Tanaffos最新文献

Connective tissue diseases, particularly scleroderma, pose a heightened risk for the development of malignancies such as breast and lung cancer. Stereotactic Body Radiation Therapy (SBRT) has emerged as an effective treatment modality for various cancers, including lung and breast cancers, due to its curative potential, especially for localized extracranial tumors. A 69-year-old patient with a 30-pack-year smoking history presented with shortness of breath and bilateral diffuse rales on chest auscultation during the outpatient clinic visit. Notably, the patient had not received scleroderma treatment for a year at the time of radiation therapy. Despite the recognized sensitivity of the lungs to radiotherapy, the occurrence of pneumothorax and pneumomediastinum following SBRT in this case raises concerns about the potential complications in scleroderma-ILD patients with lung cancer. This report underscores the need for comprehensive risk assessment and careful consideration of alternative treatment strategies for lung cancer in scleroderma patients, particularly those with pre-existing lung involvement. Further research is warranted to elucidate the mechanisms and risk factors associated with complications following radiotherapy in this patient population, guiding clinicians in optimizing therapeutic approaches for improved outcomes.

Background: Neurosurgical operations, especially for brain tumors, are among the most stressful medical procedures due to diagnostic uncertainties, high morbidity, and long post-operative recovery, including ICU admission. Stress management interventions may improve outcomes. This study aimed to compare the effectiveness of Cognitive Behavioral Therapy (CBT) and Motivational Interviewing (MI) in reducing perceived pre- and post-operative stress and ICU stay in patients undergoing brain surgery.

Materials and methods: In a quasi-experimental design, 80 neurosurgical candidates admitted to Shohadaye Tajrish Hospital during 2020-2022 were randomly assigned to intervention and control groups. The intervention group received 15 CBT-based sessions focused on stress management and cognitive restructuring. Stress levels were assessed using Cohen's Perceived Stress Scale (1983), and CBT protocols followed Miller (2003). Data were analyzed with SPSS using chi-square tests, independent and paired t-tests, and ANCOVA.

Results: Patients who received CBT demonstrated significantly lower perceived stress scores postoperatively (p<0.001) and had a shorter ICU stay by an average of 3.2 days (p=0.049). No significant demographic differences were observed between groups.

Conclusion: CBT significantly reduces perioperative stress and ICU duration in neurosurgical patients. Integrating psychological interventions like CBT into preoperative care protocols may enhance recovery, reduce complications, and lower healthcare costs.

Background: This is a rare condition, especially in adults, where digital clubbing presents as the initial manifestation of lymphoma. Here, we report a case of intrathoracic Hodgkin's disease (HD) with digital clubbing.

Case presentation: A 34-year-old female presented with B symptoms and a history of dyspnea. She did not take any particular medicine and had no history of any specific disease in herself or her family. In the examination, the patient has digital clubbing in the fingers and toes, which is painless. He also had decreased respiratory sounds and dullness in the right lung. After a CT scan and observation of consolidation and effusion, we performed a bronchoscopy on the patient. Finally, with the diagnosis of Hodgkin's lymphoma in the pathological reports, he was subjected to appropriate treatment measures.

Conclusion: A precise examination and paraclinical assistance are needed to rule out intrathoracic malignancies in patients with digital clubbing.

Background: Obstructive sleep apnea (OSA) is associated with increased vagal activity, sympathetic nervous system activation, and cardiovascular complications. Excessive daytime sleepiness (EDS) in OSA patients is a predictor of cardiovascular and all-cause mortality. Heart rate variability (HRV) can be used to assess cardiac autonomic modulation, which is affected by OSA. This study aimed to evaluate the relationship between HRV and daily sleepiness in OSA patients based on the excessive sleep scale (ESS) scores.

Materials and methods: The study included 70 patients with OSA, divided into two groups: those with EDS (ESS ≥ 11) and those without sleepiness (ESS < 11). Time and frequency domain parameters were evaluated. The results were compared and analyzed between the two groups.

Results: Patients with OSA and EDS had higher cardiovascular risk, as indicated by different HRV parameters (higher low-frequency parameter and higher time domain parameters), compared to non-sleepy OSA patients. A significant positive correlation was found between ODI and AHI with VLF, and significantly higher LF and VLF in EDS patients.

Conclusion: OSA patients with EDS had higher cardiovascular risk, as indicated by different HRV parameters, compared to non-sleepy OSA patients. A significant positive correlation was found between ODI and AHI with VLF, and significantly higher LF and VLF in EDS patients. Further studies are needed to better understand the relationship between HRV and daily sleepiness in patients with OSA.

Background: In medical science, the probability of survival is a crucial index used to assess patient outcomes. This study aims to estimate the survival probability of patients diagnosed with COVID-19.

Materials and methods: In a historical cohort study, the Kaplan-Meier method was used to assess the survival probability of 4,372 COVID-19 patients treated at Dr. Masih Daneshvari Hospital in Tehran during the pandemic.

Results: The study results indicated that 199 patients (4.6%) died during the treatment, while 4,173 patients (95.4%) were censored. The daily survival probability estimation for COVID-19 patients revealed that the highest and lowest survival probabilities within 100 days from disease onset were 96% and 55%, respectively. Additionally, the survival probabilities on the 20th, 50th, 70th, and 90th days from the onset of disease and treatment were 92%, 70%, 63%, and 61%, respectively.

Conclusion: Estimating the survival probability of COVID-19 patients offers clinicians valuable insights into mortality rates and the effectiveness of common therapeutic strategies in treating the disease.

Background: Chronic obstructive pulmonary disease (COPD) is an inflammatory systemic disorder that affects the respiratory tract airways and breathing. Left ventricular diastolic dysfunction (LVDD), which is the inability of the ventricle to fill to a normal end-diastolic volume, may be observed in patients with severe COPD. This study aimed to evaluate LVDD in patients with COPD.

Materials and methods: This cross-sectional study included 58 patients under 65 years of age with COPD as the case group. Moreover, 58 patients with normal spirometry and without pulmonary or cardiac disease were included as the control group. They referred to the cardiologist for echocardiography. Patients were tested for C-reactive protein (CRP) and N-terminal pro-B-type natriuretic peptides (NT -pro BNP). Data were analyzed with SPSS for descriptive reports of the relationship between variables.

Results: The results showed that LVDD was significantly higher in COPD patients (60%) than in the control group (12.2%). Also, there was no significant relationship between LVDD and BMI in COPD patients. Evaluation of CRP and PRO-BNP showed that the distribution of patients in different diastolic function classes is similar. It was observed that with increasing COPD severity, LVDD severity increased (p-value =0.101). There is a direct relationship between total lung capacity (TLC) and LVDD (P-value <0.0001). In COPD patients, there was a significant relationship between diastolic function and SPAP (P-value <0.0019).

Conclusion: In general, it should be noted that the prevalence of LVDD in patients with COPD is significantly higher than in other people.

Background: Using Health-related quality of life (HRQL) in chronic patients with severe respiratory insufficiency (SRI) requires a valid instrument. Hence, this study aimed to translate and validate the Persian version of the Severe Respiratory Insufficiency Questionnaire in chronic patients with severe respiratory insufficiency.

Materials and methods: In this methodological study, the original version of the HRQL questionnaire in chronic patients with SRI was translated based on the approach presented by Wild et al. Face validity, content validity such as content validity index (CVI) and content validity ratio (CVR), convergent, and discriminant validity were evaluated. Moreover, construct validity evaluation was conducted by exploratory and confirmatory factor analyses (EFA & CFA).Reliability was also evaluated by calculating Cronbach's alpha and test-retest intraclass correlation coefficient (ICC). SPSS-16 and AMOS-24 software were used for data analysis.

Results: The target group approved the face validity of the questionnaire and the content validity index was 0.94. In total, 500 chronic patients with severe respiratory insufficiency participated in the construct validity. Seven factors were extracted in exploratory factor analysis as respiratory complaints, physical functioning, social relationship, anxiety, attendant symptoms and sleep, social functioning, and psychological well-being. These factors explained 73.91% of the total variance of the concept of HRQL in chronic patients with SRI. All factors confirmed in confirmatory factor analysis based on model fit indices [Comparative Fit Index (CFI)=0.94, Goodness of fit index (GFI)=0.94, Minimum Discrepancy Function by Degrees of Freedom divided (CMIN/DF) =2.99, and Root Mean Square Error of Approximation (RMSEA)=0.01]. Convergent and discriminant validity were also confirmed. Moreover, Cronbach's alpha coefficients of 0.84 and intraclass correlation coefficient of 0.82-0.96 with 15-day intervals confirmed the internal consistency of the instrument.

Conclusion: According to the findings of the present study, the Persian version of the SRI questionnaire, with 7 subscales and 40 items, is a valid and reliable instrument to assess the HRQL in chronic patients with SRI.

Background: The current study attempts to look at the trend of medication prescription among inpatients with COVID-19 by comparing two groups of them who were admitted into our hospital at separate times at around two-year intervals.

Materials and methods: Through a retrospective cross-sectional design, the current study enrolled hospitalized cases from two separate periods including winter 2019 and summer 2021 to compare some characteristics of COVID-19 in addition to sex and age distribution as well as the approach and management and their changes as the time passed.

Results: Remdesivir was raised to be the most commonly used medication for COVID-19 after one and a half years when approved by the FDA in this regard. Tocilizumab was prescribed for just less than 6% of earlier pandemics in winter 2019 while used in more than half of hospitalizations in 2021. After two years, corticosteroids are used in 98.6% of the cases at least in our center.

Conclusion: Exact medication administration to target COVID-19 and accurate vaccination in addition to "Herd immunity" among the global population seems to be the chief secret of the current success at least for partial control of the disease now.