Predictors of length of stay in intensive care unit after coronary artery bypass grafting: development a risk scoring system

Abstract Introduction: To determine predictors of length of stay (LOS) in the intensive care unit (ICU) after coronary artery bypass grafting (CABG) and to develop a risk scoring system were the objectives of this study. Methods: In this retrospective study, 1202 patients' medical records after CABG were evaluated by a research-made checklist. Tarone-Ware test was used to determine the predictors of patients' LOS in the ICU. Cox regression model was used to determine the risk factors and risk ratios associated with ICU LOS. Results: The mean ICU LOS after CABG was 55.27±17.33 hours. Cox regression model showed that having more than two chest tubes (95% confidence interval [CI] 1.005-1.287, Relative Risk [RR]=1.138), occurrence of atelectasis (95% CI 1.000-3.007, RR=1.734), and occurrence of atrial fibrillation after CABG (95% CI 1.428-2.424, RR=1.861) were risk factors associated with longer ICU LOS. The discrimination power of this set of predictors was demonstrated with an area under the receiver operating characteristic curve and it was 0.69. A simple risk scoring system was developed based on three identified predictors that can raise ICU LOS. Conclusion: The simple risk scoring system developed based on three identified predictors can help to plan more accurately a patient's LOS in hospital for CABG and can be useful in managing human and financial resources.

Waist Circumference and Spirometric Measurements in Chronic Obstructive Pulmonary Disease

OBJECTIVES: The aim of this study was to evaluate whether the waist circumference of patients with chronic obstructive pulmonary disease (COPD), had an impact on lung function. METHODS: There were 180 patients with COPD recruited into this prospective cross-sectional study. The age, weight, body mass index and waist circumference (WC) were measured. Spirometry parameters including forced vital capacity (FVC), and forced expiratory volume in the first second (FEV1), were measured and FEV1/FVC calculated. RESULTS: The mean FEV1/FVC in both normal weight and overweight patients, did not statistically significantly correlate with WC. The COPD assessment test, positively correlated with WC ( p = 0.031). A positive correlation with body mass index ( p < 0.001), smoking ( p = 0.027), and global initiative for chronic obstructive lung disease score ( p = 0.009), were observed to positively associate with WC. WC, age, C-reactive protein, duration of disease, and gender (male), were observed to be statistically significant risk factors for the severity of COPD. CONCLUSION: WC was not observed to impact upon lung function in this study but it was a predictive factor for COPD severity in patients.

efficacy and safety of on-demand tramadol and paroxetine use in treatment of life long premature ejaculation: a randomized double-blind placebo-controlled clinical Trial

Background: Several medical therapies have been proposed for the treatment of premature ejaculation [PE]. Paroxetine and tramadol were both reported to be effective in treatment of PE. In this study, the therapeutic effects of tramadol, paroxetine and placebo were compared in treatment of primary PE

Methods: In this randomized, double-blind, placebo-controlled clinical trial, 150 patients were divided into 3 groups. One group was treated with tramadol 50 mg on- demand, the other group took paroxetine 20 mg on-demand and the third group was treated with placebo. Before starting treatment and after 12 weeks, patients were asked to measure their average intravaginal ejaculation latency time [IELT] and fill the PEP [Premature Ejaculation Profile] questionnaire

Results: At the end of the 12th week, the mean IELT and average of PEP scores improved in all 3 groups. The increase in tramadol group was significantly higher than the paroxetine and placebo groups [p<0.0001]. There were no significant differences in terms of side effects between the 3 groups

Conclusion: The results showed that despite an increase in mean IELT and PEP scores in all 3 groups, the rate of improvement in tramadol group was significantly more than the others. Thus, tramadol may be considered as an appropriate alternative therapeutic option for lifelong PE

Effect of Intravenous Intraoperative Esmolol on Pain Management Following Lower Limb Orthopedic Surgery

BACKGROUND: Lack of proper control of acute postoperative pain often leads to lingering or chronic pain. Several studies have emphasized the role of beta-blockers in reducing postoperative pain. Esmolol is a selective short-acting beta-blocker that produces few side effects. The purpose of this study was to examine the effect of intravenous intraoperative esmolol on postoperative pain reduction following orthopedic leg fracture surgery. METHODS: In a clinical trial, 82 patients between 20-65 years of age with tibia fractures and American Society of Anesthesiologists (ASA) physical status I & II who underwent surgery were divided into two groups. Group A received esmolol and group B received normal saline. Postoperative pain was measured at three time points: entering the recovery unit, and at 3 h and 6 h following surgery, using the Visual Analogue Scale (VAS). A P value of < 0.05 was considered significant. RESULTS: Mean VAS scores at all three time points were significantly different between the two test groups (P = 0.02, P = 0.0001, and P = 0.0001, respectively). The consumption of pethidine was lower in group A than in group B (P = 0.004) and the duration of its effect was significantly longer in time (P = 0.026). CONCLUSIONS: Intravenous intraoperative esmolol is effective in the reduction of postoperative pain following leg fracture surgery. It reduced opioid consumption following surgery and delayed patient requests for analgesics.

Predictors of quality of life in patients with colorectal cancer in Iran.

BACKGROUND: Colorectal cancer (CRC) is one of the most common invasive cancers and is responsible for physical and psychosocial morbidity. Quality of life (QOL) is an important outcome for these patients. The aim of this study was to determine the predictive factors of QOL in patients with CRC. MATERIALS AND METHODS: A cross‑sectional design was used to assess 110 patients with CRC who referred to Oncology Department of Razi Hospital, Guilan. Data were collected by structured interview with patients and review of medical records. Generic and specific QOL were evaluated by short form‑36 and functional assessment of cancer therapy‑colorectal, respectively. Generalized linear models identified variables significantly associated with QOL. RESULTS: Out of 110 patients with CRC, 58.2% were men. Mean age of patients was 58.33 ± 12.39 years. Mean of Generic and specific QOL were 70.92 ± 15.56 and 95.72 ± 19.18, respectively. In regression analysis, age, sex, living condition, health insurance, hospitalization frequency, Karnofsky performance status, and co‑morbidity were predictors of generic QOL and age, sex, living condition, health insurance, monthly income, family history of CRC, Karnofsky performance status, and co‑morbidity were predictors of specific QOL in patients. CONCLUSION: There are nine socio‑demographic and clinical factors that are significant predictors of QOL in patients with CRC which should be considered in treatment and care of patients. The findings of this study should be the target of future research, emphasizing the need for interventional studies that minimize the adverse impact of the disease symptoms on the QOL in patients with CRC.

[ comparison between digital panoramic view and cone-beam computed tomography [CBCT] images in diagnosis of apical radiolucent lesions]

Panoramic radiography is used extensively in the field of dentistry as a screening method. In endodontic treatment, the diagnosis and evaluation of periapical area is very important. However, using advanced imaging such as cone beam computed tomography [CBCT] has increased diagnostic ability, but it must be used precisely and in special condition. The aim of this study was to compare diagnostic value of digital panoramic view and CBCT in diagnosis of apical lucent lesion. In this cross-sectional study, digital panoramic view and CBCT of 47 patients [573 apical portions of root] who had referred to maxillofacial radiology clinic for maxillary and or mandibular CBCT procedures were assessed. All of the selected patients needed these images as their treatment protocol. According to order of CBCT [maxilla, mandible and both], the teeth of the same jaw in digital panoramic radiography by a maxillofacial radiologist were evaluated. After data enterance, agreement, Sensitivity, specificity and likelihood ratio [positive and negative] were assessed totally and for each jaw separately with 95 percent confidence interval. 0.05 was established as a level of significant. Periapical radiolucency in 15.9% of apical areas in CBCT and in digital panoramic view in 4.2% of them was detected. Overall, sensitivity and specificity of digital panoramic view were 26.4% and 100% respectively. Sensitivity of panoramic view in diagnosis of periapical lucency in mandible was higher than maxilla. According to kappa analysis, the agreement level between panoramic and CBCT was assigned low [kappa=0.374]. Although panoramic is a routine screening method in field of dentistry, it is not accurate in diagnosis of the presence of periapical lesions. This limitation in maxilla is more than mandible