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Introduction: Mannitol, an osmotic diuretic solution, is commonly utilized in priming cardiopulmonary bypass (CPB) and can impact kidney function. This study was conducted to investigate the impact of mannitol use during CPB on kidney function in patients undergoing coronary artery bypass surgery. Methods: This randomized, double-blind clinical trial studied 90 patients undergoing coronary artery bypass surgery. In the control group (n=45), the prime solution included Ringer's lactate, and in the intervention group (n=45), the prime solution had 200 ml of mannitol 20% and Ringer's lactate. A P -value<0.05 was considered significant. The primary endpoint of this study is renal function. Results: Demographic characteristics and risk factors were not significantly different between the two groups (P >0.05). Additionally, there was no statistically significant difference between two groups in terms of CPB time, aortic cross-clamp time, length of time connected to mechanical ventilation, 30-day mortality, ICU, and hospital stay time (P >0.05). Furthermore, no statistically significant difference was observed between the two groups in serum creatinine levels (P =0.53) or BUN levels (P =0.13). The study also found no statistically significant difference in the diuresis rate between the two groups (P =0.10). Conclusion: The present study has shown that adding mannitol to the prime has no effect on kidney function, length of time connected to mechanical ventilation, length of stay in the ICU, or 30-day mortality. Therefore, it suggests that mannitol cannot be used as a preventative strategy for acute kidney injury after cardiac surgery. [ABSTRACT FROM AUTHOR]

BACKGROUND: Cardiac injury in COVID-19 patients confers a worse prognosis. The interpretation of electrocardiography can be beneficial in the early diagnosis of probable cardiac involvement. After adjusting for other variables, we sought to determine if the initial ECG on admission could add additional prognostic value. METHODS: In this single-center cross-sectional study, 1165 patients with a positive COVID-19 PCR between Feb 2020 and Nov 2021 were enrolled in our study. Patients were grouped according to their admitted units, and survivors to hospital discharge or non-survivors. Predictors of ICU admission and in-hospital mortality were determined using univariate analysis and a logistic regression model. RESULTS: The mean age was 55.6 ± 16.2 years and 52% were male. Out of 1165 patients, 149 deaths (12.8%) were recorded during hospitalization. Sinus tachycardia was the most common dysrhythmia, followed by premature atrial and ventricular beats, sinus bradycardia, and atrial fibrillation (28.6%, 5.6%, 3.9%, and 2.1%, respectively). Age (p<0.001), sex (p=0.006), history of diabetes mellitus (p=0.002), hypertension (p=0.018), ischemic heart disease (p=0.004), and cancer (p<0.001) were more frequent among non-survivors. Among ECG findings, tachycardia, low voltage QRS, ST-T changes, and dysrhythmia were related to an increased mortality risk. However, in regression analysis, only sex (OR 1.89, 95% CI 1.2 to 2.9, p=0.004), age (OR 1.03, 95% CI 1.02 to 1.05, p<0.001), and initial tachycardia (OR 1.02, 95% CI 1.01 to 1.03, p<0.001) were independent predictors of in-hospital mortality. CONCLUSION: Our data suggest that initial electrocardiographic findings could be helpful in distinguishing patients with an increased risk for ICU admission or in-hospital death. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study is to compare the effect of Vitamin D and Vitamin E supplementations, alone, and in combination, on reducing the intensity and duration of dysmenorrhea in women who were referred to the Kowsar gynecological clinics of Shahid Motahari Hospital of Urmia University of Medical Sciences. Materials and Methods: A double-blinded clinical trial was conducted on 112 women with dysmenorrhea who were randomly allocated into the four study groups. Finally, 100 women complete the study and received capsules containing a placebo (n = 25), 1000 IU of Vitamin D (n = 25), 400 mg of Vitamin E (n = 25), and 1000 IU of Vitamin D + 400 mg of Vitamin E (n = 25) every 24 h for 2 consecutive months at the beginning of the menstrual period. The pain intensity and duration among groups were compared before and after the intervention. Results: The mean menstrual pain duration in all three experimental groups (Vitamin E, Vitamin D, and the combination of them) was lower than the placebo group (all P < 0.05), and the mean pain intensity scores in all three experimental groups were significantly lower than the placebo group (all P < 0.05). The results (means) for all of the drugs administered at the end of the 2nd month were better than the 1st month (all P < 0.01). Conclusions: Vitamin E and Vitamin D, as well as their combination, are recommended as an effective and safe treatment for the management of the complications of dysmenorrhea. [ABSTRACT FROM AUTHOR]

Self-efficacy predicts concordance with treatment in people with diabetes. This study aimed to assess the effects of motivational interviewing (MI) on the self-efficacy of people with type 2 diabetes. Participants were randomly allocated into intervention (n=30) and control (n=30) groups. All participants received standard care, including three diabetes education sessions per week, and the intervention group also received five 30-45-minute MI sessions. The Perceived Self-Efficacy Scale was used to evaluate self-efficacy before and after the intervention. The mean self-efficacy score was found to increase significantly in the intervention group after MI (P=0.001). Thus, this approach is recommended to be used in people with type 2 diabetes to increase their self-efficacy and promote health and quality of life. [ABSTRACT FROM AUTHOR]

Background: Chest pain, anxiety, and readmission are patients' adverse outcomes after Myocardial Infarction (MI). Therefore, post-MI patients require a proper care program to overcome these outcomes. Objectives: This study aimed to determine the effect of a continuous nursing care program on patients' anxiety level, episodes of chest pain, and readmission rate after MI. Methods: In this randomized, controlled trial, 120 patients who met the inclusion criteria were selected using convenience sampling. The patients were allocated into the control (n = 60) and intervention (n = 60) groups using numbered opaque sealed envelopes. A demographic information form and the State-Trait Anxiety Inventory (STAI) were used to collect the data (primary outcome). The patients in the intervention group received education and practical rehabilitation exercises from the beginning of hospitalization until 12 weeks after discharge. However, the control group only received the routine care. Checklists were used to record the episodes of chest pain and readmission rate (secondary outcomes). The data were analyzed using the SPSS software, version 16.0. The data were distributed normally based on the results of Shapiro--Wilk test. Hence, they were analyzed using descriptive (mean, standard deviation, number, and percentage) and inferential (independent t-test, paired t-test, chi-square, Mann--Whitney U test, and Fisher's exact test) statistics. Results: The results revealed a significant reduction in the readmission rate (P = 0.014) and episodes of chest pain (P = 0.025) in the intervention group after the implementation of the continuous nursing care program. The results also showed a significant difference between the two groups regarding the mean scores of trait and state anxiety 12 weeks after discharge (P = 0.001). Accordingly, anxiety levels reduced significantly in the intervention group after the intervention (P = 0.001). Conclusions: This continuous nursing care program, as a low-cost and nonpharmacological approach, played a vital role in caring for the patients after MI and positively affected the patients' recovery. Hence, this program could be used to improve post-MI outcomes in patients and accelerate their recovery. [ABSTRACT FROM AUTHOR]

Objective: Postoperative delirium (POD), especially after cardiac surgery with cardiopulmonary bypass (CPB), is a relatively common and severe complication increasing side effects, length of hospital stay, mortality and healthcare resource costs. This study aimed to determine the impact of using mannitol serum in the prime of CPB for preventing the occurrence of delirium in patients undergoing coronary artery bypass surgery., Methods: This study is a single-centre, double-blinded, randomised, controlled trial that was conducted from December 2022 to May 2023. Patients in the age range of 18-70 who underwent elective coronary artery bypass surgery were included in the study. In the control group (n=45), the prime solution included Ringer's lactate serum. In the intervention group (n=45), the prime solution consisted of 200 mL mannitol serum and Ringer's lactate serum. The primary outcome of the study was the incidence of POD. Secondary outcomes included the duration of mechanical ventilation, length of stay in the intensive care unit (ICU) and 30-day in-hospital mortality., Results: There were no statistically significant differences in demographic characteristics and risk factors between the control and intervention groups (p<0.05). However, the incidence of POD was significantly lower in the intervention group compared with the control group (22.25% vs 42.2%, p=0.035). There were no significant differences between the two groups regarding CPB time, aortic cross-clamp time, duration of mechanical ventilation and length of stay in ICU (p<0.05). Additionally, mortality rates and rates of return to the operating room did not differ significantly between the two groups (p<0.05)., Conclusions: This study concluded that adding mannitol to the prime of CPB pump can help reduce the incidence of delirium after cardiac surgery., Trial Registration Number: IRCT20221129056660N1., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)