Electronic Physician最新文献

Introduction: Thyrotoxic periodic paralysis (TPP) is a rare and potentially lethal complication of hyperthyroidism. It is characterized by sudden onset paralysis associated with hypokalemia. Management includes prompt normalization of potassium, which results in resolution of the paralysis. Definitive treatment of hyperthyroidism resolves TPP completely.

Case presentation: A 23-year-old African American male patient presented to the emergency room at the University of Mississippi Medical Center, USA in November 2016 with sudden onset quadriplegia. He also endorsed a history of weight loss, palpitations, heat intolerance and tremors. The patient reported similar episodes of quadriplegia in the past, which were associated with hypokalemia and resolved with normalization of potassium levels. Physical examination was significant for exophthalmos, smooth goiter with bruit consistent with the diagnosis of Graves' disease. Laboratory assessment showed severe hypokalemia, hypomagnesemia, suppressed thyroid stimulating hormone (TSH) and high free thyroxine (T4). Urine potassium creatinine ratio was less than one, indicating transcellular shift as the cause of hypokalemia. After normalization of potassium and magnesium, the paralysis resolved in 12 hours. He was started on methimazole. On follow up, the patient was clinically and biochemically euthyroid with no further episodes of paralysis.

Take-away lesson: TPP is a rare and reversible cause of paralysis. Physicians need to be aware of the diagnostic and treatment modalities as delayed recognition in treatment could result in potential harm or unnecessary interventions.

Background: Influenza outbreaks occur annually and have significant ramifications on the wellbeing of the population. Influenza is given high priority in Saudi Arabia where numerous reports of different types of influenza outbreaks have occurred in recent years.

Objective: The study aimed to determine the prevalence of influenza vaccination among healthcare providers.

Methods: The study employed a cross-sectional design, and data was collected using a predesigned questionnaire which was validated by a panel of experts and tested for reliability (Cronbach's alpha =0.8). All primary healthcare workers in Arar city (Saudi Arabia) were taken as a comprehensive sample between January and March 2018. The questionnaire used a Likert scale that assessed the reasons for embracing or rejecting the influenza vaccines. A p-value of ≤0.05 was considered statistically significant.

Results: In total, 204 health professionals (72 physicians, 102 nurses and 30 other staff members) filled the questionnaire. The mean age of the healthcare professionals was 31.9±8.7 years. Self-report of seasonal influenza vaccination uptake was 55.9% (65.3% for physicians, 55.9% for nurses and 33.3% for other staff). Perceived risk of severity of influenza was 2.5 times more in the compliant group than that of the non-compliant group (p<0.001, 95% CI: 1.4-4.4).

Conclusion: Utilization of influenza vaccine is 55% in both nurses and physicians despite 89% of them being aware of influenza vaccination guidelines and MOH recommendations. It is needed to ensure the intensive education of healthcare providers to understand the protective value of influenza vaccine.

Background: Acne vulgaris is a common heath problem affecting adolescents with considerable impact on their quality of life.

Objective: To determine the prevalence of Acne vulgaris and its psychological impact among female secondary school students.

Methods: A cross-sectional study was conducted during the period from January to March 2018, among all female secondary school students in 3 randomly selected schools, in Arar city (Saudi Arabia). The participants were clinically examined by a dermatologist to identify acne cases. Dermatological quality of life of acne cases were assessed using an Arabic version of Dermatology Life Quality Index (DLQI). Data collected were analyzed by IBM-SPSS version 20, using Chi-square, Fisher's Exact test, Mann-Whitney U, and Kruskal Wallis test. P-value ≤0.05 was considered statically significant.

Results: The overall prevalence of Acne vulgaris was 14.3%. It was not significantly affected by age, marital status or nationality of participants. Post inflammatory hyper-pigmentation and scarring were detected in 11.6% and 8.7% respectively. Twenty nine percent of the cases had no impact; 56.3% had small to moderate impact and 14.5% had large effect. The psychological impact was significantly increased with increased severity, presence of acne lesions on face and other sites, presence of hyper pigmentation and scarring (p=0.001).

Conclusion: Acne vulgaris had large impact on quality of life in 14.5% of cases. Students should be counseled and educated on how to deal with this dermatological problem.

Background: Uncontrolled symptoms of diabetes can lead to irreparable damage to vital organs. Despite the global trend towards the use of complementary alternative therapies, few studies have evaluated the effectiveness of self-acupressure in diabetes patients.

Objective: The aim of this study was to determine the effect of self-acupressure on FBS and insulin level in type 2 diabetes patients.

Methods: This randomized clinical trial was performed from September 2016 to February 2017. A total of 60 diabetic patients were selected from diabetes clinic in Rafsanjan in Iran, according to inclusion and exclusion criteria and then assigned to 2 groups (30 in acupressure and 30 in control) randomly by the minimization method. The intervention group received acupressure at ST-36, LIV-3, KD-3 and SP-6 points bilaterally for five minutes for each point in 10 seconds pressure and 2 seconds rest periods. Subjects in the control group received no intervention. The FBS and insulin levels were measured before and after the intervention for both groups. The data were analyzed by SPSS version 16 by the Chi-square test, independent-samples t-test, and paired-samples t-test. A level of 0.05 was considered significant for examining the hypotheses.

Results: There were no significant differences between the acupressure and control group regarding age, sex and level of education. The insulin level significantly increased after treatment in the acupressure group (p=0.001). There were no significant differences between the levels of insulin in study or control groups. Serum FBS level decreased significantly after intervention in the acupressure group compared to the control group (p=0.02).

Conclusion: Self-acupressure as a complementary alternative medicine can be a helpful complementary method in reducing FBS and increasing insulin levels in type 2 diabetic patients.

Trial registration: This trial was registered at the Iranian Registry of Clinical Trials with clinical trial registration number: IRCT2016122131459N1.

Funding: This study was financially sported by Deputy of Research and Technology of Rafsanjan University of Medical Sciences (Ref: 20.519).

Background: Caring for patients with brain death diagnosis is the heaviest of duties for nurses, and, due to the complexities and stressors, it is the biggest challenge of nursing in an intensive care unit.

Objective: This qualitative research aimed to disclose the nurses' experience of caring for brain-dead patients.

Methods: The present study was a qualitative research using a content analysis, where the data collection process included 21 semi-structured and in-depth interviews with intensive care nurses, physicians, head nurses, a transplantation committee coordinator, and the authority of the organ procurement unit. Adequate data were collected from March 2014 until the saturation point was reached in June 2016. Data were analyzed simultaneously with data collection using qualitative content analysis with a conventional approach.

Results: Qualitative content analysis of data resulted in two themes and eight subthemes, reflecting the analysis of nurses' experiences of caring for brain-dead patients. The themes included "Challenges of right and duty requirement," and "turbulent confrontation with successive chains of tension". Finally, the main themes of "resonance of stress and internal conflict in care" were abstracted.

Conclusion: The findings deepened our understanding and knowledge of the issue. Despite all the stress, nurses care for potential organ donors, and this results in preserving the organs' viability for donation. Nurses' problems and challenges in this caring process should be considered by policymakers of health and treatment systems and a supportive model be designed for nurses in the intensive care unit.

Background: Investing in adolescent health is one of the most important interventions in the health system. Accordingly, health-promoting schools organize their policies, methods, infrastructures, and activities towards protecting and promoting the health and well-being of the students, teachers, directors, authorities and society as a whole.

Objective: To study the health policies of schools in the southeast of Iran.

Methods: This cross-sectional study was carried out on all governmental high schools (113 schools) which were enrolled by census sampling method in January 2017, in Zahedan, in the southeast of Iran. The study tool was a validated questionnaire about the "School Health Policies and Programs" that was completed by the principals or staff of the schools. Data were analyzed by SPSS version 15, using descriptive statistic and linear regression test.

Results: About one-third of the schools did not have a health educator. Some policies, including annual medical examinations, having a healthy breakfast at school, healthy food supply at lower prices in school buffets, and counseling the students with special conditions in schools were not implemented. The most inter-sectoral cooperation was among the health centers (47.8%). The mean score of health policy implementation in schools was 89.70±11.51. Linear regression analysis demonstrated a significant relationship between type of school (p<0.05) and number of students in schools as well as attendance of a health educator in schools (p<0.001) with health policies.

Conclusions: Despite the implementation of the program in Iran in recent years, there are no clear and identical policies in the schools. Therefore, there is need to establish health policy committees in schools from among staff, teachers, parents, and students. In addition, success of the program requires inter-sectoral collaboration, supporting environmental health and improvement of parents' relationships with the school.

Background: Increased subcutaneous fat thickness and depth of target organs in over-obese patients, results in weak signals and inadequate images. Tissue harmonic imaging has been used widely in obese patients and is believed to result in higher quality images. This superiority is not proved in modern machines with improved image quality in conventional mode.

Objective: To compare the image quality between conventional and tissue harmonic ultrasound images.

Methods: This cross-sectional study was carried out from March 2015 to June 2016. Seventy-six over-obese patients referred to Ghaem Hospital (Mashhad, Iran) for weight-correction surgeries, were enrolled into the study. Conventional and tissue harmonic images of their kidneys were blinded and compared back-to-back by four expert radiologists. Data were analyzed by SPSS version 16, using Cochrane's Q test.

Results: All raters reported image quality to be better in tissue harmonic compared to fundamental frequency ultrasound (p=0.000, Cochrane's Q test). Although better image quality in tissue harmonic mode was reported by the four raters, there was weak inter-observer agreement (p=0.081 for right kidney and p=0.21 for left kidney).

Conclusion: Advances in ultrasound equipment and the introduction of tissue harmonic imaging can improve the diagnostic performance in over-obese patients and this mode of imaging should be used whenever evaluating over-obese subjects.

Background: Chronic rhinosinusitis is one of the most common diseases affecting the quality of life of patients. Patients suffer from high costs in the diagnosis and treatment of the disease. Frequent recurrence and failure of therapeutic protocols are among the most important issues in the management of this disease. In view of this, the use of traditional and complementary therapies to promote the treatment of this disease has been increasingly taken into account.

Objective: Comparison of the effectiveness of the Persian Medicine Protocol with the conventional therapy in the treatment of chronic rhinosinusitis.

Methods: A randomized clinical trial was conducted at Imam Reza Hospital in Mashhad, Iran from July 2016 to March 2017. For patients with chronic rhinosinusitis symptoms, endoscopy of the sinuses was performed by an ENT specialist and in the case of negative endoscopy, paranasal sinus CT scan was requested. A total of 42 patients with chronic rhinosinusitis were randomly assigned to two groups. The first group (classical) received systemic and intranasal cortisone, and the second group (traditional) received a therapeutic Persian medicine protocol including intranasal lavender oil, and Liquorice Marjoram Tea (L. M. tea) for six weeks. The symptoms of the patients were evaluated using the SNOT-22 questionnaire at the beginning of the study and at the sixth week. If no improvement occurs, treatment continued for 12 weeks. Data were analyzed by SPSS version 16, using ANOVA, independent-samples and paired-samples t-test, Wilcoxon signed-rank test, and simple linear regression.

Results: In 20 patients in the traditional group, the decrease in SNOT score was observed as 56% after 6 weeks treatment (p=0.001), which is similar to the effect of the first group (classical). Although there was no statically significant difference between the two groups, in clinical terms, the difference in mean systemic symptoms such as confusion with 1.05 (p=0.5) and fatigue with 1.63 (p=0.01) had more improvement in the traditional group, and the difference in mean local symptoms such as nasal congestion with 2.37 (p=0.78) and runny nose with 1.95 (p=0.14) had a more decrease in the classical group.

Conclusion: The results of this trial indicate the effectiveness of the Persian Medicine Protocol (including Lavender oil and L.M tea) in the treatment of chronic rhinosinusitis, especially on improving systemic symptoms. Nevertheless more clinical studies are necessary to support the acquired results.

Trial registration: This trial was registered at the Iranian Center for Clinical Trials (ID: IRCT2015112425217N1).

Funding: This research is part of a PhD thesis and is funded by the Vice-Chancellor for Research at Mashhad University of Medical Sciences, Grant No. 931673.

Background: Despite advantages of normal vaginal delivery (NVD) and disadvantages of caesarean section (C-section) and the increasing C-section rate Iran, appropriate training is essential in reducing this trend. Optimism is one of the important psychological determinants which is a combination of positive desire and attitude in people.

Objective: The purpose of this study was to determine the effects of optimism training as well as training the benefits of natural childbirth on attitude and intentions to choose the type of delivery.

Methods: In this experimental study, 96 primiparous women referring to health centers in Mashhad (Iran) in 2014 with pregnancy duration of 30 to 34 weeks and without indication of C-section, were selected and randomly divided into two training groups and one control group. Optimism training was provided during six 60-minute sessions, whereas training the benefits of NVD was conducted in four 60-minute sessions. Pre-test and post-test were performed using valid and reliable questionnaires, researcher-made questionnaire, attitude-measuring questions on NVD and C-section, and optimism-measuring standard questionnaires (LOT-R). Data were analyzed by IBM-SPSS version 22, using Kruskal-Wallis, Chi square, paired-samples t-test, Independent-samples t-test, Man-Whitney U, and Wilcoxon signed-rank test.

Result: There was a significant difference between the mean scores of attitudes towards natural delivery in the group that received both optimism and natural delivery advantages trainings compared with the group receiving only the latter (p>0.001). Frequency of intentions to choose the type of delivery after optimism and natural delivery advantages trainings compared with training the benefits of natural childbirth only, did not show a significant difference (p=0.135).

Conclusion: Optimism training combined with training the benefits of natural childbirth is more effective in creating positive attitude towards natural delivery in comparison with only the NVD advantages education, but it has no effect on selecting the type of delivery. Probably one of the most important reasons of failure of achieving a proper result is the low sample size.

Trial registration: The trial was registered at the Iranian Registry of Clinical Trials (http://www.irct.ir) with the Irct ID: IRCT2015063022995N1.

Funding: This trial is funded by Mashhad University of Medical Sciences in collaboration with the Evidence-Based Research Center (Ref: research/930321/1/172).

Background: Bullying and victimization behaviors are a serious problem for students, peers, parents, and school teachers. These behaviors usually persist and cause communication problems.

Objective: To determine the effect of education based on the socio-ecological theory on bullying in students.

Methods: This educational study was of the field-trial type, and carried out on 237 middle school students in Gonabad City (Iran), from September 2015 to May 2016. The intervention group consisted of 147 students, and 90 were assigned to a control group. The intervention (Five sessions of bullying and victimization were discussed) based socio-ecological theory at two levels: individual level and interpersonal level. The intervention was carried out on the students, their parents, and school teachers in two schools. To this end, the multi-stage random sampling was done. Prior to the intervention, the Illinois questionnaire as well as a researcher-made questionnaire was completed. The researcher-made questionnaire included demographic characteristics with regard to living with both parents, one parent or no parents (a guardian) and questions about bullying behaviors in the family as well as about knowledge and attitudes towards bullying. Subsequently, the questionnaire was completed by the students one month and six months after the intervention. The data was analyzed by IBM-SPSS version 21, using ANOVA, multiple regression, repeated measures, Chi-square, and Man-Whitney U test.

Results: The findings showed that there was no significant difference between the mean attitude of the students before and after training. However, the mean score of bullying behaviors in the experimental group was significantly reduced one month after the intervention, but it increased after six months. Moreover, there was a significant difference in terms of bullying behaviors between the intervention and control groups (p=0.0001). Furthermore, a significant relationship was found between the mothers' education level and the students' bullying behaviors (p=0.009.

Conclusion: Bullying is an important problem that affects schools and influences the academic and social capabilities of students. In this regard, the role of educators is the most important, and education on the basis of the socio-ecological model was proved to be effective in reducing bullying. Therefore, educational intervention should be taken at two levels of school and family.