Background: Mechanical ventilation in emergency departments (ED) is crucial to airway management. Various factors significantly influence patient outcomes. Objectives: This study aimed to evaluate the prognostic factors of mortality in patients undergoing mechanical ventilation in the ED. Methods: This retrospective cross-sectional study examined patients over 18 who underwent mechanical ventilation in the ED of a referral hospital in Tehran, Iran, between August 2022 and September 2023. The association between patients characteristic and intubation-related parameters with in-hospital mortality was measured using univariate and multivariate logistic regression, as well as Kaplan-Meier survival curve analyses. Results: We examined 430 patients with a mean age of 61.4 ± 22.0 (range: 18-103) years were studied (60.7% male). There was significant correlation between in-hospital mortality and age (P < 0.01); cancer (P = 0.002) and hypothyroidism (P = 0.009) as the underlying diseases; failure to protect airway (P = 0.27) and oxygenation failure (P = 0.04) as the causes of intubation; vasopressors usage (P < 0.001); medications which were used for rapid sequence intubation (P < 0.001); systolic blood pressure (P < 0.01) and diastolic blood pressure (P < 0.01); time to intubation (P = 0.006); platelet count (P < 0.001) and hemoglobin level (P= 0.003); and finally HCO3 (P = 0.05) and PCO2 levels (P = 0.013). Multivariate logistic regression analysis identified cancer (P = 0.019, OR = 0.13), oxygenation failure (P = 0.03, OR = 0.32), vasopressor medication (P < 0.001, OR = 0.07), systolic blood pressure (P = 0.035, OR = 1.03), platelet count (P = 0.042, OR = 0.99), and PCO2 (P = 0.013, OR = 0.95) as independent predictive factors of mortality rate. Conclusion: This study identified several predictive factors of mortality in patients undergoing mechanical ventilation in the ED, including cancer, oxygenation failure, use of vasopressors, lower systolic blood pressure, lower platelet count, and lower PCO2.
Background: Visceral fat has been associated with severe COVID-19 outcomes due to its pro-inflammatory effects. While computed tomography (CT) is the standard for measuring visceral fat, ultrasound (US) offers a non-invasive and accessible alternative. This study aimed to evaluate whether abdominal fat thickness measured via US predicts clinical outcomes in COVID-19 pneumonia. Method: This prospective cohort study included 83 hospitalized COVID-19 patients. Visceral fat thickness (VFT), subcutaneous fat thickness (SFT), and preperitoneal fat thickness (PFT) were measured with US. The primary outcome of interest was mortality. Multivariable logistic regression was used to analyze associations, adjusting for confounders such as age, sex, and comorbidities. Results: 83 patients with a median age of 62 (IQR: 49–73) years were included (53% male). Mortality was significantly higher in male (61.4% vs. 38.6%, p = 0.018); older age (73.5 vs. 59.5; p = 0.003); patients with lower median blood oxygen saturation (80% vs. 88%, p < 0.001), higher median levels of AST (66 vs. 39.5, p = 0.002), BUN (67 vs. 36.5, p < 0.001), and creatinine (1.6 vs. 1.2, p < 0.001); and patients under mechanical ventilation (p < 0.01). Based on multivariate logistic regression analysis the independent predictors of mortality were VFT (aOR: 1.025, 95% CI: 1.001–1.051, p = 0.047), old age (aOR: 1.064, 95% CI: 1.016–1.115, p = 0.008), and male sex (aOR: 4.430, 95% CI: 1.169–16.769, p = 0.029). In contrast, SFT had an aOR of 1.059 (95% CI: 0.966–1.161, p = 0.223), and PFT had an aOR of 1.016 (95% CI: 0.880–1.172, p = 0.830), neither of which was statistically significant. The area under the ROC curve of VFT in predicting mortality was 0.643. The optimal cutoff value for VFT, determined using the Youden Index, was 80.4. At this cutoff point, the sensitivity was 52.2% while the specificity was 75.0%. Conclusion: It seems that ultrasound-measured VFT is a potential predictor of mortality in hospitalized COVID-19 patients, offering a cost-effective and accessible tool for risk assessment. Further research is needed to confirm its broader applicability.
Background: Stroke is considered as one of the most important causes of emergency medical services (EMS) dispatch worldwide. Stroke is a time-sensitive condition and rapid transport of the patients improves the prognosis. In this study, we described prehospital emergency response times for stroke patients in Isfahan, Iran. Methods: In the current cross-sectional descriptive study, suspected stroke patients who were transported by EMS in Isfahan, Iran, from June 2022 to June 2023 were included. The data was extracted from patients’ files. The time interval between the receipt of a call and the EMS arrival at the scene (arrival time), the time interval between on-scene EMS arrival and the ambulance departure to the medical center (stroke scene time), and the time it takes to reach the medical center (transport time) were collected. Results: Overall, 79 patients with a mean age of 71.56 ± 12.03 were included. EMS diagnosed 63 (79.75%) of the patients with a definite diagnosis and 14 (17.72%) with probable stroke. Two false negative results were found. The average arrival time, was 11.56 ± 6.60 minutes, on-scene stroke time was 13.85 ± 7.23 minutes and the average transport time was 11.90 ± 6.08 minutes. The mean total EMS response time was 37.90 ±11.29 minutes. Conclusion: Overall, our study showed that while the EMS transport time is longer than ideal, the total time to transport to the hospital is short enough not to affect the outcome. EMS was also found to be adept at spotting the signs of stroke and rapidly starting the process of treatment.
Background: The purpose of this study was to examine the outcomes of cardiopulmonary resuscitation (CPR) including return of spontaneous circulation (ROSC), survival to hospital discharge and neurological outcome in the emergency department (ED). Methods: This prospective observational study included 233 patients with 51 cases of Out-Of-Hospital Cardiac arrests (OHCA) and 182 cases of In-Hospital cardiac arrests (IHCA). The study was performed in the ED of a tertiary health care center in North India from July 2018 to June 2021. Results: The majority of the study subjects (67.8%) were males, and the median age of patients was 47 years. 35.6% of cases (N=83) had a sustained ROSC after the first attempt of CPR. Survival to inpatient admission was seen in 20.2% of cases (N=47), and survival to hospital discharge was observed in 3.9% of cases (N=9). Out of 9 cases who survived, 7 cases (3%) were discharged with good neurological outcomes (Modified Rankin Scale of 0-2). For OHCA, the predictors of survival were witnessed arrest (Odds Ratio [OR]=4.58, 95% CI: 1.08-19.38), bystander CPR (OR=3.78, 95% CI: 1.78-18.13), and time to reach the hospital (OR=0.70, 95% CI: 0.55-0.89). Whereas in IHCA, patients with initial shockable rhythm had increased odds of survival (OR=1.49, 95% CI: 1.35-1.74). Conclusion: In our study, in contrast to the developed countries, the survival to hospital discharge in cardiac arrest patients presenting to ED was very low. Therefore, this study proposes the development of a robust cardiac arrest registry in India, to address the gaps in the existing knowledge and facilitate future research.
Background: Clinical, radiological, and laboratory findings characteristic of the coronavirus disease 2019 (COVID-19) infection have already been investigated and identified; however, data on pregnant women infected with COVID-19 are limited. This study aims to examine the clinical, radiological, and laboratory characteristics of pregnant women compared to non-pregnant women with COVID-19 disease. Method: This hospital-based retrospective age-matched case-control study included two groups, pregnant and non-pregnant women, each consisting of 51 patients hospitalized with COVID-19 in Bushehr, Iran. Demographic, clinical, and laboratory information was extracted from medical records using a predefined checklist. Results: Except for cough, there were no statistically significant differences in clinical signs and symptoms between pregnant and non-pregnant women. Although hemoglobin oxygen saturations are statistically significant among the two groups, this difference is not clinically significant (95% vs 93%). There were no statistically significant differences between pregnant and non-pregnant women in the pattern of pulmonary involvement in chest CT findings. Laboratory factors such as serum hemoglobin, red blood cell count, absolute lymphocyte count, prothrombin time and partial thromboplastin time, serum creatinine, serum potassium, and lactate dehydrogenase had statistically significant differences between the two groups. However, these differences were not clinically significant. Conclusion: In a few aspects, the clinical characteristics and laboratory test results of COVID-19 in pregnant patients seem to be distinctive from their nonpregnant controls. We believe our findings can guide the prenatal and postnatal considerations for COVID-19 pregnant patients.
Background: Emergency neurosurgery plays a critical role in the management of life-threatening neurological disorders. Previous studies have shown that the initial clinical status and prolonged time interval to surgery affect patient mortality and morbidity. This study aimed to describe the association of the baseline and clinical characteristics of patients and the timing of intervention with the emergency neurosurgical intervention outcomes. Methods: A retrospective cross-sectional study was conducted involving all patients who received emergency surgery in the theatre of Udayana University Hospital from June 2021 until 2023. Age, gender, type of surgical procedures, severity of trauma, Glasgow coma scale (GCS) at emergency room arrival, time to theatre (TTT), the duration of the operation, and length of stay (LOS) were collected. Mortality was defined as the primary outcome. Results: 43 emergency surgeries were included. The mean age was 42.35 (±21.85) years and the majority of patients were male (69.8%). 65.1% of patients were trauma cases and 51.2% underwent craniotomy. The median GCS at the time of admission was 9, the median TTT was 3 hours, the median duration of surgery was 2.41 hours, and the median LOS was 7 days. After the procedures, the survival rate was 67.4%. The GCS upon admission (p=0.003) and TTT (p=0.044) were significantly associated with the patient's mortality. Conclusion: GCS at emergency room arrival and TTT in emergency surgery were associated with the mortality of emergency neurosurgery patients.
Background: Smoking is one of the most important risk factors for cardiovascular diseases. Although numerous studies have evaluated the long-term consequences of smoking, few studies have assessed the short-term effects of smoking, especially on the electrical activity of the heart. The aim of this study was the evaluation of the acute effect of smoking on cardiac electrical function and hemodynamic indices in smokers. Materials: In this single-arm pretest-posttest study, 130 healthy smokers participated if they had smoked at least 100 cigarettes in their lifetime and were smoking daily. After considering the exclusion criteria, participants were monitored before and 10 minutes after smoking by electrocardiography (ECG) to measure QT dispersion (QTD) and P-wave dispersion (PWD), systolic blood pressure (SBP) and diastolic blood pressure (DBP), heart rate (HR), and respiration rate (RR). Finally, the data obtained before and after smoking were compared. Results: The mean age of the participants was 40.3 ± 10.6 years (range 19 to 71 years). 55 (42.3%) participants smoked between 10-15 years and 67 (51.5%) smoked 10 to 20 pack-years. After smoking, SBP (127.3 ± 10.4 vs. 138.4 ± 12.8 mmHg), QTD (33.5 ± 9.6 vs. 43.9 ± 10.7 ms) and PWD (28.9 ± 6.6 vs. 34.5 ± 7.4 ms), HR (80.1±9.8 vs 87.6±9.9) increased significantly (P value <0.001). In other parameters, no significant differences were observed. Conclusions: Smoking is associated with an acute increase in QTD and PWD, and thus an increased risk of ventricular arrhythmias (e.g. Torsade’s de pointes), atrial fibrillation, sudden death, and other heart problems.
The situation, structure, and facilities of hospitals change in a crisis, which negatively affects the provision of care quality of health services. One of the current world crises is the Covid-19 pandemic. This study aimed to investigate the preparedness of hospitals to deal with the Covid-19 crisis. This narrative review searched the SID, PubMed, Scopus, and Google Scholar databases/search engines in published articles between 2019-2022. A search strategy was defined for PubMed and it was translated into other selected databases. Also, the reference list of the included articles was searched. The databases/search engines were searched by two authors independently, and any disagreement was resolved through discussion. Inclusion criteria included being an original paper, in Persian or English, and compliance with the purpose of the study. The exclusion criteria included not having access to the full text of the article. To find related articles, Iranian and International databases were searched using Persian keywords and their English equivalents (Covid-19, Hospital, Preparedness, epidemic, and Pandemic). A total of 311 articles were found, of which 15 were reviewed. The study showed that hospital preparedness against the Covid-19 pandemic in most countries and different regions in Iran is not optimal. Hospitals should be prepared in terms of personal protective equipment, staffing, and beds. Rapid response management and hospital equipment should be strengthened. Considering the desirability of patient preparation in coping with Covid-19, it is necessary to improve healthcare facilities by increasing the number of workforce and beds.
Blood product transfusion is a double-edged sword; it can be lifesaving in many circumstances, yet life-threatening serious complications may occur. Although transfusion-related reactions have decreased over the years as a result of hemovigilance networks all over the world, human errors still remain an important concern. In this case report, we describe a patient undergoing elective spinal surgery who received an incompatible blood product. Then we will describe measures to mitigate such errors.
Cervical ectopic pregnancies (CEPs) are rare, comprising less than 1% of ectopic pregnancies. On one hand, the abundant blood supply of the cervix and its incompatibility to keep the pregnancy in progress increases the potential for bleeding following CEP, mortality, complications, and infertility in affected women. CEPs are more difficult to diagnose and get identified at later gestational ages. CEP is one of the rarest forms of ectopic pregnancies and most commonly are a consequence of assisted reproductive technology (ART); while definitive risk factors are not fully known. Possible risk factors include cervical and uterine anomalies, previous curettages or cesarean sections, smoking, tubal factor infertility, or in vitro fertilization (IVF) treatment. Our analysis of literature in 200 patient restricted to retrospective case series , showed that a history of previous C-section, uterine curettage or D&C procedures, and a history of using assisted reproductive technology might be some of the potential risk factors. The increasing application of Hegar dilators was hypothesized as the cause of the rise in CEPs. Dilation and curettage (D&C) might also make the subject vulnerable to CEP development in the future. Previous D&C history could be a potential predisposing factor that is common among CEP patients. In this review, we critically reviewed these potential risk factors. In conclusion, the risk factors of CEP and their effect on fertility are also not studied properly. The rarity of these cases makes it difficult to predict as well if the risk of their recurrence is elevated.
Cardiac tamponade is a leading cause of death in patients with aortic dissection. When aortic dissection is accompanied by cardiac tamponade, emergency surgery to repair the aorta is required. The treatment approach for this group of patients differs from other cases with pericardial effusions, and percutaneous pericardiocentesis is contraindicated. Attempting pericardiocentesis in this type of tamponade leads to increased leakage from the aorta into the pericardium, worsening the patient's condition. Here I present a 29-year-old woman with chest pain who called emergency medical service to her home. Cardiac arrest occurred during her transfer to the emergency department. During the cardiac resuscitation, this pericardiocentesis was performed, but drainage was unsuccessful due to the presence of a gelatinous fluid, despite the needle being visible within the pericardial space. Suspecting aortic dissection as the cause of cardiac tamponade, an on call cardiothoracic surgeon was immediately consulted. The surgeon ordered the patient to be transferred to the operating room, while cardiac resuscitation was continued. Following the surgery, the surgeon reported that the patient has a cardiac tamponade caused by an aortic dissection, and that the gelatinous effusion resulted was a result of clotted blood around the heart. However, the patient did not survive after surgery.
Background: Even though the basic principles of cardiopulmonary resuscitation (CPR) are simple, the patients' outcome remains inconsistent. This study aimed to investigate the CPR outcomes and associated factors in the emergency department. Method: This cross-sectional study was conducted on patients who underwent in-hospital CPR following a cardiac arrest in the emergency department for one year. The patient's baseline characteristics and CPR outcomes were recorded from patients' profiles, and the association of patient-related and CPR-related variables with the outcomes was assessed. Results: 220 patients with a mean age of 71.5 ± 16.9 (range: 20-100) years were included (60.5% male). 193 cases of cardiac arrests had occurred in the hospital. Presenting cardiac rhythm in 198 cases (90.0 %) was asystole (not requiring defibrillation). The mean duration of conducted CPR was 43.2 ± 15.6 (5-120) minutes. Only 7 patients (3.2%) achieved the return of spontaneous circulation (ROSC) and were discharged from the hospital, with one suffering from neurological impairment due to CPR. There was a significant association between age (p = 0.047), consciousness status at admission (p = 0.003), presenting cardiac rhythm at CPR initiation (p = 0.0001), and establishment of ROSC under 45 minutes (p = 0.043) with patients' outcomes. Presenting cardiac rhythm at CPR initiation (p = 0.001), ROSC under 45 minutes (p = 0.012), and consciousness status at admission (p = 0.027) were independent predictive factors of survival. The area under the ROC curve for presenting cardiac rhythm and ROSC under 45 minutes was 0.817 (95% CI: 0.617-1.000) and 0.805 (95% CI: 0.606-1.000), respectively. Conclusion: Based on the present study's findings, the survival rate of patients after CPR in ED was 3.2%. Presenting cardiac rhythm, ROSC under 45 minutes, and consciousness status at admission was among the independent predictors of mortality.
Background: Diabetic foot is one of the long-term microvascular complications of diabetes mellitus (DM). The prevention of foot ulcers is the most effective way to reduce severe morbidity and mortality in patients with diabetes. Appropriate glycemic control is one of the most important preventive measures for diabetic foot ulcers. Glycosylated hemoglobin (HbA1C) is representative of long-term blood glucose levels over the prior three months. The present study evaluated the relationship between HbA1C levels and the development of diabetic foot ulcers. Methods:The present study was an analytical case-control study conducted in Ali-ibn-Abitaleb Hospital in Zahedan, Iran, in 2022. 130 patients comprising 65 DM patients with diabetic foot ulcers and 65 DM patients without foot ulcers were included in this study. Demographic and laboratory information was collected by the researcher using a checklist. The data were analyzed using SPSS software. Results: The average age of the control and case groups was 64.1 and 62.6 years, respectively. The results showed a significant relationship between the age of 60-70 years and the onset of diabetic foot ulcers. There was also a significant relationship between the female gender and the occurrence of diabetic foot. No significant relationship was observed between the duration of DM and the onset of diabetic foot. The results showed that 87.7% of the people in the control group had no previous history of diabetic foot. However, 76.9% of the people in the case group had a prior history of diabetic foot. There was a significant relationship between the previous history of the diabetic foot and its recurrence in diabetic patients. Regarding the serum level of HbA1C, 78.5% and 12.3% of patients in the case group had moderate (7-10%) and poor control (10-13%), respectively. 43.1%, 50.7%, and 6.2% of people in the control group had good, moderate, and poor control and in the multivariable model, only the previous history remained in the model, which showed that the probability of infection in people with a previous history is almost 24 times higher than in people without a previous history. Conclusion: The results indicate that age, female gender, history of diabetic foot, and high serum level of HbA1c had a significant relationship with diabetic foot. Since the serum level of HbA1c is an important indicator of long-term blood sugar control, it can possibly be used as a reliable factor to predict diabetic foot complications
Background: Rapid antigen tests have gained importance during the COVID-19 pandemic due to low prices and availability. The present study investigated the performance of the SARS-CoV-2 rapid diagnostic test in diagnosing patients with COVID-19 referred to the emergency department. Methods: In this diagnostic accuracy study, patients with suspected COVID-19 referred to Imam Hossein and Shohadaye Tajrish Hospitals, Tehran, Iran, were examined. All patients were subjected to a rapid corona test according to the manufacturer’s guide and a chest computed tomography (CT) scan as the standard test. The screening characteristics of the rapid test compared to CT scan were calculated and reported. Results: 183 people with an average age of 46.83 ± 14.26 (range: 21-83) years entered the study. 141 suspected cases of COVID-19 (77%) had evidence of lung involvement in CT, and the rapid test was positive in 83 (45%) cases. Out of 83 patients who tested positive for COVID-19, all (100%) had positive chest CT findings. Out of the 100 patients who tested negative, 42 patients (42%) had negative chest CT findings, and 58 patients (58%) had positive CT scans. The sensitivity, specificity, and accuracy of the mentioned test were 58.86, 100.00, and 68.30 percent, respectively. Conclusion: Due to the relatively low sensitivity, the Rapid SARS-CoV-2 antigen test fails to screen for SARS-CoV-2 infection. However, it can be used to confirm the presence of the disease in symptomatic individuals and reduce virus transmission during the COVID-19 pandemic.
Introduction: Proper and effective triage of COVID- 19 patients is of particular importance. The aim of this study was to determine the effectiveness of triage in leveling patients with suspected COVID- 19. Methods: This descriptive cross-sectional study was performed in the period between April and June 2020 in one of hospitals in Tehran. A total of 1010 of COVID- 19 patients referred to the triage of Hospital in Tehran were examined. In addition, clinical and laboratory information of hospitalized patients were also examined. Patients who were discharged from triage without the need for medical intervention and were recommended to rest at home were also followed up. The collected data were analyzed using descriptive statistics such as frequency (percentage), mean (standard deviation) and also using logistic regression modeling and statistical tests of t-test and chi-square. Results: The results showed that 360 people (35.5%) were admitted to the hospital and the remaining 650 (64.5%) did not need to be hospitalized according to the triage. Patient age variables (OR = 1.024 (1.007-1.042)), D-Dimer (OR = 1.331 (1.009-1.754)), number of white blood cells at admission (OR = 1.379 (1.092-1.741)) and length of hospital stay (OR = 1.087 (1.044-1.131) showed a direct and significant relationship with mortality; but body pain (OR = 0.437 (0.217-0.883)) and SPO2 (OR = 0.933 (0.900-0.968)), first-time hemoglobin (OR = 0.907 (0.822-0.999)), second-time hemoglobin (OR = 0.828 (0.728 -0.942) and platelet count (OR = 0.515 (0.322-0.824)) showed an inverse and significant relationship with mortality. Conclusion: The results of the study showed that the triage and leveling performed for patients in Shariati Hospital was correct and was able to identify critically ill patients.
Today, clinicians use ultrasound, similar to the use of a stethoscope ten years ago. We will soon see ultrasound probes in the pockets of every medical student. Nowadays, ultrasound probes are used in the examination of patients, and ultrasound is no longer considered a para-clinical procedure, and during patient examinations, we also perform ultrasounds for our patients in order to limit differential diagnosis. As a result of these examinations and applying clinical and ultrasound findings, the desired treatment is determined. In ultrasound, one challenge that always arises is the Doppler field and vascular flow. Recent articles have emphasized the importance of using ultrasound for clinicians. There is a general lack of enthusiasm among clinicians when the term Doppler is mentioned. Due to this, I considered it necessary to write an educational article in an easy-to-understand manner and at the same time practical in this field for the medical community, especially clinicians. It is my goal to provide the information in a simple and practical manner.
Renal infarction is rare and may be considered acute renal colic in presentation. In this report, we describe a case of renal infarction caused by thrombosis that extended from the aortoiliac to the infrapopliteal segment, along with thrombosis that occurred in the right popliteal artery and left atrium. A 48-year-old man was referred to the emergency department (ED) suffering left flank pain. The pain was significant with radiation to the left lower quadrant, and the pain did not significantly decrease despite intravenous ketorolac and morphine sulfate administration. We decided to perform a color Doppler ultrasound test of intraabdominal vessels that revealed low flow in the left iliac artery. By computed tomography angiography (CTA), it was confirmed that the left renal, iliac, and popliteal arteries were thrombosed. The patient underwent anticoagulation, thrombectomy, and Mitral valve replacement surgery during the hospitalization. After 14 days, his heart rhythm returned to normal sinus and he was discharged from the hospital with proper outpatient follow-up. Patients with severe flank pain and who do not respond to routine treatments, especially patients with significant risk factors, should be evaluated more carefully for red flag diagnosis.
Ischemic heart diseases (IHDs) are among the most important causes of death and disability worldwide. Every year, 10.6 million people are diagnosed with IHDs; in 2017, 8.9 million died due to this disease. The treatment of myocardial infarction is principally based on prompt blood supply restoration to salvage the ischemic tissue utilizing timely thrombolytic medications and coronary revascularization. However, the subsequent reperfusion provokes secondary cellular damage, broadly referred to as reperfusion injury. Although a compendium of therapeutic agents has been proposed to allay the detrimental consequences of reperfusion, they do not yet have desirable efficacies, and the research for discovering novel promising treatments is still ongoing. Preclinical studies are integral to the translation of preliminary research into clinical practice. Conventionally, plausible treatments and innovative drugs are tested in animal experiments to ascertain their effectiveness and safety. Experimentations on cardiac Ischemia/reperfusion injuries comprise a significant body of literature among the preclinical studies, and one can find a myriad of evidence in online databases. Through our systematic reviews, we have encountered various myocardial ischemia/reperfusion (I/R) models, including large vessel ligation, global ischemia by administrating Isoproterenol, and interrupted perfusion of isolated hearts mounted on the Langendorff apparatus. Moreover, the studies were inconsistent regarding the duration of ischemia and, the subsequent reperfusion phase. The secondary damages in the course of I/R injury are proportionate to the extent and duration of the ischemia. Moreover, Pathways leading to myocardial damage during I/R injury are considered a dynamic and evolving process. Therefore, the efficacy of interventions in mitigating I/R injury may be misestimated depending on the duration of the ischemic and reperfusion phases. To surmount these concerns, we suggest an expert panel develop standardized guidelines for myocardial I/R injury induction in experimental studies to consolidate further the reliability and validity of the results obtained from preclinical studies, ultimately contributing to the better appraisal of the studies. In the meantime, tissue markers representative of the degree of infarction or tissue fibrosis can be used to compare the induced ischemia/reperfusion injuries in studies.
بیش از دو سال از شروع پاندمی کرونا می گذرد و هنوز زوایای زیادی از این بیماری برای نظام سلامت مجهول مانده است. این بیماری بار مالی و جانی قابل توجهی را به کشورها تحمیل نموده و قسمت عمده ای از تحقیقات نظام سلامت را معطوف به خود ساخته است. بر اساس گزارشات رسمی، تا روز ۱۵بهمن ۱۴۰۰ در مجموع ۲۲۴ کشور جهان درگیر کرونا بوده اند که مجموع مبتلایان سراسر جهان ۳۸۹ میلیون نفر و در ایران ۶۴۳۸۰۰۰ نفر و مجموع جانباختگان جهان ۵۷۳۲۰۰۰ نفر و در ایران ۱۳۲۶۲۴ نفر رسیده است.
مقدمه: احیا قلبی پیشرفته و برخورد با ایست قلبی از موضوعات مهمی است که دستیاران طب اورژانس باید با آن آشنایی کامل داشته باشند. هدف از انجام این طرح مقایسه دو روش آموزش حضوری و استفاده از سرویس های پیام رسان (که قابلیت به اشتراک گذاری صوت و تصویر را دارند مانند واتساپ) است. روش مطالعه: در این مطالعه دستیاران طب اورژانس برای آموزش احیای قلبی ریوی، به صورت تصادفی به دو گروه تقسیم شدند. گروه کنترل آموزش حضوری به صورت طرح سناریو انجام شد و در گروه دوم آموزش احیا به صورت طرح سناریو در گروه پیام رسان نرم افزار واتساپ، به صورت غیر حضوری انجام شد. پیش آزمون و پس آزمون از هر دو گروه انجام شد. نمرات آزمون ها مورد محاسبه وآنالیز آماری قرار گرفت. یافته ها: بررسی مقایسه فراوانی جنسی، مقایسه میانگین سال دستیاری، مقایسه فراوانی گذراندن دوره CPR، و میانگین سنی دو گروه مورد بررسی اختلاف معنی داری را نشان نمی دهد. همچنین میانگین درصد نمره آزمون CPR در بین دو گروه مورد بررسی قبل و پس از آموزش اختلاف معنی داری را نشان نداد. اما میانگین درصد نمره آزمون CPR در گروه مداخله قبل و پس از آموزش اختلاف معنی داری را نشان داد. میانگین درصد نمره آزمون CPR در گروه کنترل قبل و پس از آموزش اختلاف معنی دارد. همچنین در صورتی که پس آزمون را به عنوان متغیر وابسته و دو گروه را به عنوان متغیر مستقل و پیش آزمون را به عنوان کوواریانس وارد فرمول ANCOVA کنیم بین دو گروه در پس آزمون اختلاف معنی دار مشاهده می شود. (P-value= 0.002) نتیجه گیری: آموزش مبتنی بر سناریو در مورد احیا بالغین به روش بحث گروهی با نرم افزار پیام رسان بر روی دستیاران موثرتر است. برای مطالعات آتی بررسی با حجم نمونه بزرگتر و در مدت زمان طولانی تر پیشنهاد می شود.
