Internal Medicine and Medical Investigation Journal (IMMINV)
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The Impact of Educational Package on Nursing Students' Knowledge towards Fertility Preservation, a Quasi-Experimental Study
Full text linkBackground: Recent advances in diagnosis and treatment of cancers have resulted in survival improvement in young patients with cancer. Given the side effects of cancer treatments on the function of the reproductive system, health care providers need to be educated about the side effects of cancer treatment and fertility preservation. The aim of this study was to explore the effect of education on nursing students' knowledge towards fertility preservation methods in patients with cancer.
Methodology: This was a quasi-experimental one-group pre-test post-test research study that was carried out by the nursing faculty at Islamic Azad University of Tonekabon in 2018. Data was collected through a two-part questionnaire, including demographic characteristics and 32 questions about the knowledge of fertility preservation in patients with cancer. The study intervention was an educational package which includes 8 sessions of small group education, planning questions, and a booklet. Students were asked to complete the questionnaire before starting an educational session and again two weeks after the last session.
Results: The difference in the mean score of the nursing students’ knowledge before and after the educational package intervention was significant (P= 0.0001). Also, the knowledge rank of nursing students after the intervention was significantly better than before (P = 0.0001). There was a significant difference between the mean score of knowledge based on gender (0.0001), marital status (0.0001) and residency (0.0001).
Conclusion: In conclusion, educational intervention towards fertility preservation had a positive effect on nursing students’ knowledge. Therefore, the importance of considering this new approach to fertility preservation in patients with cancer should be considered in the nursing curriculum as they consider as the main resource of the medical information to the patient
Uterine Artery Embolization in The Treatment of Symptomatic Leiomyoma: Effect on Ovarian Function, Clinical Symptoms and Its Complications
Full text linkIntroduction: The present study evaluated the effect of uterine artery embolization on preservation of fertility in leiomyoma and its complications.
Materials and Methods: Thirty women with leiomyoma were included in the present study. Hormonal levels, leiomyoma size, patients’ symptoms and complications if developed were evaluated, both before and after uterine artery embolization.
Results: There was no significant difference between the mean follicle-stimulating hormone, luteinizing hormone and estradiol levels, before and after uterine artery embolization (p=0.431, p=0.672, p=0.772, respectively). Fibroids size measured before and after 6 months of uterine artery embolization were 86.47 ± 28.42 cm and 59.80 ± 20.90 cm, respectively (p<0.001). None of the patients developed complications such as embolism, wound problems or necessity for hysterectomy. After uterine artery embolization, symptoms such as hypermenorrhea, dysmenorrhea, dyspareunia, and dysuria decreased significantly among patients.
Conclusions: Our findings showed that uterine artery embolization is an appropriate choice for patients with leiomyoma, to control and relieve symptoms, to reduce fibroid size, and finally to maintain fertility among those women
Usefulness of Cardiac Index to Predict Early and 30-Day Mortality in Non-Cardiac Patients Being Admitted to Intensive Care Units
Full text linkIntroduction: Cardiac index is a hemodynamic parameter defined as the ratio of the cardiac output, i.e., the volume of blood ejected from the left ventricle in 1 min, to the body surface area. This study aimed to assess the cardiac index to predict early and 30-day outcomes of non-cardiac patients being admitted to intensive care units using a non-invasive approach.
Materials and Methods: This prospective cohort study included 31 non-cardiac patients who were consecutively admitted to the intensive care units of Rasoul-e-Akram Hospital, Tehran, Iran, in 2016. On admission, the simplified acute physiology score II to predict mortality and the cardiac output (by two-dimensional echocardiography) of each patient were determined. The cardiac index was calculated by dividing the cardiac output by the body surface area. In-hospital mortality and complications were assessed, and the association between simplified acute physiology score II and cardiac index was determined. The patients were followed-up 30 days after discharge by telephone to determine late death, occurrence of myocardial infarction, readmission, or re-hospitalization.
Results: The mean cardiac index was significantly lower among the patients who died in intensive care units than in those who survived (2.86 ± 0.63 versus 3.70 ± 0.49, p = 0.006). A significant inverse association was found between Simplified Acute Physiology Score II and cardiac index (r = −0.539, p = 0.002). The length of hospital and intensive care units stay was not associated with Simplified Acute Physiology Score -II or cardiac index. The receiver operating characteristic curve analysis revealed that the cardiac index was effective in predicting in intensive care units mortality (area under curve = 0.857, p = 0.007). The best cut-off value for the cardiac index to predict in intensive care units mortality was 3.35, yielding a sensitivity of 83.3% and a specificity of 80.0%.
Conclusion: Measuring the cardiac index during intensive care units admission using a noninvasive approach even in non-cardiac patients can predict in intensive care units mortality with high sensitivity and specificity
Preventive and Curative Effect of Omega-3 Supplementation on Bone Mineral Density in People Aged 60 Years and Older: A Review Article
Full text linkOsteoporosis and osteopenia are common worldwide problems leading to potentially life-threatening consequences. Omega-3 supplementation for treating osteoporosis is less studied and less valued by physicians. We aimed to ascertain the appropriate dosage of omega- 3 supplementation to prevent osteoporosis. Google scholar database was searched in May 2017 using the keywords: n-3 fatty acids, omega-3 polyunsaturated fatty acids, essential fatty acids, eicosapentaenoic fatty acids, docosahexaenoic acid, docosapentaenoic acid, alpha-linolenic acid, linoleic acid, osteopenia, osteoporosis, bone density, and fracture. We reviewed English language reports of randomized controlled trials with intake of omega-3 polyunsaturated fatty acids, in which subjects were over 60 years and supplemented with a quantified dosage of omega-3; and outcome was indicated by bone mineral densitometry medical record of fractures and radiological imaging, and serum biomarker to evaluate bone metabolism. We reviewed 110 papers, which only eight articles met our conclusion criteria and concluded with curative effects. Three articles came up with no prophylactic or curative effect of omega-3 supplementation, three articles suggested a dosage of omega-3 supplement that non significantly increased bone mineral densitometry or decreased absorption, and thus, had prophylactic effects. One article just concluded the positive effects, not defining the exact results. It is suggested that a dosage of 4.5 to 6 g/d of eicosapentaenoic acid and docosahexaenoic acid can have curative effects, while 900-1000 mg/d can have prophylactic outcomes. N-3 fatty acids have positive effects on bone density, but to confine definitive dosage and formulation of omega-3 supplementation for reducing the risk of osteoporosis, further investigations are required
Multiple Congenital Anomalies in a Preterm Neonate with G6PD Deficiency from Consanguineous Parents
Full text linkIntroduction: Congenital anomalies can be defined as structural or functional disorders, including metabolic disorders. The prevalence of congenital anomalies is not high. Case Presentation: We would like to present a 34-week- preterm neonate with glucose-6-phosphate dehydrogenase deficiency who was born with several fetal anomalies from consanguineous parents. Mother had a twin-birth pregnancy which one of twins died because of lung hemorrhage and the second twin was born with multiple anomalies four fingers in both hands, short legs attached to the pelvic bone, and absence of tibia, fibula, and ankle bones. Hemimelia, which was mostly known as the congenital deformity and a type of phocomelia, is extremely rare. To detect most of these types of anomalies, magnetic resonance imaging, radiography, ultrasound, and computed tomography scan can be used. Conclusion: Congenital anomalies are the cause of many infants' deaths. To detect most of these types of anomalies, MRI, radiography, ultrasound, and computed tomography (CT) scan can be used
Proton pump inhibitors and Gastric cancer correlation; Time to take it seriously?”
Full text linkProton pump inhibitors (PPI) are the most prescribed drugs globally, which are highly potent gastric acid suppressors, known for the management of numerous diseases. There is a notable correlation between Gastric cancer and PPI. It is highlighted that the underlying mechanism is in close association with a study conducted 30 years ago, which showed excessive inhibition of gastric acid secretion in rodents, with secondary hypergastrinemia, that led to enterochromaffin-like-cell (ECL) hyperplasia. In conclusion, based on the scarce literature, it is evident that the safety of PPI is under a dilemma. Developing countries like Pakistan, where there is an excessive prescription of PPI, often without justification, are a significant burden on the economy as well as a threat to life, keeping in view of the significant correlation between PPI and gastric cancer
Acromioaxillosuprasternal Notch Index and Old Head and Anatomic Neck Criteria in Predicting Difficult Laryngoscopy in Tracheal Intubation in Children under General Anesthesia
Full text linkIntroduction: Currently, various methods are being used for determining difficult laryngoscopy. The present study aimed to compare the acromioaxillosuprasternal notch index function with the old head and neck anatomic criteria in predicting difficult laryngoscopy with respect to trachea intubation under general anesthesia in children. Materials and Methods: In this cross-sectional study, 379 children under intubation with general anesthesia entered the study. Patients were divided into two groups: easy laryngoscopy (grades 1 and 2) and difficult laryngoscopy (grades 3 and 4) based on Cormack-Lehane score. The thyromental distance systems, height to thyromental distance, Upper-Lip-Bite test, neck circumference, and acromioaxillosuprasternal notch index were studied and compared. Results: Laryngoscopy was difficult in 48 subjects (38 were grade 3 and 10 were grade 4). Interestingly, no significant difference was detected between easy and difficult laryngoscopies based on the thyromental distance, neck circumference, height to thyromental distance, and acromioaxillosuprasternal notch index (P>0.05). height to thyromental distance , acromioaxillosuprasternal notch index , and neck circumference have a sensitivity of 32.2%, 47.9%, 51.1%, respectively, and the specificity was 52.7%, 45.6%, and 48.9%, respectively. Conclusion: Neck circumference and acromioaxillosuprasternal notch index outperform the height to thyromental distance. On the other hand, Modified Mallampati test is better than Upper-Lip-Bite test in determining difficult laryngoscopy in children
Paternal Smoking May be Associated with Increased Risk of Miscarriage
Full text linkThis letter to editor discuss about Paternal Smoking and Increased Risk of Miscarriag
Determining the Changes in Value of Segmental Longitudinal Strain and Global Longitudinal Strain in Discriminating Left Anterior Descending Artery Involvement
Full text linkIntroduction: The present study was conducted to determine the predictive role of the segmental longitudinal strain in predicting significant proximal left anterior descending stenosis in patients with coronary heart disease regarding specific cardiac segments.
Materials and Methods: This cross-sectional study was conducted on 90 consecutive patients who were candidates for coronary angiography and assessed using speckle-tracking echocardiography. All patients underwent echocardiography prior to coronary angiography and only patients with normal left ventricular ejection fraction were finally included. Besides, conventional echocardiography, all patients were subjected to speckle-tracking echocardiography determination, and the images were assessed in standard 3C, 2C, 4C views.
Results: 45 patients with significant proximal left anterior descending stenosis found from the coronary angiography report and 45 patients with had normal coronary arteries. Based on the surface area under the receiver operating characteristic curve analysis, the highest diagnostic ability to distinguish between left anterior descending involvement from normal coronary state was related to the segmental longitudinal strain of the septal basal segments (AUC = 0.962), anteroseptal apical (AUC = 0.942) and septal mid portion (AUC = 0.941) . For global longitudinal strain it was -20.45 (100% sensitivity, 95.5% specificity) regarding the global longitudinal strain diagnostic value in the prediction of proximal significant left anterior descending stenosis.
Conclusion: The measurement of segmental longitudinal strain in LAD segments and global longitudinal strain can predict proximal left anterior descending stenosis with high sensitivity and specificity
Correlation of Muscle Strength and Mass with Bone Mineral Density in Postmenopausal Women
Full text linkIntroduction: Osteoporosis is a systemic disease of the bone, which entails an increased riskof fracture, with high impact on morbidity, mortality and costs in the health system. Severalstudies have shown a relationship between muscle mass and strength with bone mineral density.Our objective is to determine the correlation between these variables in postmenopausalwomen. Materials and Methods: For the correlation study, 100 postmenopausal womenolder than 50 years were selected randomly and a sociodemographic survey was conducted,and muscle strength was determined by manual grip strength, which was measured with adigital dynamometer. Bone mineral density measurements and muscle mass were obtainedwith densitometry. The correlation between strength, muscle mass, and bone mineral densitywas determined by a Spearman correlation. Results: The average age was 62.8 ± 7.48. Femurand column bone mineral density were significantly related to the muscle mass index, weight,and body mass index. The prevalence of fragility fracture was 17%. The bone mineral densityof the femur was lower in patients with fragile fracture, and there was a negative and significantcorrelation between femur bone mineral density and skeletal muscle mass index. Conclusion:Bone health studies should include the study of muscle mass index and the skeletal musclemass index. The improvement of the muscle mass index can influence femoral and vertebralbone mineral density with significant impact on fragility fractures. This is the first study of itskind conducted in Colombia and South America