps > 0.05).

Combined HP and CRRT demonstrated the best result in terms of mortality, reduction of inflammatory mediators and oxygenation. Further investigations are needed to explore the role of HP+CRRT in COVID-19 patients.

Mismatched-blood transfusions in the ABO-system may lead to severe of complications such as intravascular hemolysis.

Case report:

 A 49-year-old man suffering from a right lower limb injury due to accident was admitted to hospital. Vital signs were normal. X-ray showed a femoral neck fracture. Before surgery, all of lab tests were in normal values and B+ blood- group was reported. During surgery and due to blood loss, the patient underwent blood transfusion. At the end of transfusion, a mismatched blood bag was observed. The patient had received about 400 cc mismatched-blood. Transfusion was promptly terminated and the patient received extensive IV fluids in addition to a single dose of furosemide. The patient had stable status without signs of overt hemolysis. After 3 days stay at intensive care unit, he was transferred to the ward with a stable status.

In spite of mismatched blood transfusion, the patient did not experience severe adverse events. To prevent this problem, different steps of blood transfusion should be checked by anesthesiologist

The length of hospital stay is an important indicator that can be useful for financial and management planning of hospitals. If patients who are going to stay in the hospital for a long time can be identified immediately after admission, Appropriate resources can be made available to try to speed up health care right from the start. Therefore, due to aging and on the other hand, the long queue for using ICU beds, the present study was conducted to determine the factors related to the length of stay of patients in the neurosurgery ICU of Loghman Hakim Hospital.

This is a retrospective descriptive study. The studied samples were extracted from 543 computer files of patients admitted to the ICU of Neurosurgery of Loghman Hakim Hospital affiliated to Shahid Beheshti University of Medical Sciences in the period 2016-2017. Then, using Spss software version 25, the relationship between each of the variables and the length of stay was analyzed using the chi-square test.

Based on the results of the study, the statistical population consisted of 543 patients with a mean age of 18.07±43.34, including 42.4% female and 57.6% male. The mean length of stay was 5/86±6/33days and the factors related to the length of stay of the 15 variables included: diagnosis, hypertension, type of surgery and postoperative complications: pneumonia, meningitis, epilepsy.

Using the information obtained from the analysis of the patient length of stay in hospitals, the goal of better allocation of resources and hospital beds and optimal productivity of existing beds can be achieved. According to the findings of this study and by better identifying and managing factors related to length of stay, the length of stay index can be improved and steps can be taken to reduce costs and waste resources.

 Cerebral aspergillum is rare and usually misdiagnosed because its presentation mimics tuberculous meningitis, brain abscess, or tumor. The diagnosis and treatment of central nervous system (CNS) infections due to Aspergillus are very difficult because accurate diagnosis is often made intra-operatively.

 Here, we report a case of cerebral aspergilloma in an immunocompetent host. A 35-year-old man admitted with progressive left hemifacial paresthesia followed by severe pain in trigeminal nerve territory. On physical examination, except for fifth nerve palsy and difficult mastication, there was not any sensory and motor deficit. Magnetic resonance imaging (MRI) of the brain showed T1 iso and T2 low signal lesion in the left parasellar region with enhancement. The lesion is extended to the left side of the prepontine cistern in the course of trigeminal nerve, craniotomy, and total surgical resection of the mass was performed. Isolated brain lesion and the pathology from stereotactic biopsy confirmed cerebral aspergillosis. The result of testing for human immunodeficiency virus (HIV) was negative. Although the patient had two subsequent recurrences, at first, good outcome was achieved by treatment with a combination of surgical intervention, and antifungal amphotericin B deoxycholate was administered, then changed to voriconazole. Unfortunately, after two years, he experienced new progressive symptoms, and the patient died despite several reoperations due to malfunctioning of external ventricle devices as well as the treatment of recurrent post-operation meningitis and voriconazole therapy.

 Most cases of intracranial aspergillosis show that this infection is pathogenic in immunocompromised hosts; however, in some cases, invasive Aspergillus was reported as an opportunistic infection in immunocompetent patients. In these patients, though primary cranial aspergillosis is very rare, it is possible that isolated brain involvement in a previously healthy case may be explained by unknown defects in immune pathways or massive exposure to spores.
 

Inflammation is an important mechanism in the pathogenesis of delirium. Since delirium might reduce by anti‑inflammatory effects of omega‑3 fatty acids. Based on this respect, a study was conducted to indicate the effect of omega‑3 fatty acids in the prevention of delirium in mechanically ventilated patients.

This study is a randomized, double‑blind, placebo‑controlled clinical trial. One hundred and sixty‑eight mechanically ventilated patients were selected in the investigation. Patients were randomly allocated to receive either 2 g of omega‑3 syrup or placebo once a day. Twice daily delirium was assessed due to Confusion Assessment Method and the Richmond Agitation‑Sedation Scale. The number of days with delirium during the first 10 days of admission was the primary outcome. Secondary outcomes had been included duration of mechanical ventilation, length of intensive care unit (ICU) stay, and mortality.

Patient‑days with delirium (P = 0.032), the number of ICU stay (P = 0.02), and mechanical ventilation (P = 0.042) days in omega‑3 group significantly were lower than control group. Mortality was not significantly different between two groups.

Omega‑3 fatty acids can reduce the risk of delirium in mechanically ventilated patients.