Zahra Atrkar Roushan

Peripheral intravenous catheterization (PIVC) is a common invasive procedure in hospital setting. When it fails, patients may endure discomfort and experience delays in treatment and laboratory testing. This study aimed to assess whether a pressure-controlled tourniquet (PCT) influences the success rate of PIVC in hospitalized patients. This parallel group randomized controlled clinical trial enrolled 148 eligible patients, who were randomly allocated to either the PCT or the elastic tourniquet (ET) group. The primary outcome was the First Attempt Insertion Success (FAIS) rate. Data were analyzed with SPSS 27.0.1.0. The FAIS rate for PIVC was 91.7% in the PCT group and 82.9% in the ET group, but this difference was not statistically significant (p = 0.11). Comparison of time to PIVC insertion between the two groups showed that the time was significantly (p = 0.003) shorter in the PCT group (26.59 ± 13.08 s) compared to the ET group (32.88 ± 13.89 s). Sex was a significant predictor of catheter placement success, with men being approximately 1.5 times more likely than women to achieve successful placement. A history of comorbid conditions and elevated body mass index were independently associated with a significantly lower likelihood of successful peripheral venous catheter placement (p < 0.001). The PCT significantly improved vein palpability compared to the ET, with success rates of 98.6% and 89.5%, respectively. The use of a PCT during PIVC may improve vein visualization and palpation, potentially enhancing patient comfort and reducing the time required for successful catheter placement. Although no significant difference in initial success rates was observed between the PCT and ET groups, the findings suggest that PCT may offer clinical advantages, particularly when considering patient-specific factors such as sex and pre-existing medical conditions that influence catheterization outcomes.

Background: Primary bone tumors are rare but aggressive malignancies with varying prognostic outcomes. To improve treatment methods, it is crucial to understand the survival trends and demographic attributes of these patients. Objectives: This study aimed to evaluate the survival rate and associated demographic and clinical characteristics of patients diagnosed with primary bone tumors in Guilan, the north province of Iran, between 2014 and 2018. Methods: This retrospective cohort study utilized data from the provincial cancer registry. Survival analyses were performed using life table methods, Kaplan–Meier estimates, and Cox proportional hazards regression to evaluate survival outcomes and identify factors potentially predictive of prognosis. Results: The study included 166 patients, with a male-to-female ratio of 1.7:1 and a mean age of 44.75 ± 25.55 years. The most prevalent primary bone tumor was osteosarcoma (14.5%), followed by chondrosarcoma (7.2%). The overall 5-year survival rate was 43%. Age at diagnosis had a significant effect on survival (P < 0.001), whereas gender was not significantly associated with survival. Conclusions: These results emphasize the importance of early diagnosis and appropriate management strategies for enhancing patient outcomes.

Background: Breast examination and mammography help in the detection of breast cancer and are valid in improving survival by reducing mortality. Aims: In this study, we aimed to investigate women's knowledge of breast cancer screening in the Prospective Epidemiological Research Studies (PERSIAN) Guilan Cohort Study (PGCS) population. Methods and Results: This cross‐sectional study was conducted on 476 women aged 35–70 among the PGCS population. The demographic and clinical data of participants were collected through a questionnaire. Also, the Champion Health Belief Model Scale, including the perceived benefits of breast self‐examination (six phrases), perceived barriers to breast self‐examination (nine phrases), perceived benefits of mammography (six phrases), and perceived barriers to mammography (nine phrases), was used to collect the knowledge data. The variables of the questionnaire were assessed using the Likert scale. Data were analyzed using SPSS version 20 by significant level < 0.05. Results: Most of the research subjects were within the age of 45–55 years (35.9%) and most of them (64.9%) did not mention any history of prior mammography, but among those with positive history of mammography, most of them (55.1%) had done it without any problem and only based on recommendation. The average scores of benefits and barriers for breast self‐examination among the participants were 9.9 ± 3.7 and 15.2 ± 4.6, respectively. Similarly, for mammography, the average scores were 9.9 ± 3.6 and 14.2 ± 4.7. In overall, factors including age 35–45 years, having insurance, higher education levels, having former visit of a doctor due to breast problem, family history of breast cancer in first degree relatives, and positive history of performing mammography were associated with better scores of perceived benefits and barriers in both breast self‐examination and mammography ( p ≤ 0.05). Conclusion: According to the barriers and benefits identified in this study, it is possible and also necessary to plan for breast cancer screening with organized regional educational plans. It is recommended to focus more on attracting older women to perform screening programs. It is also necessary to encourage doctors to refer women for mammography and support insurance organizations to provide screening services at a lower cost.

Background: Due to the complex anatomy of the sacroiliac joint, the success rate of accurate intra-articular injection is only 12 - 22%. Therefore, an imaging guidance tool is strongly recommended. To compare the safety and the short-term efficacy of US and FL-guided SIJ injections in patients with chronic low back pain. Methods: Eligible participants received 40 mg of prednisolone plus Marcaine. The two groups were compared based on NRS at four measurement point times (T0-T3): Baseline, 15 min, 60 min, and 24 hours after the procedure. The number of punctures, the time of the procedure, and any adverse effects were also documented and compared between the two groups. Statistical analysis was done using SPSS version 21 with a significant level of less than 0.05. Results: Seventy-six eligible cases were enrolled in the survey and randomly divided into ultrasound (US) and fluoroscopy (FL) groups. In both groups, NRS significantly decreased from baseline to 24 hours after the procedures (P = 0.001). However, no significant difference was observed. In four measurement point times, except for 60 minutes after the procedure, the NRS score was significantly lower in group FL. The number of punctures was not significantly different. However, comparing the two groups, the procedure time was considerably shorter in the US group (P = 0.001). None of our patients reported any adverse effects related to the procedures. Conclusions: The US and FL could be accepted as proper guidance tools, while the intervention time was shorter in the US group.

Introduction: Person-to-person transmission of COVID-19 disease is reported to be the main route of transmission among the population putting organ transplant candidates and recipients at a high risk of morbidity and mortality. The present study aimed to assess the frequency of following COVID-19 personal protective protocols among liver transplant candidates and ...

Background: The COVID-19 pandemic has been a significant concern for the global health community since its onset. This study aimed to evaluate lung function tests in the follow-up of COVID-19 patients discharged from Razi Hospital in Rasht, Iran, in 2020. Materials and Methods: This cross-sectional study evaluated lung functional tests, including spirometry and the six-minute walking test (6MWT), in the follow-up of 239 hospitalized COVID-19 cases. All demographical and clinical data, along with the lung performance test results of the patients, were recorded, and statistical data were analyzed using SPSS, version 24. Results: The mean age of the patients was 51.69±13.98 years, and most of them were females. About 60.25% of patients had underlying diseases. The frequency of positive 6 MWT tests during the first three, six, and nine months after discharge was 7.96%, 8.70%, and 14.29%, respectively. In the first trimester after discharge, the 6MWT test was more positive among females. In addition, forced expiratory volume (FEV1)/forced vital capacity (FVC) showed a significant positive relationship with diastolic blood pressure (DBP) and heart rate (HR). After six months, positive 6MWT results were significantly associated with older ages and underlying diseases. The amount of FVC was positively associated with DBP, distance traveled in the 6MWT test, and HR, but it was negatively related to age. Conclusion: The findings revealed that older age, female gender, and underlying diseases were associated with positive 6MWT results, decreased pulmonary function, and higher DBP and HR.

Coinfection of tuberculosis (TB) and human parasitic infections is common in developing countries. There is little information about the prevalence of Toxoplasma gondii (T. gondii) infection among TB patients in Iran. In this case–control study, anti-toxoplasma antibodies were measured by ELISA method in 100 patients with active tuberculosis and 100 healthy individuals who were matched in terms of sex, age, and place of residence. Anti-T. gondii IgG antibodies were diagnosed in 62% of TB patients (95% CI 53–71%) and 70% of control subjects (95% CI 62–78%). Anti-T. gondii IgM antibodies were found in 1% of both TB patients and control group. The seroprevalence of T. gondii infection was not significantly different between TB patients and healthy individuals (P > 0.05). None of the assessed sociodemographic and behavioral factors was recognized as a risk factor for toxoplasmosis in TB infected patients. Moreover, the level of anti-T. gondii IgG antibodies concentration in TB patients was significantly higher than in control subjects and revealed skewness towards humoral immune response in TB patients. Coinfection of toxoplasmosis and tuberculosis was prevalent but T. gondii infection was independent of active TB in this co-endemic area.

Introduction: Due to medical procedures, preterm infants are at high risk for side effects of pain. In this regard, heel lancing for capillary blood sampling is a common painful procedure. The present study was conducted to assess the effectiveness of a simulated intrauterine sound on behavioral and physiological indices of pain due to heel-prick blood sampling in preterm infants. Methods: A double‑blind randomized clinical trial (RCT) was conducted. The data were collected from September 23 to December 22, 2019. We measured the effect of a simulated intrauterine sound on changes in the behavioral and physiological parameters of pain (heart rate, SPO₂) caused by heel lance that was measured 5 min before the intervention, during the sampling, and 5 min after the procedure. We measured behavioral pain by video recording the infants’ faces and then the scoring neonatal infant pain scale (NIPS). Heart rate and SPO₂ were measured using a pulse oximeter device. The data were analyzed using analysis of variance (ANOVA) and independent t‑test in SPSS software version 20.0. Results: Eighty infants were randomized (40 in each group). Mean scores NIPS during and after intervention were in the intervention group (3.55 ± 0.84, 95% CI: 3.30–3.80(, and (1.15 ± 0.84, 95%: 0.95–1.35) and in the control group (5.57 ± 0.95, 95% CI:5.30–5.85) and (3.00 ± 0.98) respectively. There were significant differences in scores of NIPS between the two study groups during (p < 0.001) and five min after heel lancing (p < 0.001). Mean scores of heart rate in the three phases of before, during, and five min after the intervention were respectively in the intervention group (127.57 ± 4.45, 95% CI:126.27-128.99), (131.07 ± 6.54, 95% CI:129.20-133.22), (128.45 ± 5.15, 95% CI:127.02-130.07) and in the control group (128.67 ± 4.57, 95% CI:127.32-130.07), (136.07 ± 7.24, 95% CI:133.90-138.37), and (132.42 ± 6.47, 95% CI:130.37-134.49). There were significant differences in heart rate between the intervention and the control group during (p = 0.002) and five min after the heel lance (p = 0.003). Mean scores of SPO₂ in the three phases of baseline, during, and five min after the intervention were respectively in the intervention group (96.72 ± 0.93, 95% CI:96.42-97.00), (91.47 ± 1.46, 95% CI:91.05–91.92), (94.17 ± 1.03, 95% CI:93.22-94.00) and in the control group (96.6 ± 0.84, 95% CI:96.35–96.85), (91.5 ± 1.24, 95% CI:91.12–91.87), and (93.60 ± 1.27, 95% CI:93.85–94.50). Conclusion: This study showed that the simulated intrauterine sound reduces the behavioral pain and heart rate in the intervention group during and after heel lance. These results suggest using the method during the painful heel lancing to reduce pain parameters in preterm infants.

Background: Breaking bad medical news is one of the most difficult tasks of physicians. In this regard, communication skills play a vital role. Objectives: This study aimed to investigate patients’ preferences and attitudes toward receiving bad medical news in academic hospitals affiliated with Guilan University of Medical Sciences. Methods: This cross-sectional descriptive study was conducted on patients over 18 years of age from March 2021 to December 2021. A questionnaire taken from Alrukban’s study regarding patients’ demographic characteristics, preferences, and tendencies while receiving bad news was filled out through a face-to-face interview. Results: In this study, 600 patients were interviewed, 96% of which preferred to know their disease diagnosis, 76.2% preferred to be the first person to receive bad news, and employed individuals with younger ages and higher levels of education significantly preferred to be the recipients of illness news. Furthermore, 40.7% of patients preferred not to be accompanied by anyone when receiving bad news, 82.3% preferred to be broken bad news by the head of the medical team, and 50.8%, particularly female, younger, and employed patients, preferred the physician to start the conversation containing some information about the disease. Also, younger female patients significantly preferred the physician to stay with them and provide additional information after presenting the diagnosis in a completely private space. Conclusions: Most patients preferred to know about their diagnosis. The impact of socio-demographical variables, including age, gender, level of education, and marital status, should be considered when breaking bad news.