reza farahmand rad

We aimed to investigate the hypothesis that identical abbreviated injury scale (AIS) scores may lead to varying risks of in-hospital mortality and admission to the intensive care unit (ICU) depending on the specific body region affected. 

This study focused on hospitalized trauma patients with moderate to serious injuries (AIS=2, 3). The final sample was stratified based on the injured body regions. To determine the impact of these injuries on mortality and ICU admission, we conducted binary logistic regression after adjusting for confounding factors. 

Overall, 16,040 trauma patients with moderate injury (AIS=2) and 1,338 trauma patients with serious injury (AIS=3) were included in this study. When comparing outcome of trauma patients in different body region, there was no significant difference in the odds of two main outcomes in various injury sites, except for extremities (P values>0.05). When the AIS=2 patients were controlled for confounding factors, the adjusted odds of mortality were significantly higher for head, face, and neck injuries, as well as spine/back, thoracic, and abdominal injuries, compared to extremity injuries (adjusted odds ratio (aOR)s=9.81,8.78, 8.11, and 3.96, respectively; P-values<0.05). Among those with AIS=3, the odds of mortality were significantly greater for abdominal (aOR=7.05, P-value=0.009) and head, face, and neck injuries (aOR=2.73, P-value=0.001) than for extremity injuries. 

Injuries with the same AIS (=2, 3) value almost indistinguishably confer the same mortality risk and ICU admission, except for extremities. The unique AIS value assigned to various body sites almost consistently indicate the same likelihood of negative outcomes

The main objective of this study was to determine various characteristics and outcomes of self-harm and suicide in men and women with data obtained from the National Trauma Registry of Iran (NTRI).

This retrospective multicenter study using data from the NTRI included all patients who went to the emergency department (ED) due to self-harm and suicide, considering the NTRI's specific inclusion criteria, from September 2016 to January 2023. We evaluated patients regarding demographics and clinical characteristics, various outcomes, and factors influencing in-hospital death. Statistical analyses were conducted using the STATA software version 15.0. The chi-square test was used to compare the distribution of variables between men and women. Also, the logistic regression models were applied to assess the predictors of in-hospital death.

Self-harm and suicide cases were gathered from eleven geographically diverse hospitals across the country, and our study included 511 men and 347 women out of 50,661 registered trauma cases. Among them, 443 men (86.7%) and 267 women (76.9%) were between 18 and 49 years old (P < 0.001). Single women constituted 130 (37.3%) of the female cases, while single men were 313 (61.6%) of the male cases (P < 0.001). The three most common methods among our patients were poisoning with 234 (45.8%) of men and 245 (70.6%) of women cases, stab/cut with 208 (40.7%) of men and 54 (15.6%) of women cases, and fall with 16 (3.1%) of men and 26 (7.5%) of women cases (P < 0.001). The risk of death in patients with a Glasgow Coma Scale (GCS) score of 3 to 8 was 46.22 (95% CI = 18.66 to 114.45) times more than patients with a GCS score of 13 to 15.

Data on self-harm and suicide traumatology were gathered from eleven hospitals in Iran. Our findings indicated differences in the distribution of age and marital status between genders. Moreover, both genders used similar methods for self-harm and suicide, and gender did not affect the outcome.

 Lumbar spinal stenosis (LSS) is the most common indication for lumbar surgery in elderly patients. Epidural injections of calcitonin are effective in managing LSS.

 This study aimed to compare the efficacy of transforaminal and caudal injections of calcitonin in patients with LSS.

 In this double-blind randomized clinical trial, LSS patients were divided into two equal groups (N = 20). The first group received 50 IU (international units) of calcitonin via caudal epidural injection (CEI), and the second group received 50 IU of calcitonin via transforaminal epidural injection (TEI). The Visual Analogue Scale (VAS) and Oswestry Low Back Pain Disability Questionnaire (ODI) were used to assess the patient's pain and ability to stand, respectively. Visual Analogue Scale and ODI scores were recorded and analyzed.

 The results showed that caudal and TEIs of calcitonin significantly improved pain and ability to stand during follow-up compared to before intervention (P < 0.05). Additionally, CEI of calcitonin after 6 months significantly reduced pain in LSS patients compared to TEI of calcitonin (P < 0.05). However, no significant difference was observed between the two epidural injection techniques in improving the patient's ability to stand (P > 0.05).

 The results of the study indicate that epidural injection of calcitonin in long-term follow-up (6 months) had a significant effect on improving pain intensity and mobility in patients with LSS, and its effect on pain in the TEI method was significantly greater than that in the CEI method.

Lengthy hospitalization may lead to an increased hospital-acquired patient complication, including infections, as well as increased costs for both healthcare systems and patients. A few studies evaluated the impact of various clinical and demographic variables on patients' length of stay (LOS). Hence, in this study, we aimed to investigate the impact of various variables on traumatic patients' LOS.  

This is a retrospective single-center, registry-based study of traumatic patients admitted to Taleqani, a major trauma center in Kermanshah, Iran. A Minimal Dataset (MDS) was developed to retrieve traumatic data on demographic and clinical aspects. We used univariable and multiple quantile regression models to evaluate the association between independent variables, including ISS, GCS, and SBP, with LOS. LOS is practically defined as the time interval between hospital admission and discharge. The LOS durations have been presented as median (Q1 to Q3) hours. A p-value of <0.05 was considered statistically significant.   

A total of 2708 cases were included in this study, with 1989 (73.4%) of them being male. The median LOS was 87.00 (48.00 to 144.00) hours. When adjusted for systolic blood pressure (SBP), Glasgow Coma Scale (GCS), Injury Severity Score (ISS), and cause of injury, the two characteristics of spine/back and multiple trauma were significantly associated with the higher LOS, with 43 (20.5 to 65.48) and 24 (10.39 to 37.60) hours more than extremities (P < 0.001 and P = 0.005). Besides, the patients admitted due to road traffic injuries (RTI) were discharged 16 and 41 hours later than falling and cutting/stabbing (P = 0.008 and < 0.001, respectively). Moreover, the patients with ISS≥16 and 9≤ISS≤15 had a median of 51 (21 to 80) and 34 (22 to 45) LOS hours more, compared to 1≤ISS≤8, respectively (P < 0.001). The trauma cases experiencing SBP ≤ 90 mmhg on admission had a median of 41 (20 to 62) hours more hospitalization period than those with SBP> 90 mmhg (P < 0.001). At last, the patients with GCS of 9 to 12 and GCS of 3 to 8 were hospitalized for 39 and 266 hours more than GCS of 13 to 15 (P < 0.001).  

Determining independent determinants of prolonged LOS may lead to better identifying at-risk patients on admission. Trauma care providers should consider the following risk factors for increased LOS: higher ISS, Lower GCS, and SBP, multiple trauma or spine injury, and trauma resulting from falling or cutting/stabbing. As a result, the impact of extended LOS might be reduced by intervening in the related influencing factors.

 Finding the optimal combination of anesthetics to maintain hemodynamic stability during surgery can be challenging. Traditionally, strong opioid analgesics such as fentanyl and its newer analogs have been used. However, the use of narcotics is associated with certain side effects.

 This study compares the effects of labetalol and remifentanil in pain control after bariatric surgery in Hazrat Rasool Akram Hospital.

 This randomized, double-blind clinical trial was conducted on 48 laparoscopic bariatric surgery patients. The participants were randomly divided into two groups receiving remifentanil or labetalol. Postoperative pain was measured in the recovery unit using the numerical rating scale (NRS). This score was recorded upon entering recovery, and 30 minutes, 60 minutes, and 120 minutes after surgery for each patient. Also, the duration of anesthesia, the duration of the operation, the recovery time, the dose of the administered opioids, the volume of intravenous fluids, and the dose of administered propofol were recorded for each patient. Nausea and vomiting after the operation were also recorded as outcomes.

 There were no significant differences between the two groups regarding the mean duration of surgery and anesthesia, dose of the administered anesthetics, recovery period, nausea and vomiting, and the dose of analgesics after the operation. The mean pain intensity during the given period and also the trend of pain intensity changes between the two groups demonstrated no statistically significant differences (P = 0.112). During the operation, 9 subjects (37.5%) in the labetalol group and 16 (66.7%) in the remifentanil group needed more analgesics (rescue drug); in this regard, a significant difference was observed between the two groups (P = 0.043).

 Based on the study’s findings, there were no significant differences between labetalol and remifentanil in post and perioperative pain control. However, rescue drugs needed to maintain hemodynamic stability during laparoscopic surgery were significantly lower in patients who received labetalol than remifentanil. Postoperative complications were also comparable between labetalol and remifentanil.

There are many debates on socioeconomic indicators influencing trauma outcomes. This study aimed to determine the association between education as a socioeconomic indicator and trauma outcomes. This descriptive-analytical study was conducted on 30,448 trauma patients during 2016-2021. The data were based on the minimum dataset of the National Trauma Registry of Iran (NTRI) from six different trauma centers in various cities of the country. The variables used in this study included age, education level, marital status, cause of injury, Glasgow Coma Scale (GCS), intensive care unit (ICU) admission, Injury Severity Score (ISS), and in-hospital mortality. Logistic regression was used to investigate the association between independent variables and trauma outcomes. The study included 30,448 trauma patients with male predominance (75.8%). The mean age was 36.9 years. The most frequent education level was secondary education, with 14,228 (46.6%). Education levels had significant relationships with ISS, death, and ICU admission (P<0.001). Moreover, after applying the multiple logistic regression, the odds of deaths for trauma patients with no formal, primary, and secondary education levels were 3.36, 5.03, and 3.65 times, respectively, more than the odds of deaths at the higher education level after controlling for other factors (all Ps<0.05). However, there were no such relationships between education levels and the odds of ICU admission. Findings of the present study showed a significant association between the education levels and trauma outcomes. Adjusted for other covariates, the chance of death for trauma patients with no formal, primary, or secondary education levels was higher than that at the higher education level.

Postoperative nausea and vomiting (PONV) is one of the most important and distressing complications observed in the postoperative phase. One of the methods mentioned in some studies is chewing gum. The present study investigated the effect of chewing gum on nausea and vomiting after hysteroscopy.

Methods and materials: 

The present study was a double-blinded randomized controlled trial carried out on 52 female patients referred to hospitals affiliated to Iran University of Medical Sciences who underwent hysteroscopic surgery. The patients were randomly assigned to one of two groups of tasteless chewing gum or Ondansetron 4 mg IV. Then, the two groups were compared regarding severity and amount of PONV.

The time from the start of treatment to the improvement of nausea and vomiting was recorded in two groups; ondansetron group had an average time of 13.63 minutes and chewing gum group had an average time of 20.13 minutes. Ondansetron reduces postoperative nausea and vomiting faster than chewing gum. The mean improvement in PNOV in the ondansetron group was 23 out of 26 cases, of which 3 required rescue treatment, and in the chewing gum group 22 out of 26 cases recovered and 4 received rescue treatment. There was no significant difference between the two groups (P = 0.685).

Statistical comparison between the two groups of ondansetron and chewing gum does not show a significant difference in the improvement of nausea and vomiting after hysterectomy, but the time period of treatment to improvement of nausea and vomiting after hysterectomy in the ondansetron group was faster than the chewing gum group.

Injury from animal attacks is an important public health problem with high morbidity and mortality. As we cannot neglect or underestimate these hazardous conditions, we aimed to assess animal-related injuries in Iranian patients and compare the results.  In this cross-sectional study conducted on data from the National Trauma Registry of Iran, trauma patients admitted to the hospital due to animal attacks from January 15, 2018, to November 1, 2021, were assessed. A checklist gathered data consisting of baseline characteristics such as sex, age, activity, place at the time of the attack, and injury site. In addition, we extracted the clinical features of these patients, including injury severity score, Glasgow coma scale, intensive care unit (ICU) admission, hospital length of stay, surgery, and discharge status. One hundred thirty-one patients were registered in the study. Most of the patients were male (80.9%), aged 16 to 44 years (59.5%), and encountered animal attacks when they were in agricultural areas (45%). Ninety-six patients (73.3%) underwent surgery, and three were hospitalized in ICUs. We recorded 172 injuries, consisting of 92 (53.5%) injuries in the upper extremities as the most common region of the body. The males were aged 16-44 years (66%), and the females were aged 45-65 (52%) (P=0.005). Fifty percent of males and 24% of females were injured in the agricultural areas. Moreover, 24% of females and 6.6% of males were injured at home. This study showed a high incidence animal attacks in Iran. Most injuries were in middle aged males and in the agricultural area.

Liver parasites are one of the most important parasitic groups which, in addition to causing diseases in host animals, also have zoonotic importance. This study was conducted with the aim of examining the livers of sheep slaughtered in the industrial slaughterhouse of Birjand city and identifying the parasitic contamination in them, finding the cause of contamination and estimating the direct economic losses caused by them.

The present study was descriptive-analytical and it was conducted cross-sectionally in four seasons of spring, summer, autumn and winter of 2021. During the research period, by referring to the slaughterhouse, the removed livers were collected and transferred to the parasitology laboratory in cold condition and on ice bags. In the laboratory, the possible cysts in the liver were subjected to diagnostic examinations by examining the appearance and also making deep cuts in the liver tissue.

During the 12-month research period, 15319 sheep were slaughtered, among which 790 sheep had parasitic infections in their livers. Infected livers were removed wholly or partially. The total number of liver removals caused by parasites was estimated at 793 kilograms, which is based on the daily price (per kilogram of liver: one million and five hundred Rials) and it was calculated one billion one hundred eighty-nine million five hundred thousand Rials (1189500000 Rials). The parasites observed in the infected livers included hydatid cyst, fasciola, dicrocelium, cysticercus teniacolis and sarcocyst.

Considering the extent and volume of contamination and taking into account the direct financial loss caused by parasitic contamination in Birjand city, it could be estimated that parasites cause huge and significant amounts of damage to the country's animal husbandry industry every year.

Anesthesiology as a specialty has made a lot of progress during the last few decades. anesthesiology is not just an attempt to reduce pain during surgery, and anesthesiologists play a very important role in post-operative care, intensive care, labor analgesia, and pain clinics. However, studies have shown that most patients think that the anesthesiologist is the surgeon's assistant who puts the patient to sleep and wakes the patient up after the completion of the surgical procedure and they don't know about the comprehensive medical care that is provided before and after the surgery and even beyond that, that is provided by an anesthesiologist. The present study was conducted to evaluate patients who are candidates for surgery in relation to anesthesia and the different roles of anesthesiologists in the hospitals of Iran University of Medical Sciences in 1399-1400.

Method and Materials:

This study is a cross-sectional-descriptive survey on adult non-emergency surgery candidates in Rasool Akram and Firouzgar hospitals of Iran University of Medical Sciences. Data collection was done using a checklist that is provided to patients during the pre-surgery visit. Sampling in this research is done by a simple non-probability method.  The collected data are analyzed using SPSS statistical software.

In this study, 250 patients were included in the study. Age group with most of the patients were between the ages 40 to 50. 49.6% of patients were men and 50.4% were women. most of the participants had bachelor's and master's degrees, which constituted 38.8% of the patients, and 22% of the participants in this study worked in the healthcare sector. the patients of this study were divided into three groups living in the village, city, and metropolis, which included 18%, 35.2%, and 46.8%, respectively. 22.8% mentioned a previous history of surgery or anesthesia. In this study, 49.6%, 21.2%, and 35.6% were aware of the role of the anesthesiologist in pre-surgery, during surgery, and post-surgery procedures, respectively. Also, only 18.8% had sufficient information about the anesthesiologist's role in pain clinics, 13.2% of the anesthesiologist's role in labor analgesia, and 20.8% of the role of the anesthesiologist in the intensive care unit. In this study, the highest level of awareness of anesthesiology and the role of anesthesiologists was seen in the group with doctoral education and above. Also, the highest level of awareness was in the age group of 50 to 60 years. The level of knowledge about the role of anesthesiologists was higher in people who had a history of anesthesia than in people without a history of anesthesia

According to the results of our study, the level of awareness of patients who are candidates for surgery regarding the role of anesthesiologists in their treatment process and the general awareness of these patients to the different roles of anesthesiologists is low. Also, our study showed that people with older age and more education have more knowledge about anesthesia and anesthesiologist's roles in the hospital and in treating patients. However, planning to educate people to make them aware of the abilities of anesthesiologists can help in receiving appropriate healthcare services.

 Hoarseness, cough, and sore throat are the most prevalent complications after removing patients’ endotracheal tube and general anesthesia. Various methods have been proposed to reduce these complications after intubation.

 The present study aimed to assess the effect of softening the endotracheal tube with normal warm saline on reducing post-intubation complications such as sore throat and hoarseness.

 This double-blind, randomized controlled trial was performed on patients undergoing general anesthesia at Rasoul Akram and Firoozgar hospitals in Tehran, Iran. In the present study, 58 patients were randomly divided into 2 groups of 29 patients. All patients underwent the same premedication with fentanyl and lidocaine. Anesthesia was induced with propofol and atracurium. Three to 5 minutes after atracurium injection, the laryngoscopy test was performed. Randomly, some patients were intubated with a thermally softened endotracheal tube, and some were intubated with a normal tube. At the end of the operation, when the spontaneous breathing was adequate, and the patients could carry out oral instructions, the endotracheal tube was removed immediately after suctioning. All patients were evaluated for sore throat and hoarseness before discharge from recovery and 24 hours after surgery. The obtained data were analyzed using SPSS software package version 25.

 The mean incidence of sore throat in recovery in the intervention group (20.7%) decreased compared to the control group (75.8%). Moreover, the mean incidence of hoarseness in the intervention group (17.2%) decreased in comparison to the control group (41.4%, P < 0.029). Based on the data of our study, we observed that 24 hours after surgery, the mean incidence of sore throat among the patients of the intervention group was significantly lower compared to the control group, where patients in the intervention group did not feel any sore throat (P < 0.002). We also observed that 24 hours after surgery, the amount of hoarseness in the intervention group (3.4%) also decreased compared to the control group (24.1%, P < 0.022).

 Based on the results, it can be concluded that thermal softening of the endotracheal tubes with normal warm saline before intubation could be significantly effective in decrement of sore throat and hoarseness during recovery and 24 hours after surgery.

Migraine headaches can cause severe pain for patients and lead them to multiple visits to theemergency department (ED). This study aimed to evaluate the efficacy of propofol + sumatriptan combinationin comparison with sumatriptan alone in the management of acute migraine headaches.

This triple-blind clinical trial involved patients who referred to two emergency departments with acute migraine headaches.Patients were randomly assigned to control (sumatriptan and placebo) or intervention (propofol and sumatrip-tan) groups for comparison of the efficacy and side effects of treatment.

In this study, 60 patients wereincluded whose mean age was 31±8.8 years, and headaches were more common among women. After 30 and60 minutes from the beginning of treatment, the mean pain score reduction in the intervention group was sig-nificantly greater than that in the control group (p=0.012, p=0.024). In addition, the rate of chest tightness inthe control group was significantly higher than the intervention group. The absolute risk reduction of adverseevents (Chest tightness, Bradycardia, hypotension, and etc.), in patients with acute migraine headache takingpropofol and sumatriptan treatment, was 32.18% (95% CI: 8.02 – 56.35).

This study supports theuse of propofol for treatment of acute migraine headaches and shows that combining sumatriptan with propofolis more effective in relieving migraine headaches and the associated symptoms than using sumatriptan alone.However, more studies with longer follow-ups are still needed.

Brugada syndrome (BrS), a type of sudden arrhythmic unexpected death syndrome (SADS), is characterized by specific electrocardiogram (ECG) changes, a structurally normal heart, and susceptibility to life-threatening ventricular arrhythmias. General anesthesia (GA) is usually used for major surgery in patients with BrS due to concerns that some local anesthetic agents may precipitate critical arrhythmias. The majority of ophthalmic surgeries are successfully carried out under regional anesthesia (RA). The literature does not address the use of ophthalmic RA in patients with BrS except one report of peribulbar block for glaucoma surgery. This clinical case report and the liertature review suggests that for BrS patients presenting for vitreoretinal surgery, a sub-tenon block, with or without sedation may safely be used as a primary anaethestic technique.

 One of the methods of pain control after pediatric surgical procedures is regional techniques, including caudal block, despite their limitations.

 In this study, the pain score and complications of caudal tramadol were evaluated in pediatrics following lower abdominal surgery.

 In this study, 46 children aged 3 to 10 years were allocated into two equal groups (R and TR) for performing caudal analgesia after lower abdominal surgery. The injectate contained 0.2% ropivacaine 1 mL/kg in the R group (control group) and tramadol (2 mg/kg) and ropivacaine in the TR group. The pain score, duration of pain relief, amount of paracetamol consumption, hemodynamic alterations, and possible complications at specific times (1, 2, and 6 hours) were evaluated in both groups.

 No considerable difference was observed in the pain score between the groups in the first and second hours (P > 0.05). However, in the sixth hour, the TR group had a significantly lower pain score than the R group (P < 0.05). Compared to the R group, the TR group had a longer period of analgesia and lower consumption of analgesic drugs (P < 0.05). Heart rate and blood pressure differences were not significant between the two groups (P > 0.05). Similarly, the duration of operation and recovery time were not remarkably different between the two groups (P > 0.05). Complications had no apparent differences between these two groups, as well (P > 0.05).

 In this study, the addition of tramadol to caudal ropivacaine in pediatric lower abdominal surgery promoted pain relief without complications.

 Caudal block is one of the methods of pain management performed following lower abdominal surgery, though having its own limitations.

 In the present study, the effects and side effects of adding dexmedetomidine to ropivacaine in the caudal epidural block were investigated in children after lower abdominal surgery.

 In this randomized, double-blinded clinical trial, 46 children aged three to six years were divided into two groups to perform a caudal block following lower abdominal surgery under general anesthesia. The injectable solution contained ropivacaine in the R group (1 mL/kg ropivacaine 0.2%), as the control group, and dexmedetomidine (2 µg/kg) and ropivacaine 0.2% (1 mL/kg) in the DR group. The pain score (modified CHEOPS score), duration of analgesia, amount of analgesia consumed (i.v. paracetamol), hemodynamic changes, and possible adverse effects were assessed at one, two, and six hours in both groups.

 The pain score at one and two hours showed no significant difference between the two study groups (P > 0.05). In the DR group, however, the pain score at the sixth hour was significantly lower, and the duration of analgesia was longer (P = 0.001). The amount of analgesic consumption was also lower in the DR group (P = 0.001). However, there was no significant difference in systolic blood pressure and heart rate (P < 0.05), in the case of diastolic blood pressure, a significant difference (P < 0.05) was seen (DR group lower than the R group). There was no statistically significant difference between the study groups in the duration of surgery, recovery time, and side effects (P < 0.05).

 In the present study, the addition of dexmedetomidine to ropivacaine in the caudal epidural blockade improved postoperative analgesia without significant adverse effects in pediatric patients.

In the US, an estimated 1 - 2% of chronic venous insufficiency (CVI) patients (of 6 - 7 million nationwide) develop at least one venous stasis ulcer (VSU) during their illness. Of these, approximately 40% develop subsequent ulcers, making VSU prognostically poor. Current management of VSU is costly, with poor prognosis, high recurrence rate, inadequate pain management, and significantly reduced quality of life (QoL). Topical volatile anesthetic agents, such as sevoflurane, offer improved pain relief and symptom control in patients suffering from chronic VSU. The immediate impact of topical sevoflurane in reducing pain associated with ulcer bed debridement has several implications in improving the quality of life in patients with CVI induced ulcers and in the prognosis and healing of the ulcers. This review summarizes a topical formulation of a volatile anesthetic and its implications for the management of VSUs.

 World Health Organization (WHO) declared that the outbreak of COVID-19 constituted a public health emergency of global concern.

 Owing to limited data on critically ill patients admitted to ICU, we aimed to describe the clinical characteristics and prognosis of these patients based on ventilatory variables and clinical features.

 In this retrospective study, 45 critically ill patients with laboratory-confirmed COVID-19 who were admitted to Intensive Care Unit (ICU) wards of the hospital from April 8 to May 9, 2020, were enrolled. Medical files of the patients were reviewed, and demographic and clinical characteristics, laboratory data, lung CT scan findings, causes of intubation, and outcomes of the patients were all collected.

 The median age of the patients was 67 years (range 22 to 91), 64% were men, and hypertension was the most common comorbidity. History of close contact with previously confirmed patients was positive in 62.2% of the patients. The mean time from symptom onset to hospital admission was 5.98 ± 2.93 days. The most common symptoms at the onset of illness were dyspnea (95.6%), and gastrointestinal symptoms (22.2%) were rare. The average length of the intubation was 4.84 ± 3.28 days. The distribution of intubation causes in the deceased patients was significantly more than the recovered patients (P = 0.031). The mean score of lung CT involvement in deaths (370.26 ± 207.50) was significantly higher than the recovered patients (235.71 ± 81.21) (P = 0.042). Length of the intubation had a statistically direct correlation with respiratory rate (P = 0.03).

 Most of the critically ill patients admitted to ICU were older men and had poor outcomes with a high mortality rate. Furthermore, the score of chest CT involvement and respiratory rate are important prognostic factors in determining the severity of the illness, requiring ventilatory support, and outcome.
 

Electroconvulsive therapy (ECT) was first experienced in 1938 and had been conducting without anesthesia for 30 years. In this study, the most common indication for ECT was mood disorder (major depressive disorder and bipolar I disorder). We introduce a patient with a history of COVID-19 and suicide who required emergency ECT. Electroconvulsive therapy can be life-saving in patients with suicide history or catatonic schizophrenia. Health workers are at the front line of the COVID-19 outbreak control and must follow health instructions. Aerosol-producing procedures such as suction in anesthesia for ECT may facilitate the transmission of infectious diseases such as COVID-19. When performing aerosol-producing procedures during the pandemic of novel coronavirus, every patient should be considered suspicious.

Knowledge about clinical features of critically ill patients with COVID-19 still lacks adequate information up to now.

We aimed to describe and compare the epidemiological and clinical characteristics of critically ill patients with COVID-19 in Rasoul Akram Hospital.

In this case series, 70 critically ill patients with COVID-19 admitted in ICU wards of Rasoul Akram Hospital, Tehran, Iran, from 29 February to 25 April 2020 were enrolled. Demographic and clinical characteristics, laboratory data, and outcomes of the patients were all collected and compared between deceased and recovered patients.

Fifty-six cases had died of COVID-19, and 14 patients had fully recovered and discharged. The median age of the patients was 68 years old, ranging from 22 to 91 years, 66% were men, 80% had one or more comorbidities, and hypertension was the most common comorbidities (45% of deceased cases). The most common signs and symptoms at the onset of illness were SPO2 depression (92%) and dyspnea (90%). Dyspnea was significantly more common in deceased patients (95%) than recovered patients (70%) (P = 0.048). Most patients had lymphopenia (80%). The number of patients who needed mechanical ventilation in the deceased patients was 53 (95%), which was significantly more than the recovered patients (10 [70%]) (P = 0.048).

The mortality rate of critically ill patients with COVID-19 is very high, and the patients with dyspnea and required mechanical ventilation are at higher risk for death.

Coronavirus disease 2019, known as COVID-19, was first identified in Wuhan, China, in December 2019 and became a pandemic on Mar 11, according to the World Health Organization report. In the epidemic of COVID-19, many patients admitted to hospitals for other reasons may be silent carriers of COVID-19 and have the risk of infecting medical personnel. Thus, meticulous personal protection measures should be considered in suspicious patients, especially when close contact with the patient’s airway is anticipated. We introduce two airway trauma patients suspected of COVID-19 who required emergency tracheostomy. Patient one was a 29-year-old man who suffered facial trauma following a car accident. A chest CT scan showed peripheral ground-glass opacities suggestive for COVID-19. The second patient was a young elevator mechanic who experienced maxillofacial trauma after an elevator crash. The methods of anesthesia and airway protection and safety precautions are described.

It is widely accepted that increased prevalence of antibiotic resistance of pathogens grown in the respiratory system in intensive care unit (ICU) patients is a very serious problem causing expansion of mortality. The most important strategy to prevent the occurrence and appropriate solution to control the antibiotic resistance is to thoroughly investigate the pattern of resistance in the studied ward. Therefore, the purpose of this study was to determine the antibiotic resistance pattern of organisms isolated from endotracheal tube secretions of patients admitted to ICU of Khatam-Al-Anbia Hospital at Zahedan in Iran.

In the present retrospective and descriptive cross-sectional study, the medical records of patients hospitalized during 2013-2018 were included by census method and then selected based on inclusion criteria (n=1387). The required data, including age, gender, type of microorganism isolated from endotracheal tube cultures, antibiotic resistance and sensitivity, duration of intubation and cause of hospitalization, were recorded for each patient. Finally, the data were analyzed by descriptive statistics using SPSS 16 software.

Mean age of patients was 44.66 ± 21.39 years and mean duration of intubation was 17.96 ± 10.99 days. Stroke was the most common cause of hospitalization with a prevalence of 553 patients (49%). The prevalence of positive culture of endotracheal tube secretions was 1128 (81.3%) of which 71.5% were male (n=807) and 28.5% were female (n=321). The cultures of endotracheal tube secretions resulted in 933 (82.7%) gram-negative bacteria, 191 (16.9%) gram-positive bacteria and 4 (0.4%) mixed isolates. The most prevalent gram-negative bacterium was Acinetobacter baumannii (37.2%) with the highest and lowest antibiotic resistance to Meropenem (95.1% resistance) and colistin (99.5% sensitivity), respectively. In addition, the most prevalent gram-positive bacterium was Staphylococcus epidermidis (50.3%) with the highest and lowest antibiotic resistance to Meropenem (85.7% resistance) and Vancomycin (92.2% sensitivity).

The findings of the present study illustrate that there was widespread bacterial resistance to respiratory tract infections in our ICU patients. Due to the high sensitivity of gram-negative bacteria to colistin, the use of antibiotic combination with colistin in the control of pulmonary infections caused by these organisms can be a good choice. In addition, in the case of gram-positive bacteria, the highest sensitivity was to vancomycin; therefore, it can be the selective antibiotic to control infections caused by these bacteria.

For patients with prolonged bed rest and immobilization because of motor or consciousness disorders, many factors may contribute to the development of pressure ulcers. To this end, the present study aimed to investigate the frequency of pressure ulcers and the factors affecting the development of this condition in intensive care units (ICUs).

In this descriptive cross-sectional study, the case files and records of patients hospitalized between March 2017 and March 2018 entered the study using the census method. The necessary information including age, gender, location of pressure ulcers, number of ulcers on each part of the body, length of stay in ICU, and underlying diseases was extracted from the files and recorded in the data checklist. In the end, the extracted data were analyzed with SPSS 25.

Of the 781 patients studied, 71 (9.1%) had pressure ulcers, of whom 34 were men and 37 were women. A statistically significant difference was found between men and women in terms of the incidence of pressure ulcer (p = 0.0013). The most common sites of pressure ulcers were buttock with 34 cases (47.9%) and sacrum with 21 cases (29.6%).

Old age and prolonged stay in ICU are important determinants of the development of pressure ulcers.

Our knowledge of the epidemiology of rodents’ parasitic agents in Iran is scarce, although some of these pathogens play an important role in human and veterinary medicine, such as Toxoplasma gondii and Neospora caninum. The purpose of this study was to determine the seroprevalence of Toxoplasma gondii and Neospora caninum in rodents of northwestern Iran between Mar and Dec 2015.

Overall, 157 serum samples from rodents (101 Meriones persicus, 41 Mus musculus, and 15 Cricetulus migratorius) were assayed by the indirect fluorescence antibody test (IFAT) for antibodies to T. gondii and N. caninum.

We found a prevalence of 20.38% (32/157) for N. caninum, 35% (55/157) for T. gondii. Co-presence of antibodies to N. caninum and T. gondii was found in 10 (6.36%) rodents. A significant association was found between the rodents species and seropositivity to N. caninum (P<0.05) but there was no association with rodents species for T. gondii. The overall prevalence of the aforementioned parasites was higher in male versus female rodents.

The high seroprevalence of toxoplasmosis and neosporosis in rodents in the study area has implications for translocation of these infections across wider geographical regions since these rodents are mostly preyed on by cats or dogs; hence, which can transfer the parasite to other hosts.

According to the importance of preparation of health care facilities against incidents and disasters, the aim of this study is to determine the level of preparation of Yazd Shahid Sadoughi Hospital for responding to incidents and disaster after the Development of a hospital disaster-response plan.

This cross-sectional, descriptive study has investigated the level of vulnerability of the hospital against incidents and disaster and has identified the hazards threatening the Yazd Shahid Sadoughi Hospital in 2016. The used tool was the Farsi Hospital Safety Index (FHSI) questionnaire in three scopes of functional, structural and non-structural and the results were analyzed using the Excel software.

The results showed that the frequency of natural disasters in hospital was about 64.76%, functional safety level of about 56.39%, non-structural safety level was about 53.33, structural elements safety level was about 73.33, the score of weighted safety was about 63.94%, and the score of safety without weighing was about 56.41%.

According to the results, it could be concluded that the amount of preparation of the hospital is in acceptable level and by developing a disaster response plan, the level of preparation of Yazd Shahid Sadoughi Hospital to confront the incidents and disaster could be improved, especially in structural and functional vulnerability sections.

Awake oral flexible fiberoptic intubation (AFOI) is used in patients with expected difficult airways. Different drugs have been used for sedation and yet we need to define ideal drug with proper sedation and safety, less changes in hemodynamic stability and less airway compromise. We aimed to compare the efficacy of dexmedetomidine with fentanyl and midazolam during AFOI. In this randomized clinical trial, 52 patients undergoing elective surgery and candidate for AFOI were randomly allocated to two groups. First group received 1mcg/kg of dexmedetomidine in 10 minutes and then infusion of 0.5 mcg/kg/h and second group received 2 mcg/kg fentanyl and then 1 mg midazolam. Hemodynamic variables, O2 saturation (SpO2) were evaluated before and after sedation and after intubation. Ramsey sedation scale (RSS) and patient’s tolerance were evaluated during bronchoscopy and intubation. Lower heart rate after intubation (p=0.008) and higher SpO2 before sedation (p<0.001) and after intubation (p=0.02) were observed in dexmedetomidine group compared to fentanyl group. The need for propofol for further sedation was comparable between groups (11.5% vs. 7.7%, respectively; p=0.63). Both groups had comparable RSS and tolerance during intubation. Dexmedetomidine compared to fentanyl and midazolam had comparable sedation with better hemodynamic stability and O2 saturation during AFOI.