Assessment of Blood Lead Levels in Mothers Addicted to Opium and Their Neonates in Kerman: A Cross-sectional Study.

Background: High blood lead levels (BLLs) in pregnant women are associated with poor outcome in neonates. One of the newest non-occupational sources of lead contamination is opium consumption. Accordingly, this study aimed to assess BLLs in mothers addicted to opium and their neonates in Kerman. Methods: This cross-sectional was conducted in Afzalipour hospital in Kerman, from February 2019 to February 2020. The BLLs were measured in 100 opium-addicted and non-addicted mothers and their newborns, and the lead levels higher than 5 µg/dL were considered contamination. Then, the demographic and anthropometric data were compared. Findings: Based on the results of the present study, the BLLs of opium-addicted mothers (33.40±9.22 µg/dL vs 3.2±1.5 µg/dL) and their neonates (13.46±4.86 vs 1.1±0.9) were significantly higher (P=0.001) than those of non-addicts. Moreover, the average birth weight of the newborns in the addicted group was significantly lower than in the non-addicted group (2572.8±77.49 vs 2946±46.87) (P=0.001). Besides, there was a significant relationship between the average birth weight and the BLL of the mother and baby, and the average weight of the babies was significantly lower at higher levels of lead. However, no correlation was observed regarding the average height and head circumference of the neonates (P>0.05). Conclusion: It seems that the serum level of lead in neonates of opium-addicted mothers contaminated with lead is significantly higher than that of non-addicts, but their anthropometric characteristics at birth were not different from those of the nonaddicted group.

Multisystem inflammatory syndrome in children (MIS-C) post-COVID-19 in Iran: clinical profile, cardiac features, and outcomes.

BACKGROUND: In April 2020, an association between multisystem inflammatory syndromes (MIS-C) was observed in children with severe acute respiratory syndrome coronavirus infection (SARS-CoV-2). Most patients had heart involvement alone, and most patients had pericardial effusion. This study aimed to express and emphasize cardiac involvement in pediatric patients with respiratory symptoms who were diagnosed with COVID-19. METHODS: This study was conducted in July 2021 in Kerman province, Southeastern Iran, during a notable surge in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections. The study included 904 pediatric patients diagnosed with COVID-19. Data collection involved a comprehensive assessment of clinical symptoms and manifestations. Patients with fever lasting more than five days were admitted to the hospital. Echocardiography was utilized for cardiac involvement diagnosis, with 47 patients undergoing this diagnostic procedure. RESULTS: Of the 904 patients, most of them had high fevers (74%). Fifty-five patients had a fever for more than five days and were hospitalized. Of the 47 patients who underwent echocardiography, 45 (81%) had heart involvement. In 75% of patients, pericardial effusion was the only cardiac involvement. Patients with pericardial effusion were treated with dexamethasone up to 3 mg every 8 h for 72 h. CONCLUSIONS: MIS-C has a wide range of clinical symptoms. In cases where the fever is prolonged and there are gastrointestinal symptoms, physicians have clinical suspicion to diagnose this syndrome. Most cases of pericardial effusion are alone and improve with treatment with glucocorticosteroids.

Comparison of Morbidity, Mortality, and Costs of VAP Patients with Non-VAP Patients in the Tertiary Referral Hospital of Kerman, Iran.

Background: Ventilator-associated pneumonia is the most common type of nosocomial infection in ICUs. Hence, this study shall focus on the morbidity, mortality, and costs associated with this infection among ICU patients. Materials and Methods: The current research is a prospective descriptive-analytical study. The study population included patients admitted to the Tertiary Referral Hospital of Kerman University of Medical Sciences who were enrolled in the study according to inclusion criteria and demographic characteristics data, length of stay in ICU and general wards, and direct and indirect medical expenses such as unemployment and rehabilitation cost, etc. Results: Nine of the 144 patients studied died. (4 in the Ventilator-Associated Pneumonia (VAP) group and 5 in the non-VAP group). Among them, the prevalence of Acinetobacter Baumannii was significantly higher than other bacteria (P-Value=0.001). The duration of hospitalization in the ICU (18±9 vs. 9.5±6 days) and recovery time (21.6±9 9.6 vs. 13.2±7 days) were higher in the VAP group (P-Value<0.05). Moreover, the duration of hospitalization in the general ward was 15.4±8 days in the VAP group and 10.6±6 days in the non-VAP group (P-Value<0.05). The cost of treatment in the VAP group ($7952.28) was significantly higher than in the non-infected group ($4400.98). The average rehabilitation cost in the VAP group was $2571.42 and in the non-affected group was $1530.88. The financial loss due to the delay in work starting was $482 in the non-VAP group which was significantly less than the VAP group ($792). Conclusion: Having VAP can significantly increase mortality, length of stay in the ICU as well as increase direct and indirect costs for patients.

Hospital challenges and managerial approaches to combat COVID-19 outbreak: a qualitative study in southeastern Iran.

BACKGROUND: During the covid-19 pandemic, hospitals have faced several challenges, so they need to identify and address effective management strategies to cope with these challenges that enhance their current knowledge to deal with similar challenges in the future. This study aimed to identify managerial strategies for dealing with Covid-19 pandemic challenges at a hospital in southeastern Iran. METHODS: This qualitative content analysis study used purposive sampling to select eight managers, three nurses, and one worker from Shahid Bahonar Hospital. In this study, semi-structured interviews were used to collect data and Lundman and Graneheim's approach was used to analyze them. RESULTS: Three hundred fifty codes remained after constant comparison, compression, and merging. The results demonstrated one theme "Managerial reengineering in the healthcare system during the Covid-19 crisis", two main categories, seven subcategories and, 19 sub- subcategories. The first main category was "The difficulty of managing challenges," including "Insufficient resources and physical space", "Socio-organizational challenges" and, "Incompetence and unpreparedness of managers." The second main category was "Reforming the management duties." This category included "Planning and decision-making," "Organization," "Leadership and motivation," and "Monitoring and control." CONCLUSIONS: Hospitals and managers were less prepared to cope with the Covid-19 crisis challenges due to health system organizations' less attention to biological crises. Healthcare organizations can carefully evaluate these challenges, and the strategies managers adopt to deal with these problems. They also can identify the strategies' strengths and weaknesses and propose more effective strategies. As a result, healthcare organizations will be better prepared for similar crises.

Barriers to hand hygiene compliance in intensive care units during the COVID-19 pandemic: A qualitative study.

Background: The practice of hand washing is an effective way to prevent contamination and disease transmission. Following the COVID-19 pandemic, hand washing has become increasingly important. Therefore, this qualitative study aimed to understand barriers to hand hygiene compliance among healthcare workers during the COVID-19 pandemic. Materials and methods: Twenty-five healthcare workers from intensive care units were sampled using purposive sampling in a qualitative content analysis study. Data were collected through a semi-structured interview and field notes. Based on the Lundman and Graneheim approach, the data were analyzed. COREQ checklist was used to report the research. Results: According to the findings, there are three main categories of barriers to hand hygiene practice: barriers related to individuals (including two subcategories of lack of knowledge of healthcare workers and healthcare workers' improper attitude), barriers related to management (including two subcategories of wrong behavioral patterns and unsuitable training and planning), and barriers related to organizations (including four subcategories of heavy workloads, improperly designed wards, a lack of equipment, and lack of quality equipment). Conclusions: This research indicates that hand washing practice increased during the COVID-19 pandemic. Nevertheless, some barriers persist, resulting in a decline in hand washing compliance among health care workers. This finding can help managers and policymakers remove barriers to hand washing compliance and improve healthcare workers' adherence to hand washing.

Depression and Self-Efficacy Among Iranian Children During the Prevalence of COVID-19 Disease.

The coronavirus disease 2019 (COVID-19) outbreak has quickly endangered the physical and mental health of people in the community, particularly vulnerable people such as children. This study was carried out to investigate the depression and self-efficacy of Iranian children during the COVID-19 outbreak. This cross-sectional research was conducted on 321 students aged 8 to 17 in southeast Iran. A social media-based online questionnaire was used to collect data. The information was gathered using demographic and COVID-related items, the Children's Depression Inventory (CDI), and the Self-Efficacy Questionnaire for Children (SEQ-C). No significant correlation was observed between depression and self-efficacy of children (P = 0.23). However, in subscale of CDI, negative mood, ineffectiveness and negative self-esteem had a significant correlation with self-efficacy (<0.001). Depression had a significant correlation with family income (p = 0.017), being at risk of coronavirus infection (p = 0.036), effectiveness of preventive measures (p = 0.015) and how information about the coronavirus disease was obtained (p = 0.018). According to the results, the mean score of depression was higher than the midpoint of the questionnaire in Iranian children, therefore, it is needed to take the necessary measures and treatment plans to reduce the rate of depression in children. Further research is needed to assess and prevent childhood depression.

Incidence and risk factors related to anxiety of children and adolescents before elective surgery.

The goal of this study was to evaluate the preoperative anxiety in children and adolescents and to identify some of the risk factors associated with the incidence of anxiety in 9-18 years old group. Children and adolescents 9-18 years old hospitalized the night before elective surgeries were analyzed in terms of incidence and severity of anxiety using the State-Trait Anxiety Inventory (STAI) measure. Of the 164 patients, 111 (67.6%) suffered from preoperative anxiety. The incidence of anxiety in children aged 9-12 was 2.88 times the anxiety of those aged 12-18 (OR = 2.88) (1.65, 5.98). Moreover, the incidence of anxiety in only children was 0.65 times that of children with siblings (OR = 0.78) (0.11,2.93) , and in patients with a history of hospitalization, the incidence was 1.85 times the stress in children without hospitalization history (OR = 1.85)(1.31,3.99); finally, the incidence of anxiety in children of higher socioeconomic status was lower compared with those of lower socioeconomic status (OR = 0.13) (0.08,0.35). Having close frend or family in the healthcare staff decreased the prevalence (OR = 0.64 (0.23,1.79) and severity of anxiety (47.02 ± 5.48 vs. 54.18 ± 7.18) (P-value = 0.001). There was no relationship between gender and the incidence of anxiety (OR = 1). Incidence of preoperative anexiety in foriner was1.72 times of persion patients (OR=1.72) (0.99,4.25). The severity of anxiety was lower in boys (46.22 ± 6.68) compared with girls (52.55 ± 7.52) (P-value = 0.002) and lower in patients of medium-to-high socioeconomic status (43.64 ± 5.45) compared with those with lower socioeconomic status (49.66 ± 6.49) (P-value = 0.003). There was no relationship between being an only child and severity of anxiety (P-value = 0.54) (48.31 ± 5.05 vs. 48.12 ± 6.81). However, anxiety was more severe in patients with a history of hospitalization (50.55 ± 4.64) (49.2 ± 6.23) (P-value = 0.09). Severity of anexiety was not dependent to nationality of patients(P-value = 0.6) .Taken together, our data suggest that various methods should be used to reduce anxiety and associated complications, regarding the high prevalence of anxiety in mentioned groups of children and adolescents.

Efficacy of Simple Eye Ointment, Polyethylene Cover, and Eyelid Taping in Prevention of Ocular Surface Disorders in Critically Ill Patients: A Randomized Clinical Trial.

BACKGROUND: Under normal conditions, the cornea of the eye is protected from bacterial invasion, physical injury, and drying by the presence of tears, eyelids, and blinking reflex. However, patients admitted to the intensive care unit (ICU) for several reasons including loss of consciousness, receiving sedative and neuromuscular blocking agents, and mechanical ventilation may lose eye-protective mechanisms causing exposure keratopathy. Therefore, this study intended to compare three eye care methods to prevent ocular surface disorders (OSDs) in ICU patients. METHODS: This study was a double-blind clinical trial (IRCT: 201109225426N3, https://www.irct.ir/trial/5825), in which 152 patients were randomized into three groups and each group underwent a different eye care procedure. The eye care methods included simple eye ointment, polyethylene cover, and eyelid taping. The eligible patients received the care procedure for seven days, and their corneas were examined daily for OSD by a portable slit lamp with fluorescein staining. Descriptive and analytical tests (ANOVA, chi-square, logistic regression, and zero-inflated Poisson regression) were used for statistical analysis by STATA14. RESULTS: The odds of OSD (chances of getting an OSD grade between I and VI) in the ointment group were 0.19 (95% CI: 0.09, 0.41), and the odds of OSD in the polyethylene cover group were 0.06 (95% CI: 0.01, 0.20), showing a significant difference with the tape group (p=0.0001). Despite the lower odds of OSD in the cover group than in the ointment group, there was no significant between-group difference (p=0.08). However, the mean OSD scores in both the ointment and polyethylene cover groups were significantly lower than that in the tape group. CONCLUSION: The results of this study showed that polyethylene cover followed by simple eye ointment and eyelid taping were the most effective methods in preventing OSD. Therefore, polyethylene cover and simple eye ointment are recommended as effective eye care methods in ICU.

Blood Lead Level in Opiate Addicts Hospitalized in the Intensive Care Unit of a Trauma Referral Center in Kerman, Iran.

BACKGROUND: Opium is the most commonly-used narcotic in Iran and some Asian countries. There are many reports of lead poisoning in opium users. Lead poisoning encompasses a wide range of symptoms the incidence and severity of which depend on the concentration and duration of contact with lead. The present study compares blood levels of lead in two groups of non-addicted patients and opiate addicts admitted to the intensive care unit (ICU) of a trauma referral hospital in Kerman, Iran. METHODS: Two groups of about 30 patients were compared. The first group was the patients who were known as opium addict according to the Diagnostic and Statistical Manual of Mental Disorders-4th Edition (DSM-IV) and the second group was the patients who had no history of opium abuse. Patients' data were collected through a questionnaire. After determining the blood lead concentration by atomic absorption spectrophotometry (AAS) with graphite furnace, the data were analyzed by statistical tests. FINDINGS: Blood lead levels (BLLs) in both addicted and non-addicted groups showed a significant difference (P < 0.050), but there was no meaningful relationship between blood lead concentration and other factors such as age, gender, type of opium, method of consumption, amount of use, and duration of dependence. CONCLUSION: Many of opium-addicted ICU patients in Kerman had a high BLL due to opium pollution that can be harmful for these patients.

Efficacy of Dressing with Absorbent Foam versus Dressing with Gauze in Prevention of Tracheostomy Site Infection.

BACKGROUND: Tracheostomy site infection can cause numerous problems. Absorbent foam dressing may be able to prevent proliferation of infectious microorganisms by absorbing the tracheostomy stoma exudate. This study aimed to compare the efficacy of absorbent foam with gauze dressing for prevention of tracheostomy site infection. MATERIALS AND METHODS: In this double-blind randomized clinical trial, 80 patients (18 to 60 years) hospitalized in the intensive care unit (ICU) due to severe head injury were randomly divided into two groups and early tracheostomy was done for them during the first 2 days. In the first group, gauze was used as tracheostomy site dressing, while in the second, absorbent foam, was placed. Tracheostomy site was checked daily for any sign of infection and samples were taken from the stoma for culture in case of presence of any sign of infection. RESULTS: Of a total of 80, 11 had tracheostomy site infection (13.75%), including 7 (17.5%) in the gauze group and 4 (10%) in the foam group. The difference in this regard between the two groups was not significant (P=0.051). Also, the dominant strains in the culture of gauze group were hospital-acquired Gram-negative bacteria (particularly Acinetobacter), while in the foam group, Gram-positives and more commonly Staphylococcus epidermidis were found. CONCLUSION: Absorbent foam dressing is not superior to gauze dressings for prevention of tracheostomy site infection.

Acute hemodynamic effects of single oral dose of bosentan in patients with pulmonary arterial hypertension related to congenital heart disease.

BACKGROUND: Endothelin-1 is a potent endogenous vasoconstrictor and an important remodeling factor in the pathogenesis of pulmonary arterial hypertension (PAH). Bosentan, a nonselective and active dual endothelin receptor antagonist, is used as a vasodilator in treatment of such patients. This study aimed to evaluate acute response to a single oral dose of bosentan as a vasodilator agent in comparison with nasal oxygen (O2) in patients with PAH related to congenital heart disease (CHD). MATERIALS AND METHODS: We enrolled 20 patients with PAH-CHD, with a mean age of 5.45 ± 4.5 years. Hemodynamic variables were measured at baseline state, after administration of nasal O2 (5 L/min) for 20 minutes, and then when hemodynamic variables returned to the baseline, the measurements were repeated for the third time 3 hours after administration of a single oral dose of bosentan (2 mg/kg). RESULTS: Mean pulmonary vascular resistance was 9.92 ± 2.97 Wood units · m(2) at baseline and was lowered by O2 to 6.17 ± 2.71 Wood units · m(2) (P = .001) and by bosentan to 5.90 ± 2.69 Wood units · m(2) (P = .0001). Mean pulmonary artery pressure was 71.2 ± 15.4 mm Hg at baseline and was reduced to 62.6 ± 15.2 mm Hg (P = .001) by O2 and to 61.6 ± 14.8 mm Hg (P = .0003) by bosentan. CONCLUSION: A single oral dose of bosentan has the same acute vasodilatory effect on the pulmonary vascular bed as nasal O2 in patients with PAH related to CHD. Such patients may benefit from long-term therapy with this novel medication.

QT Dispersion and T Wave Peak-to-end Interval Dispersion in Children with Kawasaki Disease.

BACKGROUND: The main complication of Kawasaki disease is the Coronary Artery (CA) involvement and long term follow up of patients depends on the severity of coronary arterial aneurysms, ischemia, and thrombosis. Early diagnosis of these complications can lead to a more desirable outcome for patients. Myocardial ischemia can prolong QT dispersion and increase the risk of cardiac arrhythmias as well as sudden cardiac arrests. Also, T wave peak-to-end (Tp-Te) interval dispersion, which provides a valuable index of transmural dispersion of repolarization, can trigger the arrhythmia. MATERIALS AND METHODS: We evaluated the non-corrected QT interval dispersion (QTD) and the corrected QT (QTc) dispersion and measured Tp-Te interval dispersion in 49 Iranian children (28 males and 21 females) with the diagnosis of Kawasaki disease (KD) in the acute phase and 49 age-matched controls in a prospective study from 2009 to 2012. Student's t-test and Pearson correlation were used to analyze the data. All the statistical analyses were performed through the SPSS 16. Besides, P<0.05 was considered as statistically significant. RESULTS: Patients with KD had significantly longer QTc dispersion (0.099±0.055 s versus. 0.040±0.018 s; P<0.001), non-corrected QT dispersion (0.075±0.046 versus 0.042±0.019; P<0.001), and Tp-Te dispersion (0.047±0.054 versus 0.022±0.011; P=0.015). The patients with elevation in white blood cell count (above 15000) had a statistically significant increased in QTD (P=0.011). No significant correlation was found between coronary involvement and repolarization indexes. CONCLUSIONS: In conclusion, the QT interval (corrected or non-corrected) and the Tp-Te dispersion significantly increased in the patients with KD which shows repolarization changes during the acute phase of KD. However, there is no correlation between the QT interval and the coronary involvement.

Short-term result of ductus arteriosus stent implantation compared with surgically created shunts.

This report aims to compare the researchers' early experience with the safety, efficacy, short-term outcomes, and complications of patent ductus arteriosus (PDA) stents in neonates having duct-dependent pulmonary circulation with those of surgically created shunts. Between April 2009 and April 2011, 18 infants with duct-dependent pulmonary circulation underwent cardiac catheterization for PDA stenting as the first palliative procedure in a referral center. For comparison, 20 infants who underwent surgical aortopulmonary shunt placement in another center were used. Follow-up assessment included clinical examination, echocardiography, oxygen saturation, and cardiac catheterization studies. Access and stenting for the PDA were successful in 15 patients (83.3 %). The mean procedure time was 58.43 ± 41.25 min, and the mean fluoroscopy time was 18.81 ± 5.64 min. Three patients (20 %) in the stented group and 6 patients (30 %) in the surgical group died (P = 0.09). After a 6-month follow-up period, none of the patients had significant stent stenosis requiring reintervention. The oxygen saturation increase did not differ significantly between the two groups either immediately after the procedure or 6 months later (P > 0.5). The left pulmonary artery diameter, McGoon ratio, and Nakata index did not differ significantly between the two groups (P > 0.05), but the right pulmonary diameter was larger in the stented group (5.01 ± 0.45 vs 4.1 ± 0.49 mm; P = 0.0001). Stenting for the PDA is an appropriate alternative to surgical shunt creation in many patients with duct-dependent circulation. In our sample, the two groups did not differ significantly in terms of outcome or mortality.