Pub Date : 2023-12-23DOI: 10.18502/acta.v61i7.14497
P. Karimzadeh, Reza Shiari, M. H. Amouzadeh, Samane Rahimi, Shaghayegh Sadat Esmail Nejad, Seyed Mohammad Hashem Montazeri, M. Arjmandnia
To evaluate the prevalence of positive serum antinuclear antibody (ANA) in children with epilepsy using three major antiepileptic drugs (phenytoin, carbamazepine and ethosuximide), 60 children under 18 years with epilepsy who were referred to pediatric neurology clinic or had admitted to neurology ward in Children Hospital in Tehran, Iran, were entered our study. They had been treated with one of the three antiepileptic drugs (carbamazepin, phenytoin, ethosuximide) with suitable dose for at least one month. The patients were divided into two groups according to the classification of the International League Against Epilepsy (ILAE): drug-resistant and drug-responsive. We studied the epidemiological and clinical characteristics and also serum ANA of the patients in both groups. In this research, we studied ANA in 60 epileptic children. 30 patients were diagnosed with drug resistant epilepsy and the other 30 were drug responsive. None of them showed the clinical manifestations of lupus erythematosus. As a whole, 7 patients (11.7%) were ANA-positive, 6.7% of drug resistant and 16.7% of drug responsive group showed this finding. There was no relationship between drug resistancy and ANA according to statistical studies (P=0.21). Although in our study, epidemiological and clinical data of the patients was reported in two separate groups of resistant or responsive to antiepileptic drugs, and no meaningful statistical difference was found between these two groups. Overally in our study, the prevalence of positive ANA in patients receiving antiepileptic drugs was less in comparison with previous studies and was more common in males. Finally, we suggest a more comprehensive and extensive study with more cases and further follow-up period in order to find the cause of immunological reactions to antiepileptic drugs in children with epilepsy.
为了评估使用三种主要抗癫痫药物（苯妥英、卡马西平和乙琥胺）的癫痫患儿中血清抗核抗体（ANA）阳性的患病率，我们选取了 60 名 18 岁以下的癫痫患儿作为研究对象，这些患儿被转诊到伊朗德黑兰儿童医院的小儿神经科门诊或神经科病房。他们已使用三种抗癫痫药物（卡马西平、苯妥英、乙琥胺）中的一种并服用适当剂量至少一个月。根据国际抗癫痫联盟（ILAE）的分类，这些患者被分为两组：耐药组和药物反应组。我们对两组患者的流行病学和临床特征以及血清 ANA 进行了研究。在这项研究中，我们对 60 名癫痫儿童进行了 ANA 研究。其中 30 名患者被诊断为耐药性癫痫，另外 30 名为药物反应性癫痫。他们都没有红斑狼疮的临床表现。总体而言，7 名患者（11.7%）ANA 阳性，其中 6.7% 的耐药组和 16.7% 的药物反应组患者有此表现。根据统计研究，耐药性与 ANA 之间没有关系（P=0.21）。尽管在我们的研究中，患者的流行病学和临床数据被报告为对抗癫痫药物耐药或有反应的两组，但在这两组之间没有发现有意义的统计学差异。总的来说，在我们的研究中，接受抗癫痫药物治疗的患者中 ANA 阳性的发生率低于以往的研究，而且男性更为常见。最后，我们建议进行更全面、更广泛的研究，增加病例数，延长随访时间，以便找到癫痫患儿服用抗癫痫药物后出现免疫反应的原因。
{"title":"The Prevalence of Serum Anti Nuclear Antibodies in Children Treated With Anti-Epileptics","authors":"P. Karimzadeh, Reza Shiari, M. H. Amouzadeh, Samane Rahimi, Shaghayegh Sadat Esmail Nejad, Seyed Mohammad Hashem Montazeri, M. Arjmandnia","doi":"10.18502/acta.v61i7.14497","DOIUrl":"https://doi.org/10.18502/acta.v61i7.14497","url":null,"abstract":"To evaluate the prevalence of positive serum antinuclear antibody (ANA) in children with epilepsy using three major antiepileptic drugs (phenytoin, carbamazepine and ethosuximide), 60 children under 18 years with epilepsy who were referred to pediatric neurology clinic or had admitted to neurology ward in Children Hospital in Tehran, Iran, were entered our study. They had been treated with one of the three antiepileptic drugs (carbamazepin, phenytoin, ethosuximide) with suitable dose for at least one month. The patients were divided into two groups according to the classification of the International League Against Epilepsy (ILAE): drug-resistant and drug-responsive. We studied the epidemiological and clinical characteristics and also serum ANA of the patients in both groups. In this research, we studied ANA in 60 epileptic children. 30 patients were diagnosed with drug resistant epilepsy and the other 30 were drug responsive. None of them showed the clinical manifestations of lupus erythematosus. As a whole, 7 patients (11.7%) were ANA-positive, 6.7% of drug resistant and 16.7% of drug responsive group showed this finding. There was no relationship between drug resistancy and ANA according to statistical studies (P=0.21). Although in our study, epidemiological and clinical data of the patients was reported in two separate groups of resistant or responsive to antiepileptic drugs, and no meaningful statistical difference was found between these two groups. Overally in our study, the prevalence of positive ANA in patients receiving antiepileptic drugs was less in comparison with previous studies and was more common in males. Finally, we suggest a more comprehensive and extensive study with more cases and further follow-up period in order to find the cause of immunological reactions to antiepileptic drugs in children with epilepsy.","PeriodicalId":6946,"journal":{"name":"Acta medica Iranica","volume":"52 S1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139162684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-23DOI: 10.18502/acta.v61i7.14499
Mohammadreza Barzegartahamtan, Ali Basi, Leila Khalafi, Zahra Falahatpour, Ali Mohamad, S. R. Mahdavi
Chordoma is a bone tumor that is resistant to radiotherapy, and few studies have been published on the concomitant use of radiotherapy in combination with hyperthermia in its treatment. We reported a chordoma patient treated with both radiotherapy and hyperthermia. The patient was a 74-year-old man with chordoma who underwent radiotherapy combined with hyperthermia due to his unwillingness to undergo surgery and responded very well clinically and imaging-wise without increasing in complications. Radiotherapy combined with hyperthermia improves the response to treatment (both clinically and in imaging) and does not increase the complications.
{"title":"Chordoma: Excellent Response to Radiotherapy in Combination With Hyperthermia","authors":"Mohammadreza Barzegartahamtan, Ali Basi, Leila Khalafi, Zahra Falahatpour, Ali Mohamad, S. R. Mahdavi","doi":"10.18502/acta.v61i7.14499","DOIUrl":"https://doi.org/10.18502/acta.v61i7.14499","url":null,"abstract":"Chordoma is a bone tumor that is resistant to radiotherapy, and few studies have been published on the concomitant use of radiotherapy in combination with hyperthermia in its treatment. We reported a chordoma patient treated with both radiotherapy and hyperthermia. The patient was a 74-year-old man with chordoma who underwent radiotherapy combined with hyperthermia due to his unwillingness to undergo surgery and responded very well clinically and imaging-wise without increasing in complications. Radiotherapy combined with hyperthermia improves the response to treatment (both clinically and in imaging) and does not increase the complications.","PeriodicalId":6946,"journal":{"name":"Acta medica Iranica","volume":"43 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139162816","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-23DOI: 10.18502/acta.v61i7.14496
Mohammadreza Salehi, Mohammad-Taghi Beig Mohammadi, Seyed Hamidreza Abtahi, S. Ghazi, Abolfazl Sobati, Rama Bozorgmehr, Seyed Ali Dehgan Manshadi, Saeed Reza Jamali Siahkali, Mostafa Mohammadi, B. M. Badie, Tahereh Sajadifard, Ensiyeh Rahimi
Despite the improvement in COVID-19 therapeutic management the mortality of mechanically ventilated COVID-19 patients remains high. In this study, we determined the risk factors of death in these cases. This cross-sectional study evaluated clinical and paraclinical features of mechanically ventilated COVID-19 patients at the time of hospital admission until death or discharge from hospital between April and September in 2021 in three COVID-19 referral hospitals. The patients were divided into survivors and non-survivors and then the characteristics were compared. One hundred twenty-five patients (60% male, mean age 62±15.18, range 17 to 97 years old) were recruited to the study. 51(40%) survived and 74 (60%) didn’t survive. At the time of hospital admission, the vital signs were not significantly different between the survivors and non-survivors, although diarrhea was not reported in non-survivors, but reported in 9.5% of survivors (P=0.02). The mean age of non-survivors was higher (65.1±14.17 vs 56.9±15.41, P=0.003). The intubation time since the patients were admitted was not significantly different between the two groups (3.38±2.88 days vs 4.16±3.42 days, P=0.34). The mean of serum LDH and D-dimer at the time of ICU admission were significantly higher in the non-survivors (863±449 vs 613±326, P=0.01; 4081±3342 vs 542±634, P=0.009; respectively). However, the mean CRP was not significantly different between the two groups (76±66.4, 54±84.3; P=0.1). Mean APACHE-II score was higher in the non-survivors than the survivors (15 vs 13; P=0.01). Use of remdesivir, interferon beta-1a, and low dose corticosteroids were significantly higher in the survivors group (P=0.009, P=0.001, P=0.000). Success of weaning and ICU discharge among mechanically ventilated COVID-19 patients are probably higher in younger patients with lower D-dimmer and LDH that received remdesivir, interferon beta-1a and low dose corticosteroids, while the intubation time did not seem to play a role on patients' outcome.
尽管 COVID-19 治疗管理有所改善，但机械通气 COVID-19 患者的死亡率仍然很高。在这项研究中，我们确定了这些病例的死亡风险因素。这项横断面研究评估了三家 COVID-19 转诊医院的 COVID-19 机械通气患者从入院到死亡或出院（2021 年 4 月至 9 月）期间的临床和辅助临床特征。患者被分为存活者和非存活者，然后对其特征进行比较。研究共招募了125名患者（60%为男性，平均年龄（62±15.18）岁，年龄范围为17至97岁）。其中 51 人（40%）存活，74 人（60%）未存活。入院时，存活者和非存活者的生命体征无明显差异，但非存活者未报告腹泻，而存活者中有 9.5%报告腹泻（P=0.02）。非幸存者的平均年龄更高（65.1±14.17 vs 56.9±15.41，P=0.003）。两组患者入院后的插管时间无明显差异（3.38±2.88 天 vs 4.16±3.42天，P=0.34）。非幸存者入院时血清 LDH 和 D-二聚体的平均值明显高于幸存者（分别为 863±449 vs 613±326，P=0.01；4081±3342 vs 542±634，P=0.009）。然而，两组患者的平均 CRP 无明显差异（76±66.4，54±84.3；P=0.1）。非幸存者的平均 APACHE-II 评分高于幸存者（15 vs 13；P=0.01）。幸存者组使用雷米替韦、β-1a 干扰素和小剂量皮质类固醇的比例明显更高（P=0.009、P=0.001、P=0.000）。在接受雷米替韦、β-1a 干扰素和小剂量皮质类固醇治疗的较年轻、D-二聚体和 LDH 较低的 COVID-19 机械通气患者中，断气和出 ICU 的成功率可能较高，而插管时间似乎对患者的预后没有影响。
{"title":"Risk Factors of Death in Mechanically Ventilated COVID-19 Patients: A Multi-Center Study From Iran","authors":"Mohammadreza Salehi, Mohammad-Taghi Beig Mohammadi, Seyed Hamidreza Abtahi, S. Ghazi, Abolfazl Sobati, Rama Bozorgmehr, Seyed Ali Dehgan Manshadi, Saeed Reza Jamali Siahkali, Mostafa Mohammadi, B. M. Badie, Tahereh Sajadifard, Ensiyeh Rahimi","doi":"10.18502/acta.v61i7.14496","DOIUrl":"https://doi.org/10.18502/acta.v61i7.14496","url":null,"abstract":"Despite the improvement in COVID-19 therapeutic management the mortality of mechanically ventilated COVID-19 patients remains high. In this study, we determined the risk factors of death in these cases. This cross-sectional study evaluated clinical and paraclinical features of mechanically ventilated COVID-19 patients at the time of hospital admission until death or discharge from hospital between April and September in 2021 in three COVID-19 referral hospitals. The patients were divided into survivors and non-survivors and then the characteristics were compared. One hundred twenty-five patients (60% male, mean age 62±15.18, range 17 to 97 years old) were recruited to the study. 51(40%) survived and 74 (60%) didn’t survive. At the time of hospital admission, the vital signs were not significantly different between the survivors and non-survivors, although diarrhea was not reported in non-survivors, but reported in 9.5% of survivors (P=0.02). The mean age of non-survivors was higher (65.1±14.17 vs 56.9±15.41, P=0.003). The intubation time since the patients were admitted was not significantly different between the two groups (3.38±2.88 days vs 4.16±3.42 days, P=0.34). The mean of serum LDH and D-dimer at the time of ICU admission were significantly higher in the non-survivors (863±449 vs 613±326, P=0.01; 4081±3342 vs 542±634, P=0.009; respectively). However, the mean CRP was not significantly different between the two groups (76±66.4, 54±84.3; P=0.1). Mean APACHE-II score was higher in the non-survivors than the survivors (15 vs 13; P=0.01). Use of remdesivir, interferon beta-1a, and low dose corticosteroids were significantly higher in the survivors group (P=0.009, P=0.001, P=0.000). Success of weaning and ICU discharge among mechanically ventilated COVID-19 patients are probably higher in younger patients with lower D-dimmer and LDH that received remdesivir, interferon beta-1a and low dose corticosteroids, while the intubation time did not seem to play a role on patients' outcome.","PeriodicalId":6946,"journal":{"name":"Acta medica Iranica","volume":"50 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139162713","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-23DOI: 10.18502/acta.v61i7.14493
Gabriela Sartori, Fabiane Pertille, A. Alberti, Bruna B. da Silva, Fabiana M. Dallacosta, Graciele Fin, Renan Souza, C. M. Comim, Rudy J. Nodari Júnior
Systemic arterial hypertension is a clinical condition of great risk in the development of cardiovascular diseases and it has a high impact on public health. The disease is influenced by modifiable and non-modifiable factors. In that context, Dermatoglyphics is a method of analysis of fingerprints as a mark of biological individuality and that can be related to health, sports, and the prognosis of diseases due to being able to point out the individual with the potential to develop certain diseases. This study aimed to investigate the characteristics of the fingerprints of women with systemic arterial hypertension by comparing them with a control group, which does not present the disease. Thus, we intend to find a dermatoglyphic pattern for Brazilian women with systemic arterial hypertension. The sample in the study consisted of 732 women, 366 with a positive clinical diagnosis for systemic arterial hypertension, and 366 individuals forming a control group, which did not present systemic arterial hypertension. All individuals in the sample are of equivalent age and the fingerprints were collected from all fingers. The method used to determine the profile of the individuals is the computerized dermatoglyphic. It was used, for the collection of fingerprints, of the Dermatoglyphic Reader®, which presents results of 400% more precision. There was a statistically significant difference between the groups, and when the Adjusted Residue Analysis was performed, the Ulnar Loop figure on fingers 4 and 5 of the left hand, and fingers 1 and 5 of the right hand, was predominant in the group of women with hypertension. These results demonstrate the existence of a dermatoglyphic mark, characteristic of patients with systemic arterial hypertension. Therefore, it can be concluded that the analysis of fingerprints of the hands by the Dermatoglyphic method can demonstrate the potential that women could have developing systemic arterial hypertension.
{"title":"Dermatoglyphics of Women With Systemic Arterial Hypertension","authors":"Gabriela Sartori, Fabiane Pertille, A. Alberti, Bruna B. da Silva, Fabiana M. Dallacosta, Graciele Fin, Renan Souza, C. M. Comim, Rudy J. Nodari Júnior","doi":"10.18502/acta.v61i7.14493","DOIUrl":"https://doi.org/10.18502/acta.v61i7.14493","url":null,"abstract":"Systemic arterial hypertension is a clinical condition of great risk in the development of cardiovascular diseases and it has a high impact on public health. The disease is influenced by modifiable and non-modifiable factors. In that context, Dermatoglyphics is a method of analysis of fingerprints as a mark of biological individuality and that can be related to health, sports, and the prognosis of diseases due to being able to point out the individual with the potential to develop certain diseases. This study aimed to investigate the characteristics of the fingerprints of women with systemic arterial hypertension by comparing them with a control group, which does not present the disease. Thus, we intend to find a dermatoglyphic pattern for Brazilian women with systemic arterial hypertension. The sample in the study consisted of 732 women, 366 with a positive clinical diagnosis for systemic arterial hypertension, and 366 individuals forming a control group, which did not present systemic arterial hypertension. All individuals in the sample are of equivalent age and the fingerprints were collected from all fingers. The method used to determine the profile of the individuals is the computerized dermatoglyphic. It was used, for the collection of fingerprints, of the Dermatoglyphic Reader®, which presents results of 400% more precision. There was a statistically significant difference between the groups, and when the Adjusted Residue Analysis was performed, the Ulnar Loop figure on fingers 4 and 5 of the left hand, and fingers 1 and 5 of the right hand, was predominant in the group of women with hypertension. These results demonstrate the existence of a dermatoglyphic mark, characteristic of patients with systemic arterial hypertension. Therefore, it can be concluded that the analysis of fingerprints of the hands by the Dermatoglyphic method can demonstrate the potential that women could have developing systemic arterial hypertension.","PeriodicalId":6946,"journal":{"name":"Acta medica Iranica","volume":"134 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139161076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-23DOI: 10.18502/acta.v61i7.14500
H. Saberi, Arad Iranmehr, N. Derakhshanrad, Abolfazl Payinmahalli, Vahid Soleimani
Vertebral body location of hemangioblastomas (HB) is extremely rare. The authors report a case of spinal mass involving lower thoracic region with cord compression, approved to be spinal HB. A 57-year-old man presented to our center with eight months history of progressive intractable back pain and paraparesis. Admission computed tomography and magnetic resonance imaging (MRI) of the thoracolumbar spine demonstrated a lytic and expansile spinal mass with pedicle expansion and vivid contrast enhancement involving T11 and T12 vertebral bodies on the right side. He was a known case of von Hippel-Lindau (VHL) and he had history of 4th ventricular asymptomatic hemangioblastoma near Obex, multiple pancreatic cystic adenomas, multiple liver cysts, and right non-chromaffin adrenal mass. The patient underwent a T11-T12 partial transpedicular corpectomy with T5 to L3 posterior spinal fixation to bridge the invaded segment. The pathological and immunohistochemical findings were consistent with vertebral HB. Spinal HB although extremely rare, may be managed with subtotal tumor resection and fixation of normal adjacent vertebrae by cemented screws.
{"title":"Management of Spinal Hemangioblastoma in Von Hippel-Lindau Disease: A Case Report","authors":"H. Saberi, Arad Iranmehr, N. Derakhshanrad, Abolfazl Payinmahalli, Vahid Soleimani","doi":"10.18502/acta.v61i7.14500","DOIUrl":"https://doi.org/10.18502/acta.v61i7.14500","url":null,"abstract":"Vertebral body location of hemangioblastomas (HB) is extremely rare. The authors report a case of spinal mass involving lower thoracic region with cord compression, approved to be spinal HB. A 57-year-old man presented to our center with eight months history of progressive intractable back pain and paraparesis. Admission computed tomography and magnetic resonance imaging (MRI) of the thoracolumbar spine demonstrated a lytic and expansile spinal mass with pedicle expansion and vivid contrast enhancement involving T11 and T12 vertebral bodies on the right side. He was a known case of von Hippel-Lindau (VHL) and he had history of 4th ventricular asymptomatic hemangioblastoma near Obex, multiple pancreatic cystic adenomas, multiple liver cysts, and right non-chromaffin adrenal mass. The patient underwent a T11-T12 partial transpedicular corpectomy with T5 to L3 posterior spinal fixation to bridge the invaded segment. The pathological and immunohistochemical findings were consistent with vertebral HB. Spinal HB although extremely rare, may be managed with subtotal tumor resection and fixation of normal adjacent vertebrae by cemented screws.","PeriodicalId":6946,"journal":{"name":"Acta medica Iranica","volume":"83 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139163015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The widespread inappropriate use of intravenous (IV) pantoprazole, due to its high cost, is a substantial issue. To improve its rational use, an order entry form (OEF) based on the institutional guideline, was implemented. Physicians were required to fill an OEF upon administration of IV pantoprazole. We aimed to evaluate the compliance of physicians as well as the accuracy of filled OEFs six months after the implementation. The study was conducted in a tertiary care teaching hospital in Tehran. Chart review was performed for all patients with an IV pantoprazole order. IV pantoprazole OEFs received by the hospital pharmacy for these patients were evaluated in terms of quantity and quality (e.g., completeness, accuracy of filled items, etc.). Only for 270 (62%) patients, OEFs were received by the hospital pharmacy. Indications were specified in 199 (73.5%) forms, and their agreement with the forms filled by the researcher was 37.8%. The most frequent indication specified in OEFs was stress ulcer prophylaxis (40.7%). IV pantoprazole administration was rational only in 15.9% of cases. The emergency ward had the highest frequency of orders (57.9%), while having the lowest fill rate (56.7%) among the wards with the highest number of orders. The disagreement between the researcher and the OEFs regarding the need for IV medication was 39.5%. This study demonstrated that the compliance of physicians with the accurate completion of OEFs was suboptimal. It seems that for long-lasting changes in IV pantoprazole utilization patterns, barriers should be determined, and additional methods such as ongoing educational seminars or feedback might be needed along with OEF.
{"title":"Physicians’ Compliance With Order Entry Forms for Intravenous Pantoprazole in a Tertiary Care Hospital","authors":"Maryam Taghizadeh-Ghehi, Saeideh Mousavi, Bahareh Laki, Mona Kargar, Mohammad Reza Javadi, Kheirollah Gholami","doi":"10.18502/acta.v61i6.13837","DOIUrl":"https://doi.org/10.18502/acta.v61i6.13837","url":null,"abstract":"
 
 
 The widespread inappropriate use of intravenous (IV) pantoprazole, due to its high cost, is a substantial issue. To improve its rational use, an order entry form (OEF) based on the institutional guideline, was implemented. Physicians were required to fill an OEF upon administration of IV pantoprazole. We aimed to evaluate the compliance of physicians as well as the accuracy of filled OEFs six months after the implementation. The study was conducted in a tertiary care teaching hospital in Tehran. Chart review was performed for all patients with an IV pantoprazole order. IV pantoprazole OEFs received by the hospital pharmacy for these patients were evaluated in terms of quantity and quality (e.g., completeness, accuracy of filled items, etc.). Only for 270 (62%) patients, OEFs were received by the hospital pharmacy. Indications were specified in 199 (73.5%) forms, and their agreement with the forms filled by the researcher was 37.8%. The most frequent indication specified in OEFs was stress ulcer prophylaxis (40.7%). IV pantoprazole administration was rational only in 15.9% of cases. The emergency ward had the highest frequency of orders (57.9%), while having the lowest fill rate (56.7%) among the wards with the highest number of orders. The disagreement between the researcher and the OEFs regarding the need for IV medication was 39.5%. This study demonstrated that the compliance of physicians with the accurate completion of OEFs was suboptimal. It seems that for long-lasting changes in IV pantoprazole utilization patterns, barriers should be determined, and additional methods such as ongoing educational seminars or feedback might be needed along with OEF.
 
 
","PeriodicalId":6946,"journal":{"name":"Acta medica Iranica","volume":"68 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135918424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-13DOI: 10.18502/acta.v61i6.13833
Maziar Maghsoudloo, Sina Abbassi, Shahram Samadi, Mohammad Taghi Beigmohammadi, Asghar Hajipour, Mahboubeh Atashgahi, Siavash Abbassi, Fariba Badrzadeh, Omid Nabavian
The aim of this study was to compare the post-operation analgesic effects of patient-controlled epidural analgesia and patient-controlled intravenous analgesia for patients who were undergoing esophageal cancer surgery. This was a randomized clinical trial. 80 patients undergone esophagostomy were randomly divided into two groups: 40 patients in the epidural PCA and 40 patients in the intravenous PCA group were evaluated. Post-operation pain score was assessed using the universal pain assessment tool (UPAT) in both groups at 24 and 48 hours after surgery. Secondary outcomes included AKI, MI, CVA, pulmonary complications, ICU stay and three months survival. Mean pain scores were similar in the two groups (P>0.05). There was no significant difference between the two groups for rescue treatment, three months’ survival, CVA, MI and AKI. However, ICU stay (P=0.008) and pulmonary complications (P=0.05) were greater in PCIA group. The results indicate that none of the PCEA and PCIA methods have any superiority in terms of pain control and the incidence of analgesic-related side effect complications after surgery in patients undergoing esophagostomy and confirm sufficient analgesia by both.
{"title":"Comparison Between Two Methods of Patient-Controlled Analgesia Through Intravenous and Thoracic Epidural to Control Pain and Complications After Surgery in Esophageal Cancer Patients: A Randomized Controlled Trial","authors":"Maziar Maghsoudloo, Sina Abbassi, Shahram Samadi, Mohammad Taghi Beigmohammadi, Asghar Hajipour, Mahboubeh Atashgahi, Siavash Abbassi, Fariba Badrzadeh, Omid Nabavian","doi":"10.18502/acta.v61i6.13833","DOIUrl":"https://doi.org/10.18502/acta.v61i6.13833","url":null,"abstract":"The aim of this study was to compare the post-operation analgesic effects of patient-controlled epidural analgesia and patient-controlled intravenous analgesia for patients who were undergoing esophageal cancer surgery. This was a randomized clinical trial. 80 patients undergone esophagostomy were randomly divided into two groups: 40 patients in the epidural PCA and 40 patients in the intravenous PCA group were evaluated. Post-operation pain score was assessed using the universal pain assessment tool (UPAT) in both groups at 24 and 48 hours after surgery. Secondary outcomes included AKI, MI, CVA, pulmonary complications, ICU stay and three months survival. Mean pain scores were similar in the two groups (P>0.05). There was no significant difference between the two groups for rescue treatment, three months’ survival, CVA, MI and AKI. However, ICU stay (P=0.008) and pulmonary complications (P=0.05) were greater in PCIA group. The results indicate that none of the PCEA and PCIA methods have any superiority in terms of pain control and the incidence of analgesic-related side effect complications after surgery in patients undergoing esophagostomy and confirm sufficient analgesia by both.","PeriodicalId":6946,"journal":{"name":"Acta medica Iranica","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135918426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-13DOI: 10.18502/acta.v61i6.13831
Samrand Fattah Ghazi, Nima Nazari, Mohammad Taghi Beigmohammadi, Masoud Ramezani, Mohammadreza Salehi, Yeganeh Abedipour
The decision to perform tracheostomy during the COVID-19 pandemic has been based mainly on practical and empirical standards. Also, the amount of scientific evidence to determine the exact timing of tracheostomy in patients with severe COVID-19 on mechanical ventilation is not significant. We conducted a retrospective cohort study on mechanically ventilated COVID-19 patients from April 25, 2021 to January 25, 2022 in intensive care units of Imam Khomeini Hospital Complex, Tehran, Iran. The 30-day survival of patients was calculated and compared between patients under tracheostomy and those without tracheostomy. A number of 135 COVID-19 cases (75 patients in the intubated group and 60 patients in the tracheostomy group) were included in this study. The mean age of the population was 53.6±12.4. The overall mortality rate was 101 (74.8%). The 30-day mortality rate was significantly higher in the intubated group (90.6%) than in the tracheostomy group (55%) (P< 0.001). The mortality rate was 60% in the early (≤ 7 days) tracheostomy group and 50% in the late (>7 days) group. This difference was not statistically significant (P> 0.05). Tracheostomy is a preferred method in airway management of severe COVID-19 patients under mechanical ventilation; however, early tracheostomy during the first week of intubation may not be superior to late tracheostomy in decreasing the mortality rate.
{"title":"Early Versus Late Tracheostomy in Mechanically Ventilated COVID-19 Patients: A Comparative Study","authors":"Samrand Fattah Ghazi, Nima Nazari, Mohammad Taghi Beigmohammadi, Masoud Ramezani, Mohammadreza Salehi, Yeganeh Abedipour","doi":"10.18502/acta.v61i6.13831","DOIUrl":"https://doi.org/10.18502/acta.v61i6.13831","url":null,"abstract":"The decision to perform tracheostomy during the COVID-19 pandemic has been based mainly on practical and empirical standards. Also, the amount of scientific evidence to determine the exact timing of tracheostomy in patients with severe COVID-19 on mechanical ventilation is not significant. We conducted a retrospective cohort study on mechanically ventilated COVID-19 patients from April 25, 2021 to January 25, 2022 in intensive care units of Imam Khomeini Hospital Complex, Tehran, Iran. The 30-day survival of patients was calculated and compared between patients under tracheostomy and those without tracheostomy. A number of 135 COVID-19 cases (75 patients in the intubated group and 60 patients in the tracheostomy group) were included in this study. The mean age of the population was 53.6±12.4. The overall mortality rate was 101 (74.8%). The 30-day mortality rate was significantly higher in the intubated group (90.6%) than in the tracheostomy group (55%) (P< 0.001). The mortality rate was 60% in the early (≤ 7 days) tracheostomy group and 50% in the late (>7 days) group. This difference was not statistically significant (P> 0.05). Tracheostomy is a preferred method in airway management of severe COVID-19 patients under mechanical ventilation; however, early tracheostomy during the first week of intubation may not be superior to late tracheostomy in decreasing the mortality rate.","PeriodicalId":6946,"journal":{"name":"Acta medica Iranica","volume":"58 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135918947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-13DOI: 10.18502/acta.v61i6.13834
Amir Davoodabadi Farahani, Maryam Hassaninevisi, Ali Sobhani Firoozabadi, Seyed Mohamad Hosseinian, Fatemeh Shirani
Osteoarthritis (OA) is the most common type of arthritis and although there is no definitive cure for it, there are treatments for symptom management. The present study was conducted to evaluate the effects of silicon dioxide (SiO2) on clinical symptoms of knee OA and compare it with avocado soybean unsaponifiable (ASU) and placebo. This study is a double-blind randomized clinical trial on 104 patients with knee OA referred to Rheumatology Clinic, Rasoul Akram Hospital, Tehran. Patients were randomly divided into three groups, including patients treated with ASU, SiO2, and placebo for 3 months. Subsequent referral was performed at weeks 4, 8, and 12, and the stiffness, physical function, and pain scores were recorded based on the WOMAC questionnaire. In this study, the effect of treatment of placebo and SiO2 and ASU in patients with knee OA based on WOMAC questionnaire showed a significant reduction in terms of pain, joint stiffness, physical function, and total scores of WOMAC in the cases of the SiO2 group compared with the other two groups. The findings of this study showed that the therapeutic effects of SiO2 in patients with knee OA in terms of pain and stiffness and physical function scores were more than the ASU and placebo groups.
{"title":"The Effect of Silicon Dioxide on Knee Osteoarthritis: A Randomized Clinical Trial","authors":"Amir Davoodabadi Farahani, Maryam Hassaninevisi, Ali Sobhani Firoozabadi, Seyed Mohamad Hosseinian, Fatemeh Shirani","doi":"10.18502/acta.v61i6.13834","DOIUrl":"https://doi.org/10.18502/acta.v61i6.13834","url":null,"abstract":"Osteoarthritis (OA) is the most common type of arthritis and although there is no definitive cure for it, there are treatments for symptom management. The present study was conducted to evaluate the effects of silicon dioxide (SiO2) on clinical symptoms of knee OA and compare it with avocado soybean unsaponifiable (ASU) and placebo. This study is a double-blind randomized clinical trial on 104 patients with knee OA referred to Rheumatology Clinic, Rasoul Akram Hospital, Tehran. Patients were randomly divided into three groups, including patients treated with ASU, SiO2, and placebo for 3 months. Subsequent referral was performed at weeks 4, 8, and 12, and the stiffness, physical function, and pain scores were recorded based on the WOMAC questionnaire. In this study, the effect of treatment of placebo and SiO2 and ASU in patients with knee OA based on WOMAC questionnaire showed a significant reduction in terms of pain, joint stiffness, physical function, and total scores of WOMAC in the cases of the SiO2 group compared with the other two groups. The findings of this study showed that the therapeutic effects of SiO2 in patients with knee OA in terms of pain and stiffness and physical function scores were more than the ASU and placebo groups.","PeriodicalId":6946,"journal":{"name":"Acta medica Iranica","volume":"33 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135918422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-13DOI: 10.18502/acta.v61i6.13835
Masoud Motasaddi Zarandy, Shadman Nemati, Ahmad Daneshi, Seyed Basir Hashemi, Ali Eftekharian, Mohsen Rajati, Ali Kouhi, Sevil Nasirmohtaram, Ehsan Kazemnejad Leyli, Maryam Khoshbakht
In order to decrease medical errors and improve organized, targeted education pre- and post-graduation, we intended to detect 10 most important concepts that neuro-otologists believe family physicians and general practitioners must know. A multi-center study based on Delphi’s method was designed and conducted in three stages. Of 31 topics gathered by expert panel, 10 top priorities were ranked based on 50 neuro-otologists’ opinion over the country. Early diagnosis and management of sudden sensorineural hearing loss, foreign body removal from external ear canal, proper management of otitis extern, and management of emergency situations in chronic otitis media gained the highest scores among all. Also, some topics, such as managing serous and acute otitis media, differentiating peripheral vs. central vertigos, and early hearing screening at birth were among top topics, contrary to others, such as surgery in only hearing ears, or hearing losses after COM surgeries. Almost all of the top-ranked topics are among critical/organ saving, or most prevalent medical concerns in all of the world. Sudden deafness, complicated COM, and mis-diagnosing vertigo may be organ/life threatening, while foreign bodies or inflammations of external ear, acute or serous otitis media, and congenital hearing loss are among the most prevalent medical problems worldwide, with numerous malpractices in their diagnosis and management. Regarding educational and practical priorities should be considered a basic step in neurotology field, and targeted programming policies.
{"title":"Ten Top Topics That Neuro-Otologists Think General Practitioners and Family Medicine Specialists Must Know: A Multi-Center Study Using Delphi Method","authors":"Masoud Motasaddi Zarandy, Shadman Nemati, Ahmad Daneshi, Seyed Basir Hashemi, Ali Eftekharian, Mohsen Rajati, Ali Kouhi, Sevil Nasirmohtaram, Ehsan Kazemnejad Leyli, Maryam Khoshbakht","doi":"10.18502/acta.v61i6.13835","DOIUrl":"https://doi.org/10.18502/acta.v61i6.13835","url":null,"abstract":"In order to decrease medical errors and improve organized, targeted education pre- and post-graduation, we intended to detect 10 most important concepts that neuro-otologists believe family physicians and general practitioners must know. A multi-center study based on Delphi’s method was designed and conducted in three stages. Of 31 topics gathered by expert panel, 10 top priorities were ranked based on 50 neuro-otologists’ opinion over the country. Early diagnosis and management of sudden sensorineural hearing loss, foreign body removal from external ear canal, proper management of otitis extern, and management of emergency situations in chronic otitis media gained the highest scores among all. Also, some topics, such as managing serous and acute otitis media, differentiating peripheral vs. central vertigos, and early hearing screening at birth were among top topics, contrary to others, such as surgery in only hearing ears, or hearing losses after COM surgeries. Almost all of the top-ranked topics are among critical/organ saving, or most prevalent medical concerns in all of the world. Sudden deafness, complicated COM, and mis-diagnosing vertigo may be organ/life threatening, while foreign bodies or inflammations of external ear, acute or serous otitis media, and congenital hearing loss are among the most prevalent medical problems worldwide, with numerous malpractices in their diagnosis and management. Regarding educational and practical priorities should be considered a basic step in neurotology field, and targeted programming policies.","PeriodicalId":6946,"journal":{"name":"Acta medica Iranica","volume":"126 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135918421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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