The Rationality to Requesting in-ward Magnetic Resonance Imaging Investigation.

Background: Magnetic Resonance imaging (MRI) is a valuable diagnostic tool by its non-invasive/non-ionizing nature. Objective: This study aims to determine justification of MRI in hospitalized patients at a tertiary provincial referent medical center in a one-year period. Material and Methods: In the present retrospective and descriptive cross-sectional study, 438 admitted patients referred for MRI during 2017 were selected using systematic random sampling. The age, gender, investigated organ, the specialty of requesting physician, MRI with and without contrast, MRI diagnostic outcome were collected using checklists. Descriptive statistics and chi-square test were used for data analysis. Results: The mean age of the patients was 42±26 years-old and female represented 53% of enrolled patients. The most and less prevalent investigated organs were the cerebrum and the orbit. After excluding cancer diagnosis, cancer staging, and therapeutic follow-up exams, MRI request was oriented in 64.3% and 77.2% of positive results was concordant with aforementioned diagnostic orientation (P<0.001). Oriented diagnostic MRI requesting is influenced by age, medical specialists and, investigated organ (P<0.001). The positive MRI is influenced significantly by oriented MRI request, gender, medical specialists and investigated organ (P<0.001). The diagnosis concordance of MRI is influenced significantly by oriented MRI request, medical specialists and investigated organ (P<0.001). Conclusion: Appropriate implementation of medical imaging requires boosting employed rationality by the concerned physicians. The current suboptimal results to requesting MRI rationality should mandate supplementary educational programs as to incite the medical corpus more closely implementing the published medical practice guidelines.

Massive intraperitoneal hemorrhage in patients with COVID-19: a case series.

Coronavirus disease (COVID-19) initiates several life-threatening complications including coagulopathies with a unique characteristic that made this problem challenging. Here we presented 4 cases of RT-PCR positive patients that have experienced deadly intraperitoneal hemorrhage with fourth WHO Bleeding Grade after overcoming their respiratory phase. COVID-19 could induce several coagulopathies with different features that besides iatrogenic interventions increases its mortality and morbidity due to lack of clinical evidence based on well-designed randomized clinical trials on anticoagulation therapies (AT) and administration of varieties of newly approved and non-approved medicines. This report showed the urgent need for investigation on the pathophysiology of COVID-19-associated coagulopathy esp. in hemorrhagic events which are needed to make the best therapeutic decision.

Effect of progressive muscle relaxation with analgesic on anxiety status and pain in surgical patients.

INTRODUCTION: surgery is a stressful experience for patients and most surgical patients have some degree of anxiety. The purpose of this study was to investigate the effect of a relaxation technique in addition to narcotic analgesic on health promotion in surgical patients. METHODS: in this clinical trial, 70 patients who were candidates for elective upper and lower gastrointestinal system surgery were selected. They were randomly divided into two groups: case (morphine 0.15 mg/kg daily in divided doses and progressive muscle relaxation (PMR)) and control (morphine 0.15 mg/kg daily in divided doses). The intervention group (case group) performed PMR from 6 hours before surgery until 24 hours after surgery. Vital signs and anxiety were evaluated in the two groups after surgery. Data were analysed by t-test, analysis of variance, and chi-square test. RESULTS: a statistically significant difference was seen in vital signs, pain and anxiety between the two groups. However, there was also a significant difference between them in terms of economic status and insurance coverage, which could have had an effect on stress and anxiety. CONCLUSION: PMR could increase the pain threshold, stress and anxiety tolerance and adaptation level in surgical patients. Therefore, using this technique could be an appropriate way to reduce analgesic drug consumption.