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Ability to predict surgical outcomes by surgical Apgar score: a systematic review
No full textBACKGROUND: The Surgical Apgar score (SAS) is a straightforward and unbiased measure to assess the probability of experiencing complications after surgery. It is calculated upon completion of the surgical procedure and provides valuable predictive information. The SAS evaluates three specific factors during surgery: the estimated amount of blood loss (EBL), the lowest recorded mean arterial pressure (MAP), and the lowest heart rate (LHR) observed. Considering these factors, the SAS offers insights into the probability of encountering postoperative complications. METHODS: Three authors independently searched the Medline, PubMed, Web of Science, Scopus, and Embase databases until June 2022. This search was conducted without any language or timeframe restrictions, and it aimed to cover relevant literature on the subject. The inclusion criteria were the correlation between SAS and any modified/adjusted SAS (m SAS, (Modified SAS). eSAS, M eSAS, and SASA), and complications before, during, and after surgeries. Nevertheless, the study excluded letters to the editor, reviews, and case reports. Additionally, the researchers employed Begg and Egger's regression model to evaluate publication bias. RESULTS: In this systematic study, a total of 78 studies \were examined. The findings exposed that SAS was effective in anticipating short-term complications and served as factor for a long-term prognostic following multiple surgeries. While the SAS has been validated across various surgical subspecialties, based on the available evidence, the algorithm's modifications may be necessary to enhance its predictive accuracy within each specific subspecialty. CONCLUSIONS: The SAS enables surgeons and anesthesiologists to recognize patients at a higher risk for certain complications or adverse events. By either modifying the SAS (Modified SAS) or combining it with ASA criteria, healthcare professionals can enhance their ability to identify patients who require continuous observation and follow-up as they go through the postoperative period. This approach would improve the accuracy of identifying individuals at risk and ensure appropriate measures to provide necessary care and support
A systematic review and meta-analysis on the prevalence and impact of coronary artery disease in hospitalized COVID-19 patients
No full textBACKGROUND: COVID-19 accounts for more than half a billion deaths globally. The clinical manifestations may vary in due course. Despite several studies aimed at determining the extent to which the disease's severity and mortality remain high when combined with other comorbidities, more research is required. Therefore, this review aimed to measure the pooled prevalence of coronary artery disease (CAD) among COVID-19 patients, specifically those with a history of CAD. Additionally, we aim to assess the association between mortality due to CAD and the severity of COVID-19 among hospitalized patients. METHOD: A comprehensive search in PubMed, Web of Science, the Cochrane Library, and the WHO COVID-19 database was conducted. English studies with original data on CAD, mortality, and ARDS among COVID-19 patients were included. PRISMA guidelines were followed. RESULTS: Among the 2007 identified articles, 76 studies met the inclusion criteria. The pooled prevalence of CAD among COVID-19 patients was 14.4(95 CI: 12.7-16.2). The highest prevalence was observed in European studies at 18.2(95 CI: 13.3-24.2), while the lowest was in Asian studies at 10.4 (95 CI: 6.4-16.3). Participants with concurrent CAD at the time of hospital admission had twice the odds of mortality due to COVID-19 (2.64 95% CI: 2.30-3.04) with moderate heterogeneity (I2 = 45%, p < 0.01). Hospitalized COVID-19 patients with CAD had a 50% higher risk of ARDS (95% CI: 0.62-3.66), but this difference was not statistically significant. CONCLUSION: Although our analysis revealed evidence for a relationship between concurrent CAD at the time of hospital admission and mortality from COVID-19, however, global variation in health infrastructure, limitations of data reporting, and the effects of emerging variants must be considered in future investigations
Which are best for successful aging prediction? Bagging, boosting, or simple machine learning algorithms?
No full textBACKGROUND: The worldwide society is currently facing an epidemiological shift due to the significant improvement in life expectancy and increase in the elderly population. This shift requires the public and scientific community to highlight successful aging (SA), as an indicator representing the quality of elderly people's health. SA is a subjective, complex, and multidimensional concept; thus, its meaning or measuring is a difficult task. This study seeks to identify the most affecting factors on SA and fed them as input variables for constructing predictive models using machine learning (ML) algorithms. METHODS: Data from 1465 adults aged >/= 60 years who were referred to health centers in Abadan city (Iran) between 2021 and 2022 were collected by interview. First, binary logistic regression (BLR) was used to identify the main factors influencing SA. Second, eight ML algorithms, including adaptive boosting (AdaBoost), bootstrap aggregating (Bagging), eXtreme Gradient Boosting (XG-Boost), random forest (RF), J-48, multilayered perceptron (MLP), Naive Bayes (NB), and support vector machine (SVM), were trained to predict SA. Finally, their performance was evaluated using metrics derived from the confusion matrix to determine the best model. RESULTS: The experimental results showed that 44 factors had a meaningful relationship with SA as the output class. In total, the RF algorithm with sensitivity = 0.95 +/- 0.01, specificity = 0.94 +/- 0.01, accuracy = 0.94 +/- 0.005, and F-score = 0.94 +/- 0.003 yielded the best performance for predicting SA. CONCLUSIONS: Compared to other selected ML methods, the effectiveness of the RF as a bagging algorithm in predicting SA was significantly better. Our developed prediction models can provide, gerontologists, geriatric nursing, healthcare administrators, and policymakers with a reliable and responsive tool to improve elderly outcomes
Amelioration of amyloid beta (Aβ1-40) neurotoxicity by administration of silibinin; a behavioral and biochemical assessment
No full textObjective(s): Alzheimer's disease (AD), the most common cause of dementia, is one of the leading causes of morbidity and death in the world. Currently, treatment mostly used to slow down the disease progression. Herbal remedies are considered by many in the community as a natural and safe treatment with fewer side effects. Silibinin, the active ingredient of Silybum marionum, has anti-oxidant, neurotrophic and neuroprotective characteristics. Therefore, here, the effect of different doses of Silibinin extract on oxidative stress and expression of neurotrophic factors was investigated. Materials and Methods: Forty eight male Wistar rats were randomly divided into sham, lesion; Aβ1-40injection, lesion-treatment; Aβ1-40injection followed by different doses of silibinin (50, 100, 200 mg / kg) through gavage and lesion-vehicle group; Aβ1-40injection + vehicle of silibinin. Morris water Maze (MWM) was done 28 days after the last treatment. Hippocampal tissue was removed for biochemical analysis. Production of nitric oxide (NO) and reactive oxygen species (ROS), expression of BDNF/VEGF and cell viability were measured using Griess, fluorimetry, Western blotting and MTT techniques. Results: Different concentrations of silibinin improved behavioral performance in animals. Higher doses of Silibinin could improve memory and learning function through MWM. Also, increasing the concentration of silibinin resulted in decreased ROS and NO production in a dose-dependent manner. Conclusion: Consequently, silibinin may act as a potential candidate for alleviating symptoms of AD. © 2023 Mashhad University of Medical Sciences. All rights reserved
Relationship Between Pain and Disability Among Stroke Patients
No full textBackground: Stroke is prevalent in Iran, and its complications can decline patients’ quality of life and psychological state. Objectives: This study aimed to investigate the relationship between pain following stroke (PFS) and disability in stroke patients. Methods: The current case-control study was conducted on 184 stroke patients (92 cases and 92 controls). Data collection tools included a demographic questionnaire, the Visual Analog Scale (VAS), and the Disabilities of the Arm Shoulder and Hand (DASH) questionnaire. Based on the medical files of all patients with stroke, eligible ones were invited to participate in the study via phone calls. The collected data were then analyzed. Results: The disability rate was higher in the case group of patients with a history of hemorrhagic stroke, smoking, stroke, and diabetes (P < 0.05). The mean ± SD age was 72.45 (11.54). Also, the level of disability in patients increased with age (P = 0.000). The mean ± SD disability score was 78.63 (6.92) in patients with PFS and 54.9 (10.87) in patients without PFS. Also, R = 0.795 and R2= 0.631 indicated the significance of disability severity in patients with PFS. Conclusions: The prevalence of disability was higher in patients with higher PFS levels. Hence, drug interventions or rehabilitation programs can be used to reduce the disability of stroke patients. © 2023, Author(s)
Nursing student's satisfaction with two methods of CBL and lecture-based learning
No full textBackgroundCase-based learning (CBL) is an effective teaching-learning strategy that provides a learning environment similar to actual practice. The aim of the present study was to determine the nursing student's satisfaction with two methods of CBL and lecture-based learning.MethodsThis descriptive observational study was conducted in 2019 in School of Nursing and Midwifery in Ilam. All 128 undergraduate nursing students in the 3rd, 4th, and 5th semesters of nursing were enrolled in the study to compare students' satisfaction with CBL and lecture-based learning. Data collection tools included a demographic information questionnaire and a researcher-made questionnaire consisting of 20 questions based on the Likert scale. Data analysis was performed using SPSS Statistics 22.ResultsMore than two thirds of the students (81.3) found the CBL method was better than lectures. 60 of male students and 62 of female students stated that the CBL method increased their self-confidence compared to the traditional lecture-based learning (p 0.05). However, 4th semester students were more satisfied than other students (P = 0.02).ConclusionThe results show that CBL, as a teaching-learning technique in specialized nursing courses, increases students' satisfaction and self-confidence compared to lecture
Association between the increased level of high-sensitive CRP (hs CRP) and non-arrhythmic ECG changes and echocardiographic abnormalities in patients with acute coronary syndrome
No full textBackground: Abnormality in the cardiovascular system such as left ventricular dysfunction caused increased serum CRP and change in electrocardiography pattern. The present study aimed to understand the association between increased levels of highly sensitive CRP (hs-CRP) and non-arrhythmic ECG changes and electrocardiographic abnormalities in patients with the acute coronary syndrome.Methods: This study was done on 120 patients diagnosed with acute coronary syndrome and hospitalized at CCU. The patients were classified into two groups, one group with an increased level of hs-CRP and another with a normal hs-CRP level.Results: The patients with an increased level of hs-CRP showed a significantly higher level of cardiac enzymes also ST-segment elevation myocardial infarction (STEMI) was seen in the group with an increased level of hs-CRP than those with normal serum hs-CRP level, but another diagnosis including unstable angina, non-STEMI, heart failure, and emergency hypertension was similarly observed in both groups. Two groups were assessed in terms of left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVeDD) the prevalence of valvular heart disease, and wall motion abnormality, also showed that groups with increased hs-CRP level, ST-segment elevation leads more significant differences than a normal group (P=0.001).Conclusion: Patients with an increased level of hs-CRP can be diagnosed as STEMI but not valuable to suppose as echocardiographic abnormalities such as left ventricular dysfunction or hypertrophy
Association between Pro-oxidant-Antioxidant balance and high-sensitivity C-reactive protein in type 2 diabetes mellitus: A Study on Postmenopausal Women
No full textIntroduction: Oxidative stress known as a predictive marker for cardiovascular and metabolic diseases could be measured through pro-oxidant antioxidant balance (PAB). The present study aimed to evaluate PAB and its association with high-sensitivity C-reactive protein (hs-CRP) in the serum of postmenopausal women with diabetes mellitus. Methods: In this case-control study, 99 diabetic and 100 healthy postmenopausal women without diabetes mellitus were recruited. Serum PAB values, hs-CRP, lipid profile, insulin, and vitamin D levels were measured. Moreover, insulin resistance (HOMA-IR, HOMA-beta and QUICKI), waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), and body mass index (BMI) were calculated. Results: Serum PAB, hs-CRP, insulin resistance, HOMA-beta, QUICKI, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides (TG) levels were significantly higher in the postmenopausal women with diabetes mellitus, while there was no significant difference in the total cholesterol (TC), serum insulin, WC, WHR, WHtR and vitamin D levels between the groups. Pearson correlation coefficient showed that HDL-C and insulin levels were directly correlated with serum PAB. Also, there was a significant direct relationship between LDL-C and insulin levels and hs-CRP. There was no meaningful relationship between serum insulin and vitamin D levels and other assessed parameters. Backward logistic regression showed a positive relationship between diabetes mellitus and serum PAB and an inverse relationship with serum HDL levels. Conclusions: Serum PAB, hs-CRP concentration, and lipid profile were significantly different between postmenopausal women with and without diabetes mellitus. These differences may contribute to the development of coronary complications
Prescribing pattern of antibiotics by family physicians in primary health care
No full textPurposeIrrational prescription of antibiotics is an ongoing global public health concern, leading to antibiotic resistance. Understanding the prescribing pattern of antibiotics is important to tackling mal-prescription and antibiotic resistance. We aimed to investigate the pattern and factors affecting outpatients' antibiotic prescribing by family physicians in Primary Health Care (PHC).MethodsA cross-sectional study was conducted in 19 PHC facilities in Alborz province. Prescribing pattern of antibiotics was evaluated among 1068 prescriptions by family physicians. Prescribing pattern of antibiotics included prescriptions containing antibiotics, the number of antibiotics per prescription, type, name of antibiotic, and mal-prescription. Multiple logistic regression analysis was used to estimate the adjusted odds ratios and 95 confidence intervals.ResultsOverall, 57 of the prescriptions had >= 1 antibiotic and the average number of antibiotics per prescription was 1.27. Amoxicillin was the commonly prescribed antibiotic. There was a significant relationship between age, sex, type of health insurance, work experience of the physician, and seasons with antibiotic prescribing (P < 0.05). In 59.31 of antibiotic prescriptions at least one of the scientific criteria was not fulfilled. In the final analysis, after adjusting for the potential confounders, field experts of physicians (OR = 1.59; 95 CI: 1.08-6.17), female sex (OR = 2.23; 95 CI: 1.18-4.21), and winter season (OR = 3.34; 95 CI: 1.26-8.15) were found associated factors with antibiotic prescribing.ConclusionThe average number of antibiotics per prescription and the percentage of irrational prescriptions were relatively high in this study. There is need to improve antibiotic prescribing patterns among family physicians working in primary health care
An Investigation into the Surface Dose Using Eclipse Treatment Planning System and Film Dosimetry for Treatment of Breast Cancer
No full textPurpose: Accurate knowledge about surface dose distribution is a critical issue in skin irradiation. This study was conducted to investigate the surface dose using the Eclipse Treatment Planning System (TPS) calculation and GAF chromic film measurement for breast cancer treatment. Materials and Methods: An inhomogeneous chest phantom was used in the present study. Irradiations were done with a 6 MV energy beam of a linear accelerator (Varian 2100C/D). TPS calculations and film measurements were compared for surface dose estimations. Results: The average difference between film measurements and TPS calculations was 7.1. Surface doses were lower in TPS calculations in comparison with film measurements. Conclusion: TPS plays a significant role in radiotherapy. However, they have many errors in measuring surface doses. Because of the inaccuracy of the majority of treatment planning systems in calculating the surface dose, the need for practical measurements is essential. Copyright © 2023 Tehran University of Medical Sciences