A transvaginal ultrasound-based diagnostic calculator for uterus post-cesarean scar defect.

BACKGROUND: A cesarean scar defect (CSD) is incomplete healing of the myometrium at the site of a prior cesarean section (CS), complicating more than half of all cesarean sections. While transvaginal ultrasound (TVU) is the most common modality for diagnosing this defect, hysteroscopy remains the gold standard. We aimed to develop an efficient diagnostic tool for CSD among women with abnormal uterine bleeding (AUB) by integrating TVU findings and participants' demographic features. METHODS: A single-center cross-sectional study was conducted on 100 premenopausal and non-pregnant women with a history of CS complaining of AUB without a known systemic or structural etiology. Each participant underwent a hysteroscopy followed by a TVU the next day. The defect dimensions in TVU, patients' age, and the number of previous CSs were integrated into a binary logistic regression model to evaluate their predictive ability for a hysteroscopy-confirmed CSD. RESULTS: Hysteroscopy identified 74 (74%) participants with CSD. The variables age, the number of CSs, defect length, and defect width significantly contributed to the logistic regression model to diagnose CSD with odds ratios of 9.7, 0.7, 2.6, and 1.7, respectively. The developed model exhibited accuracy, sensitivity, and specificity of 88.00%, 91.89%, and 76.92%, respectively. The area under the receiver operating curve was 0.955 (P-value < 0.001). CONCLUSION: Among non-pregnant women suspected of CSD due to AUB, looking at age, the number of previous CSs, and TVU-based defect width and length can efficiently rule CSD out.

Evaluation of Pain Assessment and Management in Critically Ill Intubated Patients in a Referral University Hospital in Iran.

OBJECTIVE: This study aims to evaluate current pain assessment and management in critically ill patients and to describe (1) pain management episode, according to the behavioral pain scale (BPS), and (2) the effectiveness of analgesics, according to the recommendation of guidelines. METHODS: In this cross-sectional study, a sample of 60 intubated critically ill patients was selected from the intensive care units (ICUs). A researcher evaluated the patient' pain severity using the BPS tool in patients receiving analgesics according to nurses' note. At each time of analgesic administration, the BPS score was recorded, and this process was repeated 72 h later. The appropriateness of pharmacological interventions was assessed according to the American College of Critical Care Medicine guideline. FINDINGS: The most prescribed analgesic was morphine sulfate (48.3%) followed by fentanyl (23.3%). 55% of analgesics on day 1 and 25% on day 3 were prescribed appropriately according to the guideline recommendation and BPS score. Morphine was the most effective drug (17 patients out of 29). Even though a BPS score was <5, 26 patients received analgesics. CONCLUSION: Quality of pain assessment and management in our setting is inappropriate and inadequate, which leads to over- or under-use of analgesics. The lack of an established pain protocol may contribute to this situation.

The Relation between Iranian Medical Science Research in PubMed and Burden of Disease.

INTRODUCTION: Scientific productions have been accelerated in Iran in past decades but its association with health problems and disease burden is doubtful. The aim of this study is assessment of the relationship between scientific productions with disease burden in Iran in PubMed dataset during 2010 to 2014. METHOD: The study was performed with the library method. Data Gathered using Scientometrics indicators and direct observation. The current research includes all articles written by Iranian researchers during 2010 to 2014 which were published in PubMed-indexed journals. The search was performed using keywords included road accident, ischaemic heart diseases, major depression disorders and cerebral vascular diseases. RESULTS: In total 910 articles had been published PubMed -indexed journals. Among them Substance-Related Disorders and Accidents, Traffic had the highest (263 records) and lowest (94 records) records respectively. There was not a direct correlation between Years of Life Lost, Years Lost due to Disability and mortality rate with scientific productions. CONCLUSIONS: our results showed Iranian scientific productions in PubMed data set are not related to disease burden however they are not related to high mortality diseases.