Effect of Tracheal Suctioning on Cuff Pressure in Mechanically Ventilated Patients: a Quasi-Experimental Study.

BACKGROUND: Endotracheal tube cuff pressure must be kept in an optimal range, but it might change during some nursing procedures. If the cuff pressure gets outside the normal range, it can cause mucosal damage, insufficient ventilation, and microaspiration. This study aimed to determine the effect of endotracheal suctioning on cuff pressure in patients during mechanical ventilation. MATERIALS AND METHODS: This is a quasi-experimental study utilizing repeated measures with a within-subject design. Using a simple convenience sampling method, 61 patients were studied during intubation on mechanical ventilation. Baseline cuff pressure was adjusted to 25 cm H 2 O. Then, at 15, 30, and 60 minutes' intervals, cuff pressures were measured once without suctioning and again after suctioning. RESULTS: The results showed a significant change in the mean endotracheal tube cuff pressure during suctioning (p<0.001, d=7.47). During suctioning, cuff pressure exceeded the normal range in 64% of the patients. After suctioning, although endotracheal tube cuff pressure decreased in both conditions, it decreased more significantly (F (2.17, 260.55)=238.19, p<0.001, ν=0.665, d=1.37) in the suctioning condition. CONCLUSION: The results suggest that endotracheal tube cuff pressure increases suddenly and briefly during suctioning, but within 60 minutes after suctioning, it becomes more reduced in suctioning conditions than without suctioning. Therefore, patients are at risk of mucosal damage and microaspiration after and during suctioning, respectively. It is suggested that nurses use continuous cuff pressure regulation methods to prevent potential risks.

Spontaneous and induced chromosomal aberrations in peripheral blood of women with endometriosis: evidence of genomic instability.

BACKGROUND: Endometriosis is a prevalent gynecological disease which can lead to certain types of cancers. We investigated the spontaneous and induced chromosomal aberrations in peripheral blood lymphocytes (PBL) of endometriosis patients. METHODS: We performed a pilot study utilizing mitomycin C (MMC) to assess chromosomal instability in the peripheral blood of participants. The patient group consisted of 20 infertile endometriosis patients and the controls of 20 healthy fertile women. Blood samples were collected, and two distinct lymphocyte cultures were prepared to evaluate the baseline and the MMC induced chromosomal aberrations. RESULTS: The results showed a significant difference before and after MMC treatment in both groups (P<0.001) and also revealed that endometriosis patients are far more sensitive to MMC than controls (P<0.001). CONCLUSIONS: The significantly higher frequency of induced and spontaneous chromosomal aberrations in patients can be consider as a sign of genomic instability and the defect in DNA repair mechanisms, which can be both assumed as a driver of cancer development in endometriosis patients.

A 7-year study on the prevalence of congenital hypothyroidism in northern Iran.

BACKGROUND: Congenital hypothyroidism (CH) is one of the most common congenital endocrine disorders.The present study determined the prevalence and demographic characteristics of congenital hypothyroidism in the north of Iran. OBJECTIVE: To determine the prevalence of congenital hypothyroidism based on transient and permanent types with demographic characteristics in Mazandaran province in northern Iran. METHODS: This retrospective descriptive survey analyzed the medical records of children with primary diagnosis of CH in health centers in all cities of Mazandaran Province between June 2009 and March 2016. To compare the study groups (CH type) in terms of quantitative and qualitative variables, the t-test and Chi-square test were used, respectively using the SPSS22. P-value <0.05 was considered as significant. RESULTS: Of 269,088 infants screened during the study period, 548 infants with primary congenital hypothyroidism were identified (a prevalence of 1 per 491 births) and congenital hypothyroidism was definitively diagnosed in 389 children (a prevalence of 1 per 453 births); of them, 169 had permanent CH (a prevalence of 1 per 1043 births) and 220 had transient CH (a prevalence of 1 per 801 births). The female to male ratio in the permanent congenital hypothyroidism group was higher than that in the transient congenital hypothyroidism group (p=0.08). The family relationship between mother and father was stronger in the permanent congenital hypothyroidism group than in the transient congenital hypothyroidism group (p=0.03). CONCLUSION: These findings show that congenital hypothyroidism is more prevalent in the north of Iran than in other areas of Iran; the prevalence of transient CH is particularly higher than permanent CH.

Massage as adjuvant therapy in the management of post-cesarean pain and anxiety: A randomized clinical trial.

OBJECTIVE: The present study was conducted to determine the effect of massage on post-cesarean pain and anxiety. METHODS: The present single-blind clinical trial was conducted on 156 primiparous women undergone elective cesarean section. The participants were randomly divided into three groups, including a hand and foot massage group, a foot massage group and a control group (n = 52 per group). The patients' intensity of pain, vital signs and anxiety level were measured before, immediately after and 90 min after the massage. RESULTS: A significant reduction was observed in the intensity of pain immediately and 90 min after massage (P < 0.001). Moreover, changes in some of the physiological parameters, including blood pressure and respiration rate, were significant after massage (P < 0.001); however, this change was not significant for pulse rate. A significant reduction was also observed in the level of anxiety (P < 0.001) and a significant increase in the frequency of breastfeeding (P < 0.001) after massage. CONCLUSION: As an effective nursing intervention presenting no side-effects, hand and foot massage can be helpful in the management of postoperative pain and stress.

Varicose veins of the legs among nurses: Occupational and demographic characteristics.

This study aims to determine the relationship between occupational and demographic hazards that characterize varicose veins (VV) in the legs and their intensity among nurses.A cross-sectional study was carried out among 203 nurses from three general hospitals in Amol, Iran. The required subjects' information was collected through a self-filled questionnaire and the physical examination of the VV intensity was based on the Clinical finding using the Etiology, Anatomic finding, Pathophysiological standards. The prevalence of VV, with different degrees, was 72.4% (95% CI 65.7-78.4), with women having a higher prevalence compared with men (77.9% vs. 56.9%, P = 0.004). The other non-interventional risk variable was having longer years of service. Interventional variables were long-standing hours, overtime work and body mass index status. This study had determined the occupational risk variables on VV which could be interventional in improving the working nurses' environment and quality of life for their long-term career.

A Rare Case of Klinefelter Syndrome Patient with Quintuple Mosaic Karyotype, Diagnosed by GTG-Banding and FISH.

Klinefelter syndrome (KS) is the most common sex chromosomal disorder in men. Most of these patients show the 47,XXY karyotype, whereas approximately 15% of them are mosaics with variable phenotype. A 39-year-old male investigated for primary infertility, was clinically normal with small firm testes and elevated levels of FSH, LH and low level of testosterone. Total azoospermia was confirmed on semen analysis. Testicular histopathology revealed no spermatogenesis and absence of germ cells. Karyotype from whole blood culture showed cells with 47,XXY/46,XX/ 45,X/48,XXXY/ 46,XY mosaicism. The predominant cell line was 47,XXY (83.67%). This was confirmed by fluorescence in situ hybridization (FISH). Also the presence of a small population of cells with the 48,XXXY and 45,X karyotypes was detected by FISH. This case illustrates the utility of FISH as an adjunct to conventional cytogenetics in assess the chromosome copy number in each cell line of a mosaic.

Nurses' attitude to patient education barriers in educational hospitals of Urmia University of Medical Sciences.

BACKGROUND: The purpose of this study was to explore nurses' attitudes to the barriers of patient education as a right for getting information based on work situation of nurses, educational facilities in hospitals, and patients' situation. MATERIALS AND METHODS: The study was conducted using a cross-sectional design. The populations consisted of 240 nurses affiliated in the Educational Hospitals. The data were gathered by a questionnaire. Demographic variables and three domains were studied. Twenty questions were about their working situation, 4 questions about hospital educating facilities, and 12 questions were about patients' situation in hospital. The type and frequency of education barriers were evaluated, and variables associated with reporting an obstacle were analyzed. FINDINGS: In our questionnaire, we used a Likert scale for determining severity of three domains as the barriers of patient education that ranged from 0 to 4. Generally, it was obvious that educational condition in our hospitals was not good and most of the nurses believed that patient education is not their duties, facilities in hospitals are not sufficient and shortness of time is the most important cause of insufficiency of patient education. CONCLUSIONS: The interactions of patient, physician and systemic factors have implications for the implementation of patient education. The failure of adequate patient education may be attributed to the lack of patient adherence, the failure of nurses' knowledge and skill level or the insufficient funding and organization of necessary programs in the current health care system.

Prevalence burn injuries and risk factors in persons older the 15 years in Urmia burn center in Iran.

BACKGROUND: Burn injuries in many respects is the most tragic that a person may experience. The purpose of this study was to know the burn casualties prevalence in people over 15 years old to identify the risk and predisposing factors in the province of west Azarbaijan of Iran. METHODS: This cross-sectional study was performed from March 2008 to March 2010. The demographic and epidemiologic information about burn and its complications were extracted from the data banks and records. Data were collected and analyzed. RESULTS: Four hundred twenty eight patients (44.9% female and 56.1% male) were studied. Most of the admissions were in 16 to 25 years age bracket. Burning with fire accounted (39.2%) of admission in males and (53.2%) in females which was the most common cause of burning. Percentage patients who had more than 40% body surface area (BSA) burned was 42.0% in males, and 30.1% in females. Patients with >40% BSA burn had a mortality of 73.8%. The mean body surface area burned was 33.8% in males and 25.2% in females. The mean duration of hospitalization was 6.19 days. CONCLUSION: The results of this study show that the prevalence of burn injuries is relatively high with high mortality rate in those with BSA> 40%. The commonest cause of burn was fire.