جستجوی مقالات مرتبط با کلیدواژه « artificial » در نشریات گروه « پزشکی »

A decision-making guideline on when to intubate an older person based on predictors of intubationoutcome would be extremely beneficial. This study aimed to identify the associated factors that could predict the out-comes of endotracheal intubation among older adults in the Emergency Department (ED).

In this retrospec-tive cross-sectional study, patients aged≥65 years intubated at the ED of University of Malaya Medical Centre, KualaLumpur, Malaysia, from 2015 to 2019 were studied. The association between age, gender, place of inhabitation, Identifi-cation of Seniors at Risk (ISAR) score for frailty, Charlson Comorbidity Index (CCI), Acute Physiology and Chronic HealthEvaluation-II (APACHE-II) score, indication for intubation, and diagnosis on admission with in-hospital mortality (pri-mary outcome) and duration of ventilation, and length of stay (secondary outcomes) were evaluated using univariateanalysis and Cox’s regression survival analysis.

889 cases aged 65 years and above were studied (61.5% male).The rate of in-hospital mortality was 71.4%. There was a significant association between age (p < 0.001), nursing homeresidency (p = 0.008), CCI≥5 (p = 0.001), APACHE-II (p < 0.001), pre-intubation Glasgow Coma Scale (GCS) (p < 0.001),cardiac arrest as indication of intubation (p < 0.001), diagnosis on admission (p < 0.001), length of stay (p < 0.001), andlength of ventilation (p = 0.003) and in-hospital mortality. Age≥85 years (HR= 1.270; 95%CI=1.074 to 1.502) and 75 to84 years (HR=1.642; 95%CI=1.167 to 2.076), cardiac arrest as indication of intubation (HR: 1.882; 95% CI: 1.554 – 2.279),and APACHE-II scores 25 – 34 (HR: 1.423; 95% CI: 1.171 - 1.730) and≥35 (HR: 1.789; 95%CI: 1.418 - 2.256) were amongstthe independent predictive factors of in-hospital mortality.

Nearly three out of four individuals aged≥65years intubated at the ED died during the same admission. Older age, cardiac arrest as indication of intubation, andAPACHE-II score were independent predictors of in-hospital mortality.

The posterior denture teeth wear faster than the anterior teeth, which can result in occlusal interferences, loss of vertical dimension of occlusion, greater stress accumulation in the anterior region, and higher ridge resorption. This study aimed to compare the wear resistance of three types of artificial acrylic teeth before and after removing the glaze layer.

This in vitro study compared three types of artificial acrylic teeth, namely, Finex (F), SR Orthotyp DCL (S), and Vita Physiodents (V) in six groups (n = 10). Half of the artificial teeth of each brand underwent 0.5‑mm buccal reduction to remove the glaze layer (groups FC, SC, and VC). The teeth were thermocycled and placed in a chewing simulator. The teeth with and without the glaze layer were weighed before and after the wear test. The data were analyzed using ANCOVA (the level of significance was 0.05).

The weight reduction (indicative of wear) was 0.03 ± 0.02 and 0.12 ± 0.03 mg in Groups S and SC, 0.03 ± 0.02 and 0.25 ± 0.04 mg in Groups V and VC, and 0.11 ± 0.15 and 0.28 ± 0.1 mg in groups F and FC, respectively. Removing the glaze layer (P < 0.01), type and brand of acrylic tooth (P < 0.01), and the baseline weight of artificial teeth (P < 0.01) had significant effects on wear resistance of artificial teeth.

The wear of artificial teeth was greater after removing the glaze layer, and the magnitude of wear was also significantly different among the three brands. The group FC showed maximum wear while the groups S and V showed minimum wear.

Cardiac problem causes changes in different aspects of life in patients, including their activities of daily living (ADL). Because of the important role of family in caring for patient after pacemaker implantation, this study was done to evaluate the effect of family-centered empowerment model on ADL of patient after pacemaker implantation.

This randomized clinical trial study was performed on 70 patients who underwent pacemaker implantation in Shahid Chamran Hospital, Isfahan, Iran. Patients and their family in the intervention group received educational program according to family-based empowerment program. The control group only received routine interventions. Data were collected using a valid specific quality of life (QOL) questionnaire and analyzed by SPSS software.

Patient's self-efficacy, self-esteem, and personal QOL have been improved after the empowerment program compared with the baseline and the control group (P < 0.05 for all).

The QOL in patients with pacemaker is relatively low. Similar to previous studies, family-centered empowerment model, due to participation of the patients and their families in education, learning, and taking care of the patients, could be an appropriate model to implement.

This study aimed to assess the color change (∆E00) of 7 brands of denture teeth (conventional acrylic and composite teeth) following immersion in staining solutions.

Maxillary central incisor denture teeth made of 4 conventional acrylic resins (Vitapan, SR Vivodent PE, Beta Star and Crystal) and 3 composite resins (Finex, Emeral and Phonares II) were randomly divided into four groups (n=5). Denture teeth of different brands were immersed in tea, coffee, cola, and turmeric solutions. The solutions were incubated at 37°C. The baseline color of the teeth was measured using an intraoral spectrophotometer. The color of the teeth was measured after 24 h (∆E12), 1 week (∆E13), 2 weeks (∆E14), and 1 month (∆E15). ∆E00 was calculated and analyzed using one-way ANOVA. Pairwise comparisons were performed by the Tukey’s post-hoc test (P<0.05).

The color stability of all teeth was significantly affected by the solutions (P<0.001). The type of tooth and coloring solution had significant interactions at all times (P<0.05). Turmeric caused the maximum color change in all teeth after 1 month. Repeated measures ANOVA showed that ∆E00 of all teeth was significantly affected by the duration of immersion in the solutions (P<0.001).

within the limitations of this study, 1-month immersion of denture teeth in coffee, tea and cola solution altered the ∆E values; however, they were within the acceptable range, except for Beta Star. Turmeric solution caused unacceptable color change in all denture teeth even after 24 h of immersion.

Temporary pacemaker wires are commonly used for the diagnosis and treatment of arrhythmias in the acute postoperative period. We herein describe a 65-year-old woman with a history of coronary artery bypass graft surgery who was referred to the hospital with a purulent discharge in the lower third of the sternal region while on antibiotics. Two years later, following treatment failure, 2 sternal wires were removed. Several years after the surgery, the patient developed a purulent discharge. On suspicion of rib osteomyelitis, the last left cartilage attached to the sternum was excised and removed together with an infectious tract. During the operation, the right ventricle was torn, and tampons were used to control bleeding. The patient was placed under cardiopulmonary bypass via the cannulation of the left femoral artery and the right femoral vein. The sternum was opened, and the rupture site was repaired. A temporary epicardial pacing wire was found at the site of the right ventricular rupture.  Several days later, the patient was taken from the intensive care unit to the operating room due to a pulsatile hematoma in the left groin and a diagnosis of a pseudoaneurysm of the femoral artery. After a week, the purulent discharge at the lower sternum improved, and the patient was discharged. At 1 month’s post-discharge follow-up, the infection was eradicated.

Despite recent progress in treatment of burn injuries, head and neck burn and its complications isstill considered a challenge. This study aimed to evaluate the baseline characteristics and outcomes of patientswith head and neck burn.

In this retrospective cross-sectional study, the medical profiles of patientswith head and neck burn referring to a burn care center during 2 years were reviewed and analyzed regarding thebaseline characteristics and outcomes of participants.

392 (17.97%) cases suffered from head and neckburns. The mean burn percentage of participants was 29.31 ± 24.78, and 126 (32.14%) cases required trachealintubation. There was a direct correlation between length of hospital stay and the degree of burn (p < 0.001). Thelength of hospitalization for patients burned by electricity was longer than those burned by other mechanisms(p = 0.003). There was a significant correlation between degree of burn and abnormal laryngoscopy findings (p= 0.036), developing acute respiratory distress syndrome (ARDS) (p < 0.001) and pneumonia (p < 0.001), needfor mechanical ventilation (p < 0.001), and mortality rate (p < 0.001).

Based on the findings of thepresent study, the prevalence of head and neck burn injuries was about 18% and 32.14% of these cases requiredairway management. 19 (4.85%) cases developed ARDS, 41 (10.46%) developed pneumonia, and 50 (12.76%)cases died. There was a significant correlation between degree of burn and abnormal laryngoscopy findings,developing ARDS and pneumonia, need for mechanical ventilation, and mortality rate.

Endotracheal suctioning is a method commonly used to clean airway secretions in patients under mechanical ventilation (MV ). This study aimed to compare the effects of open and closed suction methods on the occurrence of ventilator associated pneumonia (VAP).

This comparative study was carried out on adult intensive care unit (ICU) patients in need of MV for more than 48 hours, from October 2018 to January 2019. Patients were randomly allocated to either closed tracheal suction system (CTSS) group or open tracheal suction system (OTSS) group. Patients were monitored for developing VAP within 72 hours of intubation and the findings were compared between groups.

120 cases with the mean age of 57.91 ± 19.9 years were randomly divided into two groups (56.7% male). The two groups were similar regarding age (p = 0.492) and sex (p = 0.713) distribution. 22 (18.3%) cases developed VAP (12 (20%) in OSST group and 10 (16.7%) in CSST; p = 0.637). The most prevalent bacterial causes of VAP were Acinetobacter_Baumannii (72.7%), Klebsiella pneumoniae (18.2%), and Methicillin-Resistant Staphylococcus aureus (9.1%), respectively. There was not any significant difference between groups regarding the mean duration of remaining under MV (p = 0.623), mean duration of hospitalization (p = 0.219), frequency of VAP (p = 0.637), and mortality (p = 0.99).

It seems that type of endotracheal suction system (OSST vs. CSST) had no effect on occurrence of VAP and other outcomes such as duration of need for MV and ICU stay as well as mortality.

Apixaban was introduced in clinical use for nonvalvular atrial fibrillation as an alternative to warfarin. There is a dearth of information regarding apixaban use in patients suffering from atrial fibrillation with intracardiac foreign bodies such as pacemaker leads. In this report, we describe a 72-year-old female patient with a complaint of weakness in both legs of a few days’ duration. She was detected to have a thrombus over the pacemaker lead and inside the left atrial appendage during apixaban treatment. After the discontinuation of apixaban and the commencement of warfarin, the thrombus was resolved. Our case is the first report to show that apixaban treatment (5 mg, twice daily) may not prevent the development of pacemaker lead thrombosis in patients with atrial fibrillation.

Slow heart rates, due to sinus node disease or atrioventricular conduction block, are a significant problem for many patients. Currently, these patients are treated with electronic pacemakers, which provide effective therapy, but are also associated with many problems. Use of biological pacemakers is an attractive solution to these problems. Approaches for the creation of such pacemakers include either the injection of cells that have pacemaker activity (cell-based approach) or modification of cells in the heart to induce pacemaker activity by delivering genes (gene-based approach). This article reviews the progress in the development of biological pacemakers.

Waiting period of fertility treatment is stressful, therefore it is necessary to use effective coping strategies to cope with waiting period of intrauterine insemination (IUI) treatment.

The aim of this study was comparing the effect of the positive reappraisal coping intervention (PRCI) with the problem-solving skills training (PSS) on the coping strategies of IUI waiting period, in infertile women referred to Milad Infertility Center in Mashhad.

In this randomized clinical trial, 108 women were evaluated into three groups. The control group received the routine care, but in PRCI group, two training sessions were held and they were asked to review the coping thoughts cards and fill out the daily monitoring forms during the waiting period, and in PSS group problem-solving skill were taught during 3 sessions. The coping strategies were compared between three groups on the 10th day of IUI waiting period.

Results showed that the mean score for problem-focused were significantly different between the control (28.54±9.70), PSS (33.71±9.31), and PRCI (30.74±10.96) (p=0.025) groups. There were significant differences between the PSS group and others groups, and mean emotion-focused were significantly different between the control (32.09±11.65), PSS (29.20±9.88), and PRCI (28.74±7.96) (p=0.036) groups. There were significant differences between the PRCI and the control group (p=0.047).

PSS was more effective to increase problem-focused coping strategies than PRCI, therefore it is recommended that this intervention should be used in infertility treatment centers.

During sliding mechanics, the frictional force (FF) is an important counterforce to orthodontic tooth movement. The purpose of this in vitro study was to investigate the static and kinetic FFs of S silica‑insert ceramic (SIC) brackets with Teflon‑coated (TC) and conventional S stainless steel (SS) archwires.
The target group of this study included 80 maxillary canine 0.022 inch slot SIC brackets. Forty SS brackets were used as the control. TC and conventional uncoated SS archwires of different dimensions (0.016, 0.018, 0.016 × 0.022, and 0.018 × 0.025 inch) were examined. All tests were carried out under artificial saliva injected condition. Scanning Electron Micrographs were prepared for two samples of coated and uncoated archwires. Analysis of variance and Tukey post hoc tests were used for statistical purposes (level of significance P SIC brackets showed significantly lower levels of FFs than SS brackets. TC archwires had greater frictional values than conventional uncoated ones. They also exhibited an unusual behavior of increasing kinetic FFs with time. Indentation and delamination of coating were obvious under scanning electron microscopy observations.
From the standpoint of friction, SIC brackets may serve well, even better than SS brackets, in sliding mechanics. The coating layer of the archwires may delaminate and lost, causing an impediment to tooth movement.

Intraoperative right ventricular perforation due to pacing catheter after its successful and uneventful insertion is a rare complication. Here, we present a case of cardiac arrest due to right ventricular perforation associated with a pacemaker lead during off-pump coronary artery bypass graft surgery.
The case was a 68-year-old male, who was admitted to our hospital with retrosternal chest pain. He had a history of implantation of a permanent pacemaker due to symptomatic complete atrioventricular block. Based on angiography, the diagnosis was 3- vessel disease involving the left anterior descending, second obtuse marginal, and right coronary arteries. The right ventricle was perforated by the tip of the permanent pacemaker lead during off-pump coronary artery bypass graft surgery. Subsequently, the patient suddenly experienced cardiac arrest and underwent emergency on-pump cardiac surgery.
This case showed that in some situations, emergency surgery as a life saving procedure may be required in cardiac perforation due to permanent pacemaker lead even following cardiac arrest.

The purpose of triggering in ovulation induction is to induce the final maturation of oocytes and their release from the ovary for fertilization.

The aim of the present study was to compare the effectiveness of gonadotropin-releasing hormone (GnRH) agonist and human chorionic gonadotropin (HCG) on the final maturation of oocytes and pregnancy rates in intrauterine insemination (IUI) cycles.

In this randomized clinical trial, 110 infertile women who were selected for IUI entered the study. Ovulation induction was performed. Group I received 0.1 mg GnRH agonist as triggering and group II received 10,000 IU of HCG. The serum Estradiol (E2), Luteinizing Hormone (LH), and Follicle-Stimulating Hormone (FSH) levels were measured at 12 and 36 hr after injection.

LH surge was detected in all patients. LH levels at 12 and 36 hr after triggering was higher in Group I and it washed out earlier than group II (p=0.00). The pregnancy rate was higher in Group I, but the difference was not statistically significant (26.9% vs. 20.8%, respectively p=0.46). Also, the incidence of ovarian hyperstimulation syndrome was not different between the two groups (p=0.11). There was a significant difference regarding the estradiol levels at 36 hours after triggering (p=0.00).

Effects of GnRH on endogenous LH surge is sufficient for oocyte releasing and final follicular maturation. Pregnancy rates and ovarian hyperstimulation syndrome incidence were not different between the groups. We suggest that GnRH agonists might be used as an alternative option instead of HCG in IUI cycles.

Most patients experience decreased physical, psychosocial, and spiritual comfort while receiving mechanical ventilation. Regarding the Muslim patients, diminished comfort might be associated with alterations in performing daily rituals, such as saying prayers (salat) and reciting the Holy Qur’an. This pilot study aimed to determine the effects of comfort care integrated with the Holy Qur’an recitation on comfort in Muslim patients being mechanically ventilated.
This quasi-experimental study was performed on a group of participants using pretest-posttest design. The samples consisted of ten Muslim patients under mechanical ventilation who met the inclusion criteria. Each participant was provided with the comfort care integrated with the Holy Qur’an recitation for three days. A modified version of Shortened General Comfort Questionnaire was utilized to evaluate comfort of the participants. The data were analyzed by SPSS using paired t-test.
Mean score of total comfort increased significantly after receiving the comfort care integrated with recitation of the Holy Qur’an (t=11.42, p=0). In addition, mean score of each context of comfort (i.e. physical, psychospiritual, environmental, and sociocultural comforts) also augmented significantly post-intervention.
This pilot study showed that the comfort care integrated with the Holy Qur’an recitation can be an effective way of enhancing comfort of Muslim patients under mechanical ventilation.

HLA-B27 is considered as one of the causes of heart conductive disorders. We studied the frequency of HLA-B27 among Iranian patients who had undergone permanent pacemaker implantation.
This descriptive and analytical study was performed among patients who underwent permanent pacemaker implantation. The questionnaire contains demographic data, underling diseases, and history of heart disease or heart surgery. The type of conductive heart disorder was mentioned there, too. We determined the regurgitation of aorta valve and its severity. Finally, HLA-B27 was accessed.All the data was entered in SPSS software and analyzed.
From a total of 103 patients entered in this study, only 6 (5.8%) were HLAB27- positive. The disturbance of conductive heart disorders based on the HLA-B27 positive or negative patients was not statistically different. Patients with HLA-B27 mostly had regurgitation of the aorta valve.
We concluded that the frequency of positive HLA-B27 genotype in patients with permanent pacemakers did not have any significant difference with the ones with negative HLA-B27 genotype. However; this genotype was associated with regurgitation of the aorta valve.

An electrocardiogram from a patient implanted with a dual-chamber DDD pacemaker showed paced QRS complexes whose morphology and frontal-plane axis were consistent with biventricular stimulation with right ventricular lead located at the apex. However, some electrocardiographic findings were suggestive, rather, of univentricular right apical pacing and sustained ventricular fusion with competing native atrioventricular conduction in the presence of patient’s spontaneous QRS showing right bundle branch block plus left anterior hemiblock. Shortening atrioventricular delay with magnet application advanced right ventricle stimulation and prevented the supraventricular impulse to contribute to ventricular depolarization, thereby making clear the mechanism of right ventricular apical pacing.

Infertility is becoming a world-wide concern in developed and developing countries. Multiple causes are responsible for the situations and various therapies have been developed to overcome this problem in infertile couples, as in the case of intrauterine insemination (IUI), with considerable variations between pregnancy rates in relation to the method employed.
To compare pregnancy rate, by human chorionic gonadotropin (HCG) administration and urinary luteinizing hormone (LH) surge method, for insemination in patients undergoing IUI.
Patients and The present study included 309 infertile women, candidate for IUI, randomly divided into LH surge and HCG groups (each participant was assigned a number from 1 to 309, of which odd numbers were for LH and even numbers for HCG groups, respectively). All patients were subjected to baseline ultrasound and received clomiphene citrate before undergoing serial transvaginal sonography. The LH was measured using LH kit, when 2 - 5 follicles (18 - 20 mm) appeared in LH surge group, and, if positive, IUI was performed after 24 hours. In HCG group, the patients received HCG 1000 units and underwent IUI after 36 hours. The pregnancy rate was then compared in LH and HCG groups.
We found no significant differences in pregnancy rates between the two groups. Also, we compared pregnancy rates between the two groups based on age, infertility cause, number of follicles, number of previous IUI and previous abortions. We found no significant differences between the subgroups, in terms of pregnancy rate.
The urinary LH surge and HCG administration methods for IUI timing are similar and none had any considerable advantages over the other. However, the use of the urinary LH surge has no side effects or injection pain, in relation to HCG administration methods.

A 22-year-old pregnant woman referred with syncope due to pacemaker malfunction. During the second trimester of pregnancy, the right ventricular (RV) lead pacing threshold increased and led to early generator depletion. We believe that this might happen due to lead micro-dislodgement or less probably effect of hormonal changes during pregnancy on electrode-myocardium interface.

Venous obstruction is relatively frequentfollowing permanent pacemaker orimplantable cardioverter-defibrillator(ICD)implantation. However, most of them are asymptomatic. Although the exact risk factor for this complication isnot known, number of leads, heart failure and infection may prone the patient to this complication. The goal standard for detection of vein stenosis is venography; however, ultrasound sonography has an acceptable accuracy. Anticoagulant therapy may be considered for symptomatic patients. For device upgrading, non-functional leads removal, venoplasty and rarely surgical treatment may be indicated.