ali bahramifar

Intubation is normally conducted in an emergency or prior to surgery. A cuffed tracheal tube is fitted, whose inflated cuff exerts pressure on the tracheal wall. Such pressure should, therefore, be monitored every day by use of pressure gauge devices. The general guideline in this regard is that the pressure of the cuff must lie between 20 and 30 cm of water. The exaggerated pressure may cause tissue ischemia, wound, and necrosis of the tracheal wall; if it is too low, this could result in air leakage and oropharyngeal secretions, increasing the risk of insufficient ventilation and aspiration pneumonia. This study aimed at comparing the cuff pressure of an endotracheal tube inflated with alkaline lidocaine versus air for any post-extubation complications and cuff pressure changes.

This prospective cohort study was conducted on patients who were admitted to the intensive care unit of Baqiyatullah Al-Azam Hospital in Tehran between May 2023 and February 2024, underwent intubation in this unit and met the inclusion criteria for the study. This prospective study included 62 patients, and tracheal tube cuff pressure was recorded at 30 minutes, 60 minutes, 120 minutes, 6 hours, and 24 hours after intubation with a pressure gauge. Patients were randomly divided into two groups-an 'air group', whose cuff was inflated to the pressure of 20 cmH2O by air, and a 'lidocaine group,' whose cuff was filled with 2% lidocaine to the same pressure. In this study, the post-extubation complications, such as sore throat, hoarseness, and cough, were assessed immediately and 24 hours after extubation. Similarly, the tracheal tube displacement during the intubation process was monitored in both groups.

The results showed that the pressure of an endotracheal tube cuff inflated with lidocaine was drastically lower than the one inflated with air, with a p-value of 0.001. On the other hand, the sore throat, cough, and hoarseness after extubation and 24 hours later were significantly fewer in the lidocaine group compared with the air group at a p-value of 0.001.

Cuffs inflated with alkalinized lidocaine clearly avoided high cuff pressure at induction and reduced postextubation sore throat. Hence, alkalinized lidocine-filled endotracheal tube cuffs are comparatively safer and more beneficial than conventional air-filled cuffs.

This study aimed to assess the clinical outcome of combined pars plana deep vitrectomy (PPV) with temporary keratoprosthesis and penetrating keratoplasty (PK) in severe military ocular trauma patients. During 12 months of follow-up, 13 eyes of 12 patients operated on from September 2017 to March 2018 were evaluated. Ocular history, visual acuity (VA), and clinical findings of the cornea and retina were recorded. Twelve patients with severe military ocular trauma and light perception VA were included. At the end of the visit, 66.5% of the patients had better visual acuity; the cornea remained clear in 50%, and the retina was attached in 91.6% of the eyes. The rate of additional surgery was 25% of cases due to corneal graft failure. The long-term results of combined PPV with PK in eyes that would otherwise be untreatable due to severe injury are often limited by secondary graft failure. Although the clinical outcomes are not very satisfactory in the long term, the combined surgery gives these patients these patients the last chance to conserve their remaining vision and undergo anatomic reconstruction.

Delay in the transfer of critically ill patients admitted to the emergency department to the intensive care unit (ICU) leads to worsening of their clinical outcomes. The long time from the beginning of the primary organ disorder to the appropriate interventions in critically ill patients has a direct impact on the survival rate of these patients because critically ill patients often need time-sensitive therapeutic interventions to reduce mortality.  Shortening the admission time of critically ill patients who need to be hospitalized in ICU can be significantly decreased mortality in the patients. Different interventions can be done in this field. One of the most cost-effective measures to reduce the mortality of these patients is to preserve the golden and precious time to start the care and treatment process. Evidence-based and need-based training is always effective and beneficial. This letter highlights the crucial role of RCCN in emergency and critical care settings and emphasizes the need for a comprehensive training program to equip them with the necessary skills. By investing in the development of RCCN, we can enhance patient outcomes, reduce complications, optimize resource utilization, and ultimately save lives.

Clinical evaluation is one of the main components in the discussion of clinical education in the field of nursing. Based on Miller's Pyramid in Education, objective structured clinical examination becomes one of the applied assessment methods to evaluate clinical skills. One of the clinical skills of nurses, especially in the Intensive Care Unit (ICU), is mechanical ventilation. This study was conducted with the aim of designing an objective structured clinical examination to evaluate the competence of nurses in mechanical ventilation.

This descriptive study was conducted in 1401 in Tehran, Iran. According to the educational content of basic mechanical ventilation principles and the purpose of the study, six stations were determined and a specialized checklist was designed accordingly for each station. Checking the validity of the content of the designed checklists was done using the opinions of experts in both qualitative and quantitative ways.

Finally, the number of six stations with 31 items with titles; Tubing connection and initial preparation of the ventilator, initial and basic settings of the ventilator, check and intervention in the oxygenation status, check and intervention in the ventilation status, management of clinical challenges and management of alarms were finalized. Scoring ranged between 1 and 5, and the sum of the scores of the stations would indicate the nurse's clinical competence in mechanical ventilation.

According to the results of the present study, the use of an objective structured clinical examination designed to evaluate the clinical competence of nurses in basic mechanical ventilation is suggested.

The epidemiology of ocular manifestations and associated complications in patients with Corona Virus Disease 2019 (COVID-19) have been investigated worldwide. Herein, we aimed to summarize the frequency of ocular symptoms of COVID-19 in the current systematic review and meta-analysis using available literature.

A search of PubMed, Scopus, Web of Science, EBSCO, and Embase electronic databases to review the systematic literature until August 2021. The Hoy et al., 2012 tool was used to evaluate the quality of studies. For Data extraction, two reviewers blind and independently extracted data from the abstract and full text of the studies included. 95% confidence interval for effect size with random effect model and restricted maximum likelihood (REML) method were calculated. Meta-analysis was performed using Stata/MP v.16 software (The fastest version of Stata).

Initially, 210 studies were retrieved, of which we reviewed the full text of 24 records, and eight were selected for final meta-analysis. The prevalence of redness in patients with COVID-19 was 12.37% (ES, 95% CI -1.11%, 25.85%), and heterogeneity was found (I2 = 99.37%; p <0.001) (High heterogeneity). The prevalence of Ocular manifestations as the first symptom of COVID-19 in patients was 2.63% (ES, 95% CI 1.23%, 4.03%).

This systematic review and meta-analysis found the prevalence of redness, dryness, ocular pain, foreign body sensation, discharge, itching, follicular conjunctivitis, and watering as 12.37%, 26.70%, 30.64%, 14.47%, 19.93%, 8.77%, 12.77%, and 10.23%, respectively.

The ICU liberation campaign helping improve quality of intensive care and reduces post-intensive care syndromes through the release of ABCDEF bundle, which utilizes an interprofessional approach. Evidence has shown barriers to proper bundle implementation (such as complexity and multiplicity of bundle interventions, limited bundle understanding by staff, poor interprofessional collaboration, shortage of staff) may play an important role. A multistage study was conducted to localize the ABCDEF bundle.
 Firstly, the ABCDEF bundle was translated into Persian using the WHO protocol. The initial Persian translation was performed by both a nonmedical and medical individual. After combining and enhancing the translations, it was transformed into a checklist comprising 6 elements and 53 items, which were directed to experts to evaluate its face validity and qualitative content validity. After adjustment, the first expert panel validated the checklist, and a 5-point Likert rating system for assessment of importance, relevance, and feasibility were scored by them. Based on the results of descriptive analysis by SPSS, the experts' consensus led to elimination of one item and inclusion of other 52 items. Next, the second expert panel was held.
The final ABCDEF bundle was prepared with 52 items and, the plan, the proper time and implement responsible, for its management is proposed.
 Due to absence of the Iranian version of the ABCDEF bundle, our study provided a fluent and eloquent translation, to be both comprehensible and practical for the intensive care team members. The expert panel's opinion, adapted the bundle for implementation in the ICUs of Iran. We recommend that the localized ABCDEF bundle be implemented in specialized intensive fields (such as medical, surgical, trauma, etc). The contents of the bundle could not only be incorporated into ongoing training of staff, but also into the curriculum of undergraduates and medical residents.

Supportive respiratory care and airway management are very important in treating COVID-19 patients with respiratory failure. There are two techniques for supporting patients with respiratory failure.
The current study aims to evaluate the efficacy and quality of patient care with early tracheostomy in intensive care unit (ICU) and compare mortality, hospital stay, and outcome between intubation and early tracheostomy.
This study is conducted on total patients with confirmed COVID-19 in the ICU centers of a tertiary hospital. At the beginning of the study, all patients were intubated and connected to a mechanical ventilator. Within three days, the intensivists randomly performed bedside percutaneous dilational tracheostomy (PDT) for half of the patients. Early tracheostomy was defined as conducting tracheostomy within three days from intubation.
The total number of 36 patients was included in the study and categorized into two groups, including 18 patients in the early tracheostomy and 18 in orotracheal intubation. Half of the patients (50%) in the tracheostomy group were recovered from COVID-19 respiratory failure and discharged from ICU and hospital. All patients in the intubation group were expired. The length of staying alive in ICU in patients with an early tracheostomy was 26.47 ± 3.79 compared with 7.58 ± 2.36 days in intubated patients.
The early tracheostomy compared with orotracheal intubation in respiratory failure patients with COVID-19 can significantly decrease mortality. However, airway management with an early tracheostomy increases the hospitalization stay and can increase recovery. So, conducting the early tracheostomy is recommended in this study.

The present in vitro study aimed to evaluate whether Lactobacillus delbrueckii and Lactobacillus rhamnosus treatments can induce regulatory phenotype, together with modulating the expression of chemokine receptors (CRs) in dendritic cells (DCs). The CRs of DCs have been found to be involved in the pathogenesis of Systemic lupus erythematosus (SLE) through directing recruitment and migration of immune cells.

In brief, monocytes of patients with SLE and healthy donors were isolated and differentiated to regulatory or inflammatory mature DCs through treatment with L. delbrueckii, L. rhamnosus, mixed probiotics, and LPS. 

FACScan analysis showed that the expression of CRs including CXCR3, CCR5, CCR4, and CCR3, was significantly reduced in all probiotic-treated groups of SLE and healthy (control) donors when compared with the LPS treated group. 

The results demonstrated that tolerogenic probiotics could prevent or decrease the expression of inflammatory CRs on the surface of tolerogenic DCs during the maturation process.

The epidemic of COVID-19 and its associated acute respiratory syndrome has posed an unprecedented challenge in identifying effective drugs to prevent and treat it. Due to the high prevalence of this disease and the high number of people at risk, medical staff needs accurate evidence regarding effective drug treatments for this infection. There is currently no effective treatment for COVID-19. But the rapid development of knowledge about the virology of SARS-CoV-2 provides a significant number of potential pharmacological targets. Evidence suggests that the data provided on the efficacy of hydroxychloroquine is contradictory, but it seems that Remdesivir, although not yet approved by the US Food and Drug Administration, has strong laboratory activity against the virus is the most promising drug treatment. In addition to these results, some clinical trials have ruled out the effectiveness of Oseltamivir and limit the use of corticosteroids. Also, current clinical evidence does not support the use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers in patients with COVID-19.The COVID-19 epidemic is the largest global public health crisis of the present era since the outbreak of the flu pandemic in 1918. The speed and volume of clinical trials that have begun to examine potential treatments for COVID-19 indicate the urgent need to find the optimal treatment for this problem as soon as possible, which has not yet been conclusively effective.

In times gone by, militaries have pursued to increase the lethality of weapons to better achieve military success and political objectives. In the current political environment, this approach may not be the most effective means to achieve stability. Political, societal, and operational factors have limited the effective use of traditional military response. Emerging non-lethal weapon technologies may offer the means to meet today’s security problems. Definition of non-lethal weapons provided by NATO are: Non-Lethal Weapons are weapons, which are explicitly designed and developed to incapacitate or repel personnel, with a low probability of fatality or permanent injury, or to disable equipment, with minimal undesired damage or impact on the environment. Unlike conventional lethal weapons that destroy their targets principally through blast, penetration and fragmentation, non-lethal weapons employ means other than gross physical destruction to prevent the target from functioning. Non-lethal weapons are intended to have one or both of the following characteristics: 1) they have relatively reversible effects on personnel or material, 2) they affect objects differently within their area of influence. Some expressions used for these capabilities are: Non-injurious, disabling measures, system disabiling, immobilizers, discriminate force, less letal, less-than-lethal, minimum force, strategic immobilizers, mission kill, new age weapons, soft kill, stabilizing technology, denial of services concepts, limited effects technology, neutralizing technology, reduced lethality weapn, low collateral damage, weapons which do not cross the death barrier, and pre-lethel. Non-lethal technologies cover a broad, diverse range of capabilities. The technology ranges from biological, chemical, information warfare, crowd control measures, to the latest offerings of exotic weapons. The paper will review and introduce all kinds of non-lethal weapons, including anti-personnel and anti-material weapons and the ways of defending them.

Gastrointestinal surgery is one of the procedures that result to produce inflammatory reactions and pain to patients. Administrate of high-safe analgesia in surgery is very essential, to reduce pain and improve inflammatory reactions.

The present study compared inflammatory markers and pain relief with the epidural infusion of bupivacaine-fentanyl and intravenous morphine bolus in gastrointestinal cancer surgeries.

This randomized control clinical trial study was carried out from December 2018 to October 2020, on ASA I and II patients aged between 30-80 years who referred for gastrointestinal cancer surgery. Cases were randomly distributed into two groups. Group I received epidural catheter with bupivacaine (18 cases), and group II received fentanyl and morphine bolus injection (18 cases). On the first and second days post-operation, data on pain scores based on visual analogue scale (VAS) score, inflammatory markers (procalcitonin [PCT] and C-reactive protein [CRP]), platelet (PLT), white blood cells (WBCs), and erythrocyte sedimentation rate (ESR) was recorded.

The mean age was 52.21±16.13 years (41.6% male, 58.4 female). The mean of ESR, CRP and PCT postoperative were significantly higher than preoperative (P < 0.05). There were no differences between the two groups regarding PLT, ESR, CRP, and PCT preoperative postoperative (P > 0.05). The mean of pain was less in the epidural group than in the morphine group postoperative (P = 0.02).

The results showed that epidural fentanyl-bupivacaine infusion was more effective in pain reduction than the intravenous infusion of morphine in cases undergoing gastrointestinal cancer operation. However, both analgesic approaches were similar in inflammatory functions.

There is evidence of undesirable effects of deep and prolonged diving on lung function and respiratory system diseases. The current study was conducted to determine the relationship between diving activity and pulmonary function changes in professional divers.

The current analytical study was conducted in 2017 on the coast of south and north of Iran. According to inclusion and exclusion criteria, all professional divers were studied in the census (consecutive) method. The demographic and clinical data were recorded. Diving experience (years), average diving hours, and average diving depth performed by the professional divers in their routine activities was recorded. The divers were visited by the pulmonologist and a thorough examination of the chest and internal lung examination was done and data was recorded. For all divers pulmonary or lung function tests and spirometery tests were done. Data analysis was performed using SPSS 18.

61 male professional divers with an average age of 34.5±4.2 years (29-38 years old) participated. 91.8% (56 people) was non-smokers (and the same with no allergies). The average diving experience was 10.5±5.5 years (range of 4-25 years). The average diving hours were 1071.8±753.2 hours in the range of 50-3500 hours. The average diving depth was 37.4±13.5 meters in the range of 5 to 60 meters. Relationship of experience, hours and average depth of diving with pulmonary symptoms (normal, cough, dyspnea, sputum, abdominal pain), pulmonary findings (normal, abnormal sound), chest graph (normal, pulmonary involvement, parenchyma involvement, lung adenopathy), Spirometry (normal, obstruction and restriction), FVC and FEV1 (Limiting disease, normal), FVC (patient, healthy), FEV1 (abnormal, normal, measurable, limiting disease), FEF (patient, healthy) was significant.

Increasing the experience, length, and the average depth of diving, as the factors in diving, has a negative effect on lung function. Therefore, it seems that the professional divers are prone to loss of lung function over time. However, the effect of diving on lung function depends on other factors, as well as on the individual itself.

Abdominal adhesions are considered as an important problem in abdominal surgery. In this study we compared the effectiveness of atorvastatin, hyaluronic acid and interceed (oxidized cellulose) in prevention of postoperative intestinal adhesions. A total of 40 Wistar-albino rats were randomly divided into 5 groups: Group 1 (Sham); Group 2 (Control or Adhesion induction); Group 3 (Adhesion induction + hyaluronic acid); Group 4 (Adhesion induction + oxidized cellulose); and Group 5 (Adhesion induction + atorvastatin). A same experimental method of cecal abrasion and ligature was used to produce adhesions in all rats. Fourteen days after adhesions formation, animals were killed and adhesions were scored according to macromorphological characteristics and adhesion-carrying tissues under standard histologic examination. Inflammation, vascularization and fibrosis in granulation sites were graded in all samples. Adhesion scores in all experimental groups were slightly lower than control group. Group 3 had the lowest mean adhesions score (1.18 ± 1.24) based on surgeon observation. The mean of adhesion score in Group 3 (1.18 ± 1.24) was significantly lower than that in Group 4 (3.43 ± 0.53) (p=0.004). Group 5 showed the lowest mean adhesions score on pathological examination (5.62 ± 3.73). The mean of adhesion total score in Group 3 was slightly lower than that in other groups; however, this difference was not significant. Hyaluronic acid, oxidized cellulose, and atorvastatin are effective in treatment and prevention of intestinal adhesions during open abdominal surgery. Although hyaluronic acid was slightly more effective, further studies are needed to evaluate the effect of combination therapy with these agents.

Military personnel who work with radar missiles are exposed to electromagnetic waves. The negative effects of these waves on human health have been reported in some studies. The aim of the current study was to determine the relationship between exposures to electromagnetic waves with some clinical disorders in radar device users.

This cross-sectional study was conducted in 4 cities near to Persian Gulf, in 2018. All personnel who were exposed to electromagnetic waves due to occupational reasons (radar device users) were included in a census. Demographic data and a self-declaration of clinical disorders (such as headache) were recorded in the checklist. Work experience (years) in the radar section was recorded. The clinical examination was performed by a general practitioner. CBC, diff blood tests and peripheral blood smears were tested in the laboratory, and the results were explained and interpreted by the pathologist. Eye examinations were performed by an ophthalmologist. The association between possible complications with work experience in the radar section and exposure to electromagnetic waves was analyzed.

A total of 161 radar users with mean work experience of 8.6 years (2-22 years) who had long exposure to electromagnetic waves were studied. A total of 113 (70.2%) had more than 5 years of work experience in the radar sector. Only 6 (8.1%) out of 74 were infertile. A total of 7 (0.4%) of the 161 had cataracts, and inflammation and redness of the eye was observed in 13 (8%) of the 161. Headache was recorded in 62 (38.5%) of the 161. No cases of leukemia were recorded. The relationship between the duration of exposure to electromagnetic waves with complications such as infertility, cataracts, inflammation and redness of the eye, and headache was not significant. However, in those who were exposed to electromagnetic waves for more than five years, the frequency of these complications was higher.

The increase in the duration of exposure to electromagnetic waves with complications such as infertility, cataracts, inflammation and redness of the eye, headache in radar users were not significantly related. However, in people working with electromagnetic waves for more than five years, the frequency of these complications was higher. Therefore, general precautions in workplace safety guidance and regular medical examinations for these personnel is recommended.

Inflammation has a major role in disease lead to renal failure and diabetes mellitus, controlling inflammation in diabetic kidney receivers could decrease morbidity and mortality. This study designed for evaluating the efficacy of pioglitazone on C-reactive protein and lipid profile in diabetic kidney transplant receivers. Patients and In this double blinded clinical trial, 58 diabetic renal transplant receivers, in first month after transplantation, randomized into two groups; receiving insulin and pioglitazone (15 mg tablet daily, group A); and insulin and placebo (group B). Blood pressure, weight, body mass index (BMI) and laboratory data compared in before and after 4-month treatment in two groups by SPSS. Fifty-eight patients with mean age of 44.15 ± 2 years included. There were no significant difference between groups in demographic data and other baseline measured variables (P > 0.05). The mean weigh and BMI were slightly increased in group A and decreased in group B. The mean hs-CRP was decreased 4.82 mg/dL in group A and 1.93 mg/dL in group B (P = 0.007). The mean total serum cholesterol was significantly decreased 34 mg/dL in group A and 18.07 mg/dL in group B (P = 0.027). The mean serum HDL-C was significantly increased 13.31 mg/dL in group A and 5.89 mg/dl in group B (P < 0.001). Pioglitazone seems to be a safe drug for reducing serum lipids and CRP in kidney transplant receivers with diabetes mellitus in short term. Long term effect of this drug could be evaluated in future studies.