جستجوی مقالات مرتبط با کلیدواژه "ترومبوز وریدی" در نشریات گروه "پزشکی"

With advancements in treatment and an increase in the prevalence of diseases, the number of patients requiring mechanical ventilation in intensive care units (ICUs) continues to rise each year. The ABCDE bundle is a multi-component, evidence-based approach designed to improve patient outcomes in the ICU. This study aimed to determine the effect of the ABCDE bundle on the risk of pressure ulcers, deep vein thrombosis and delirium in patients undergoing mechanical ventilation.

Methods & Materials: 

This randomized, single-blind clinical trial was conducted between September 2021 and January 2022. The sample included 100 patients undergoing mechanical ventilation in the ICU department of Imam Reza Hospital in Mashhad, who were randomly assigned to either the intervention or control group using block randomization. The intervention group received the ABCDE bundle over a period of 7 days. The control group received routine care. The criteria for assessing complications included the risk of pressure ulcers and deep vein thrombosis (DVT), evaluated at the end of the intervention and on days 0, 1, 3, 5, and 7. The study utilized several assessment tools: the COMHON Index for pressure ulcers, the Wells Deep Vein Thrombosis Scale, and the Delirium Evaluation Tool in the Intensive Care Unit (CAM-ICU). Data analysis was performed using SPSS software version 20, employing chi-square, Mann-Whitney, and independent t-tests.

A decrease in the average pressure ulcer risk score was observed in the intervention group on day seven (P<0.05). In this group, the incidence of delirium fell decreased from 64.4% to 13.3% (P<0.05), indicating a statistically significant reduction. Additionally, the risk score for deep vein thrombosis in the control group significantly increased on day seven compared to the intervention group (P<0.05).

The use of the ABCDE bundle significantly reduces the risk of pressure ulcers, deep vein thrombosis, and delirium in patients undergoing mechanical ventilation and represents an effective strategy that can be implemented by nurses and other trained healthcare professionals.

High incidence and mortality rate of pulmonary thromboembolism urge physicians to be aware of its occurrence and treatment. Pulmonary thromboembolism (PE) typically manifests itself with acute dyspnea and tachycardia and may occur along with deep vein thrombosis. However, syncope, chest pain and heart failure decompensation in previously stable patients might be another presenting signs and symptoms.  Although there are several guidelines about PE prophylaxis both in medical and surgical patients, guideline adherence is not good enough. The most important reasons are; inappropriate PE risk scoring, insufficient prophylaxis dosage and the fear of probable bleeding. Both unfractionated and low-molecular-weight heparin has been suggested as prophylactic agents. The role of echocardiography in the diagnosis of PE has been challenged; however, it is mandatory to do an echocardiogram to define the prognosis and also the proper treatment approach. Based on the severity of right ventricular dysfunction, biomarker levels and hemodynamic status of the patients, they will be categorized as low, moderate and high-risk. Moderate to high risk patients should be planned for more invasive treatments such as thrombolytic therapy. In conclusion, PE is the third common cardio-vascular acute condition after myocardial infarction and cerebrovascular accident. The most important reason for death in PE is right-side heart failure. Besides, PE is the most preventable fatal disease in hospitalized patients. Long hospital stay, inappropriate thromboembolic prophylaxis and baseline comorbidities predispose patients to this fatal event. Sometimes, the fear of probable bleeding precludes guideline-based thromboprophylaxis, especially in post-operative patients. If PE occurs; it will be hard to manage and treat. New oral anticoagulants are advised as fixed-dose which does not need to be closely monitored. Drug and food interaction is significantly lower in New oral anticoagulants (NOACs). Thrombo-prophylaxis is better than mechanical thrombo-prophylaxis. Post-discharge thromboprophylaxis is also advised in orthopedic patients. It is mandatory to advise patients to walk after discharge and avoid long-term bedrest if possible. A too early discharge may also be an important risk factor and prone patients to PE at home.

Considering the different treatment methods and their controversial efficacy and the importance of proper treatment with decreasing complications and costs for patients with acute Ileofemoral DVT, this study aimed to assess the success rate and complications of catheter-directed thrombolysis in patients with acute Ileofarmal DVT, referred to Razi Hospital in Rasht, 2017-2018.

To evaluate the Success Rate and Complication after Catheter Directed Thrombolysis in Acute Deep Vein Thrombosis of Ileofemoral Vein

This case-series study was performed onthe  patients with acute Iliofemoral DVT underwent catheter-directed thrombolysis referred to Razi Hospital in Rasht, 2017-2018. All patients diagnosed with acute Iliofemoral DVT on the basis of color Doppler ultrasonography and venography were candidates for treatment. Patients with concomitant illnesses, such as diabetes mellitus, hypertension, underlying conditions such as malignancy and any other illnesses other than DVT, were excluded. The variables studied in this study were collected using a questionnaire.

In this study, 20 patients with acute Iliofemoral DVT younger than 60-year-old with the onset of symptomless than 2 weeks were studied. The mean age of the subjects was 39.15±12.07 years, 11 (55%) cases were male and the rest were female. 13 cases were affected by acute left Iliofemoral DVT. AS for initial symptoms, the highest frequency (65%) was related to pain, swelling, and tenderness. The results of the study showed that there was a 100% success rate, and none of the patients in the follow-up period of 6 months showed restenosis.

Based on this study and comparison to other authors’ recommendations, it seems that the success ratein catheter-directed thrombolysis in patients with acute Ileofemoral DVT was100%. There were no complications in 75% of the patients. The most reported complication was pain and there was no statistically significant relationship between the complications of the patients during the treatment, the duration of admission and age and sex.
Conflict of interest: non declared

Two hundred and eight asymptomatic individuals from different origins of Iran were included in this study in order to assess the distribution of the Prothrombin G20210A polymorphism responding for cardiovascular disease (CVD) in the general Iranian population using a novel technique reverse hybridization StripAssay for the rapid and simultaneous detection. The test is based on multiplex PCR and hybridization to a teststrip presenting a parallel array of allele-specific oligonucleotide probes for each mutation. The allele frequencies of mutant Prothrombin G20210A (0.005) in our cohort were below previously published figures on the population of Tehran (1.5). Here we describe the distribution of mutant allele Prothrombin G20210A in different ethnicities of Iranian population and compare the results to previously reported data. Our data represent the most comprehensive study to date with respect to thrombophilic gene polymorphism in Iran.