Search

Background: Most acromioclavicular joint (ACJ) injuries are caused by direct trauma to the shoulders, and various methods and techniques are used to treat them; however, none of the options can be considered the gold standard. This study examines the horizontal stability of the ACJ after a complete dislocation was repaired using one of two Ethibond suture techniques, the loop technique and the two holes in the clavicle technique.Methods: In this single-blind, randomized clinical trial, 104 patients diagnosed with complete ACJ dislocation type V were treated using Ethibond sutures with either the loop technique or the two holes in the clavicle technique. Horizontal changes in the ACJ were radiographically assessed in the lateral axial view, and shoulder function was evaluated by the Constant (CS) and Taft (TS) scores at intervals of 3, 6, and 12 months after surgery.Results: The horizontal stability of the ACJ was better with the two-hole technique than the loop technique at all measurement times. CS and TS changes showed a significant upward trend over time with both techniques. The mean CS and TS at the final visit were 95.2 and 11.6 with the loop technique and 94.0 and 11.9 with the two-hole technique, respectively. The incidence of superficial infections caused by the subcutaneous pins was the same in the two groups.Conclusions: Due to the improved ACJ stability with the two-hole technique, it appears to be a more suitable option than the loop technique for AC joint reduction.

Background: Several therapeutic methods have been proposed for frozen shoulder syndrome. These include suprascapular nerve block, a simple and cost-effective technique that eliminates the need for nonsteroidal anti-inflammatory drug therapy.Methods: This was a clinical trial that included patients with unilateral shoulder joint stiffness. Patients were divided into three groups: those treated with isolated physiotherapy for 12 weeks (PT group), those treated with a single dose intra-articular injection of corticosteroid together with physiotherapy (IACI group), and those treated with a suprascapular nerve block performed with a single indirect injection of 8-mL lidocaine HCL 1% and 2 mL (80 mg) methylprednisolone acetate together with physiotherapy (SSNB group). The variables assessed were age, sex, side of involvement, dominant limb, presence of diabetes, physical examination findings including erythema, swelling, and muscle wasting; palpation and movement findings; shoulder pain and disability index (SPADI) score; and the visual analog scale (VAS) score pre-intervention and at 2-, 4-, 6-, and 12-week post-intervention.Results: Ninety-seven patients were included in this survey (34 cases in the PT group, 32 cases in the IACI group, and 31 cases in the SSNB group). Mean age was 48.55±11.06 years. Fifty-seven cases were female (58.8%) and 40 were male (41.2%). Sixty-eight patients had a history of diabetes (70.1%). VAS and SPADI scores and range of mototion degrees dramatically improved in all cases (p

Background: Rotator cuff tears cause pathologies of the long head of the biceps tendon (LHBT). One of the surgical treatments for such a tear is LHBT tenodesis to the humerus. This study aims to compare simultaneous rotator cuff repair and LHBT tenodesis with or without detachment of the proximal end of the LHBT (PELHBT) from its site of adhesion to the glenoid.Methods: This retrospective study involved patients affected by LHBT pathology with rotator cuff tear. The patients were divided into two groups, with or without PELHBT detachment from the glenoid. Therapeutic outcomes were investigated by evaluation of patient satisfaction, pain based on visual analog scale, shoulder function based on Constant score and simple shoulder test, and biceps muscle strength based on the manual muscle testing grading system before surgery, at 6 months, and at the final visit after surgery.Results: Groups 1 and 2 comprised 23 and 26 patients, respectively, who showed no significant differences in demographic characteristics (p>0.05). Shoulder function, biceps muscle strength, pain, and satisfaction rate improved over time (p0.05). No post-surgical complication was found in either group.Conclusions: There was no difference in final outcomes of tenodesis with or without detachment of the PELHBT from the supraglenoid tubercle. Such tendon detachment is not necessary.

Introduction: Acute Coronary Syndrome (ACS) is one of the most common causes of death in patients with Cardiovascular Diseases (CVD). In addition to the known physical factors influencing the incidence of CVD, some psychologists have pointed to the role of psychological factors such as personality type. Objective: This study aimed to determine the role of type D personality in ACS patients in Iran in 2019. Materials and Methods: In a case-control study, 112 participants were included. A total of 56 patients with ACS were compared with 56 matched people without ACS. They were selected by the convenience sampling method. Type D scale 14 (DS14) was used to assess the type D personality. The Chi-squared test, independent t-test, and multivariate logistic regression were used to analyze the obtained data. Results: The Mean±SD age in the case group was 57.23±8.562 years, and in the Mean±SD age in the control group was 57.25±8.529 years. Also, most participants in both groups were men (71.4%). The result showed that type D personality was more prevalent in patients with ACS (26% vs 7.1%; P=0.006). Based on multivariate regression analysis and after controlling for demographic and clinical risk factors, type D personality was independently associated with ACS (OR=5.323, 95% CI; 0.987-28/712, P=0.052). Also, after investigating subscales, only social inhibition had a significant association with ACS (P=0.008). Conclusion: Type D personality is an independent risk factor of the ACS. Thus, type D personality may make people vulnerable to the ACS. Therefore, besides medical interventions, clinicians must consider behavioral interventions to reduce the incidence of ACS.

Background: To investigate the therapeutic effects of PRP injection + conservative treatment as the intervention group versus normal saline injection + conservative treatment as the control group. Objectives: This study we determined the effects of underlying factors, including age, gender, and body mass index (BMI), on the therapeutic effects of PRP. Methods: In this single-blinded randomized clinical trial, 60 patients with grade 2 knee OA with an age of 40 - 65 years were enrolled. In the intervention group, leukocyte-poor PRP with double spinning, and in the control group, normal saline was injected with a similar protocol. All patients in both groups were also provided with a conservative protocol, including oral celecoxib 100 mg BID for four weeks, modifying physical activity, and 15 sessions of physiotherapy. Results: Demographic characteristics (age, gender, and BMI) and pre-treatment scores were similar between the two groups (all P > 0.05). The WOMAC score was improved from pre-treatment to first week post-treatment in both groups (from 54.89 ± 3.4 to 64.9 ± 3.7 in the intervention group and from 53.7 ± 3.1 to 63.8 ± 3.9 in the control group). It means that PRP + conservative treatment was effective, similar to normal saline + conservative treatment. After adjusting BMI as an underlying variable, it was indicated that in the patients with lower BMI, PRP + conservative provided a better outcome in comparison to saline + conservative treatment (P = 0.014 and P = 0.019, respectively). Also, the comparison of functional scores changes with age as an underlying variable, demonstrating that younger cases obtained a better response from PRP + conservative rather than normal saline + conservative (P = 0.012 and P = 0.007, respectively). Conclusions: PRP seems to be an appropriate choice for treatment of moderate osteoarthritis, especially in younger patients and those with lower BMI.

Objective: Evaluating the abilities of emergency medical services (EMS) staff who are in the frontline of the diseases could be an excellent reflection of the accuracy of curriculum both before and after graduation. This study was done to determine the clinical competencies of Guilan EMS staff in responding to emergency conditions using Objective Structured Clinical Examination (OSCE). Methods: In this descriptive study, 70 EMS staff from selected Emergency Centres in Guilan were recruited. Data were collected using a questionnaire and a checklist which included 9 different skills. Validity of the checklist was assessed by obtaining the opinions of 10 experts. The content validity index (CVI) and content validity ratio (CVR) of the checklist were 0.7 and 0.8, respectively. The reliability of the checklist was obtained using the test-retest method (r=0.89). In order to collect data, observations were done using the designated checklist. Data were analysed using SPSS software version 22 and descriptive statistical tests. Results: Findings showed that 56.3% of the paramedics got good scores for trauma competency but the mean scores for two competencies of spinal cord immobilization and vehicle extrication were low, indicating major skills problem. There was a statistically significant relationship between education (P=0.02) and work experience (P=0.03) as well as clinical skills in confronting trauma. Conclusion: Although the EMS staff had an acceptable range of performance in most of the skills, it seems that there is a need for training of performance-based competencies in which paramedics had a poor performance.

Introduction and Objective: The risk of an anterior cruciate ligament (ACL) injury in young patients and those with sports activity is increasing. Regarding the need of athletes with ACL re-rupture to return to sports, ACL revision surgery has received great importance. This study was conducted to evaluate the outcome of ACL reconstruction revision surgery in athletes. Method In general, 62 patients with primary surgery and 62 patients with revision ACL surgery were investigated in this study. The study subjects were matched in terms of age, gender, involved leg, injury mechanism, sports group, time of surgery, and the degree of cartilage injury and ankle meniscus rupture. The studied variables included age, gender, body mass index (BMI), sports group, infection, meniscus injuries, chondral lesion, time to return to sports, quality of return to sports, range of motion, Lachman’s test, and knee injury and osteoarthritis outcome score (KOOS), International Knee Documentation Committee score, Lysholm, and Marx scores. They were obtained through the information in the patients’ medical records and the questionnaire filled out by the participants and the examiner’s physician through the follow-ups. Then, the collected data were imported into the SPSS software and underwent analysis. Results The mean follow-up of patients was 49 months (in the range of 2–6 years). None of the patients had a chronic infection. The mean time to return to sports was 29.2 ± 3.2 and 35.3 ± 4.3 weeks in the primary surgery and revision surgery groups, respectively. In addition, 34 (54.8%) and 25 (40.3%) patients of the primary surgery and the revision surgery groups returned to the same level before injury, respectively. On the latest follow-up, the results of the Lachman test showed no significant difference between the two groups (P = 0.222) whereas Lysholm, IKDC, MARX, and KOOS scores on the latest follow-up in primary surgery were significantly higher than those of revision surgery (P Conclusion The rate of return to sports in revision surgery was 14.5% lower than that of primary surgery, and the average time of return to sports was six weeks. The rate of return to sports, similar to before the injury, was significantly lower in the revision group, females, the age group of over 25 years, and contact sports activity, and patients with a chondral lesion. All knee performance scores were also poorer in the revision surgery.

Pectoralis major tendon rupture rate is increasing due to increased tendency to bodybuilding exercises, specially the bench press workout, and weight-lifting. The aim of this study was to determine the results of pectoralis major rupture repair with Achilles tendon allograft in bodybuilding athletes.In this case series study, 22 bodybuilding athlete patients (24 pectoralis major ruptures) were undergone open surgical repair during January 2016 till December 2020. 21 ruptures were chronic (2 ruptures were revision) and 3 ruptures were acute. Surgical method was based on Achilles tendon allograft used to augment the ruptured site for lengthening the shortened tendon.The results were analyzed using Bak's criteria and Constant score in pre operation visit and 6th and 12th months and in the last follow up.All cases were male with the mean age of 32.1 ± 5.4. The mean duration time between injuries to surgery was 37 ± 46 month (1-182 months). Return to professional sport began at 10.9 ± 2.8 months after surgery in which 16 cases (66.7%) have returned to their pre surgery bench press workout records. No infection or hematoma occurred. At the final follow-up, Bak criteria demonstrated excellent, good and fair in 4, 18 and 2 shoulders respectively. The constant score increased from 87.9 ± 7.9 in pre operation visit to 92.7 ± 6.4 in the last follow up (P 0.001).It seems that our surgical method is an effective approach in cases with acute or chronic pectoralis major ruptures.Level IV.

Background: The clinical outcomes of rotator cuff repair (RCR) surgeries vary because each method has its own advantages and limitations. Objectives: This study aimed to compare the short-term outcomes of arthroscopic RCR (ARCR) and mini-open RCR (MRCR). Methods: In this study, we included 49 patients with a diagnosis of full rotator cuff tear who had undergone ARCR and MRCR at Poursina Hospital of Rasht and Akhtar Hospital of Tehran from 20 March 2017 to 20 March 2020. The patients were divided into ARCR (n = 24) and MRCR (n = 25) groups. The two surgical procedures were compared with each other before surgery and three and six months after surgery in terms of shoulder function based on UCLA, disability based on QUICKDASH, range of motion (ROM), and pain based on Visual Analogue Scale (VAS). Data were analyzed by chi-square, independent t-test, and repeated measures analysis of variance (ANOVA). Results: There were no differences between the groups in terms of demographic details. The mean duration of surgery was significantly higher in the ARCR group compared to MRCR group (125.5 vs. 70.42 minutes). The short-term outcomes in the two groups on three measurement occasions showed a significant improvement in shoulder function, disability, and ROM in both groups along with a reduction in pain severity (P < 0.05); however, there was no significant difference between the two groups on any of the three occasions (P > 0.05). Conclusions: Shoulder function, disability, ROM, and pain were not different between the two groups, but duration of surgery was less in MRCR group. Therefore, under the same conditions, MRCR is a better choice than ARCR due to its short duration of surgery.

Background. In the central nervous system, glioblastoma multiforme (GBM) is one of the most important neoplasms in adults. Amplification of EGFR and VEGF genes is common in GBM. However, the role of overexpression of EGFR and VEGF in survival of patients with GBM has been a contentious issue. Therefore, we performed the present study to assess the survival rate of patients with EGFR and VEGF overexpression. Materials and methods. Resected samples of GBM patients were evaluated by immunohistochemistry for overexpression of VEGF and EGFR. The patients were followed up for a year. Results. The mean±sd of age of patients was 56.2±13.1 years. The majority of the patients were male (65.9%). Most of the patients had primary GBM (67%), notwithstanding 33% of the patients with secondary GBM. Moreover, 19.2% and 49.5% of the samples were VEGF-positive and EGFR-positive, respectively. Overall 6, 12-, and 18-month survival rates were shown to be 61.5±5.1%, 17.6±4%, and 4.4±2.1%, respectively. There was a significant difference between the mean±se survival rate in VEGF-negative patients (12±1.9 months) VEGF-positive patients (7.8±0.5 months) (P=0.045). Conclusions. We found an association between VEGF and EGFR over-expression and the survival rate of GBM patients. The VEGF overexpression was significantly associated with the overall survival rate of the GBM patients, but failed to have a prognostic value for their mortality rate. However, EGFR was a predictor of overall survival rate and mortality of GBM patients. Moreover, VEGF overexertion has a stronger association with survival rate in GBM, compared to EGFR overexpression.

Aims: In order to reduce the rate of cesarean section (CS), it is necessary to be aware of attitudes of women to predict their preferred method of delivery and its related factors. This study aimed to compare attitudes of medical and non-medical female students regarding the preferred method of delivery and its related factors in 2019. Study Design: cross sectional-analytical study. Place and Duration of Study: Medical and non-medical undergraduate female students of Guilan, Rasht, Iran, were randomly selected between October 2019 and November 2019. Methodology: We included 1040 students (873 non-medical, 167 medical students; mean age 20.90 ± 1.54 years). The data were collected by a researcher-made questionnaire and analyzed using descriptive and inferential (Chi Square, Fisher's exact test, Kruskal–Wallis, Mann-Whitney and multiple regression) statistics (P =.05). Results: In general, 71.50% of subjects in both groups had a neutral attitude. For group comparison, the medical and non-medical groups (24% and 12.40%) had a positive attitude towards CS and (11.40% and 14.80%) had a positive attitude towards normal vaginal delivery (NVD), respectively. Attitude score according to the university (P =.002), the school (P =.002), the academic year (P =.001), age (P =.031), ethnicity (P =.001), child rank (P =.042), father education (P =.007), mother education (P =.006), childbirth method of the mothers in other children (P =.007), and delivery method of the relatives (P =.05) was significant. Conclusion: Although non-medical students had more possitive attitude towards NVD, in general, in both groups, the majority of them had a neutral attitude towards the mode of delivery. It seems necessary to develop the educational-counseling interventions to form a positive attitude towards NVD in all students and youngs.

Coronary angiography due to the risk of vascular complications and low back pain development can lead to undesirable outcomes. This clinical trial was performed on 110 patients undergoing CAG through the femoral artery in 2019. Low back pain was assessed by VAS at baseline, 2, 4, 6 and 24 hours after angiography and vascular complications were investigated 9 times in this period. Results of group and time interaction analysis revealed that pain and vascular complications were significantly different between these two groups (P

Background: Adolescence is an important and vital period in the human lifespan. Adolescent girls’ health is affected by special cultural and social factors; investing in their health requires careful planning and effective intervention. For any planning, accurate knowledge of their needs is necessary. Objective: This study aims to assess the healthcare needs of adolescent girls in Iran. Materials and Methods: This descriptive cross-sectional study was conducted on 850 female students who were studying in first- and second-grade high schools in Rasht, Iran. They were selected using a multistage cluster sampling technique. In this study, a demographic form and the Female Adolescents Health Needs Questionnaire (FAHNQ) were used for data collection. The collected data were analyzed in SPSS V. 21 software using descriptive statistics. Results: According to the participants, the top priority healthcare need was related to the emotional need (23.47±12.22%), followed by social (21.02±11.68%), educational (18.63±16.01%), physical (15.12±10.34%) and spiritual needs (13.86±11.99%). Conclusion: The decision-makers in the health sector should pay more attention to the emotional needs of adolescent girls to promote their primary health.

Introduction: The intensive care unit is a stressful environment due to the high mortality rate of patients, the occurrence of moral problems and working in a tense atmosphere. Faced with these conditions, nurses may be exposed to moral distresses. Therefore, it is important to study the moral distresses that nurses face in these units. Objective: This study aimed to determine the level of moral distress and related factors in nurses working in the intensive care units of Guilan Province, Iran. Materials and Methods: This analytical cross-sectional study was performed on nurses working in all intensive care units in 20 hospitals affiliated to Guilan University of Medical Sciences. The study samples were 414 intensive care nurses chosen by census method in 2018. The data collection instruments were the individual-social factors questionnaire and the 21-item Corley’s moral distress scale standard questionnaire. Data were analyzed using descriptive and inferential statistics (Mann-Whitney, Kruskal–Wallis and Logistic Regression). Results: The majority of the studied samples were women (90.6%), married (67.4%), full-time employees (44.6%), undergraduate (90.3%) with Mean±SD work experience of 75.69±9.93 months in the intensive care units. The mean total score of moral distress was 91.30±65.03 (out of 0-332 scores). Based on the final logistics regression model, gender (OR=2.410, CI95%; 1.19-5.6, P=0.016) and work experience in the intensive care unit (OR=0.64, CI95%; 0.43-0.94, P=0.023) were identified as two factors related to moral distress. Conclusion: The results of this study support the existence of moral distress in nurses in intensive care units, can be considered in planning to reduce the moral distress of nurses in the workplace and improve the quality of nursing care.

Introduction: Adherence to patients’ rights is one of the most important ethical issues in the hospital that should be considered. An efficient health system requires active participation and proper interaction between health care recipients and providers. Objective: This study was conducted to determine the status of observing the charter of patients’ rights and related factors from the perspective of hospitalized patients in educational-therapeutic centers in Rasht City, Iran. Materials and Methods: The present study was a cross-sectional analytical study conducted on 342 hospitalized patients during discharge in Rasht City in north of Iran educational-therapeutic centers in 2018. The samples were selected by stratified random sampling. The study instrument was a researcher-made questionnaire with two sections: The first section was related to individual, social, and disease-related information, and the second section to determining the status of the patient’s compliance. The obtained data were analyzed using descriptive (Mean±SD) and inferential statistics (The Chi-Square test, Friedman, and logistic regression). Results: The status of observing the charter of patients’ rights from the patients’ point of view was desirable at 65.8% in general, 85.1% in case of receiving health services, 3.69% in receiving information, 57.6% in the patient’s right to choose and decide freely in receiving health services, 66.7% in providing health services based on the respect for the patient’s privacy and adhering to the principle of confidentiality, and 19% in access to efficient systems to handle complaints. Also, among the variables studied, the only reason for referral (the physician’s recommendation to emergency referral) was related to the status of observance of the charter of patients’ rights and was considered as a predictor (P=0.013), OR 1.9, CI95%; 1.150-3.233). Conclusion: According on presenting the results to the health service managers, emphasizing the need to observe the charter of patients’ rights by the health system staff, measures can be taken to improve the status of patients’ rights and prevent any violation of their rights, who are considered vulnerable in society.

Background: Junk food consumption is an unhealthy adolescent nutritional habit that is affected by family structure, peer groups, and socioeconomic status. The present study was conducted to determine the association between junk food consumption and personal, familial, and social characteristics considering high school students in Rasht, Iran. Methods: This cross-sectional study was conducted on 341 students in their second year of high school in Rasht, Iran in 2017. They were selected using a two-stage cluster random sampling. Data was collected using a checklist. Data was analyzed in SPSS 16 using Mann-Whitney and Kruskal-Wallis tests at a significance level of 0.05. Results: Sweet snacks were consumed the most (27.3%). Frequency of junk food consumption was significantly higher in students whose fathers had a university degree (P=0.037) and those with monthly family income of more than 2 million Rials. (P=0.004). Conclusions: The results indicate that students whose fathers have a higher education and income level have more tendencies toward junk food consumption; hence, it is worth considering the relevant factors in order to improve the adolescents' health.

Background:One of the leading causes of death in patients with breast cancer is delays in help-seeking, which is influenced by various factors, including social factors such as cancer stigma. Objectives:This study aimed to determine the relationship between perceived stigma and delay in seeking help for women with breast cancer. Methods:In this cross-sectional study, 140 women with breast cancer referred to Besat Clinic in Rasht, Iran, were included. The data gathering tools included a demographic questionnaire, a cancer stigma questionnaire and a delay questionnaire completed through interviews with patients. Data analysis was performed using SPSS software V.21 and the descriptive and inferential statistics were performed using correlation coefficient, chi-square test, logistic regression, Mann-Whitney U-test, and Kruskal-Wallis test. Results:In this study, 72.1% of patients were aged between 39 and 57 years, with a mean age of 47.99±8.03 years; 34.3% and 16.4% of patients delayed seeking help between 30 and 90 days, and more than 90 days (with mean±SD of 75.35±165.19), respectively. Breast cancer stigma was present in 45% of patients. Delay in seeking help based on stigma was significant (P

Background: The aim of the study is to compare the results of anterior cruciate ligament reconstruction (ACL-R) in people aged more than 50 and under 30 years of age. Methods: A total of 64 patients with ACL rupture were evaluated for eligibility. Thirty-two patients with ACL rupture, aged more than 50 years (54.38 ± 1.26) were matched in all of the background factors, with 32 patients suffering from ACL rupture under 30 years old. They were followed for clinical and functional results at six and on average 45.58 months after surgery. These evaluations included the Lachman test, KT-1000, International Knee Documentation Committee (IKDC) score, Lysholm knee score (LKS), return to exercise activity, post-operative satisfaction rate, and pain intensity based on Visual Analogue Scale (VAS) and rates of extension and flexion loss. Results: Our findings indicated that knee stability, return to exercise activity, LKS and IKDC scores, as well as pain intensity and satisfaction were significantly improved in both groups. Indeed, the satisfaction rate of patients over 50 years at six months after surgery was less than those under 30 years (P < 0.001); however, it was approximately similar to the group under 30 years of age in the final follow-up (P > 0.05). The rate of return to sports activity was also lower in patients over 50 years. Conclusions: The comparable results at the patients with < 30 years demonstrated that arthroscopic ACL-R in patients over 50 years of age with no or mild DJD has good results.

Background: This study was designed to evaluate and compare the diagnostic value of magnetic resonance imaging (MRI) and indirect magnetic resonance arthrography (I-MRA) imaging with those of arthroscopy and each other.Methods: This descriptive-analytical study was conducted in 2020. All patients who tested positive for labrum lesions during that year were included in the study. The patients underwent conservative treatment for 6 weeks. In the event of no response to conservative treatment, MRI and I-MRA imaging were conducted, and the patients underwent arthroscopy to determine their ultimate diagnosis and treatment plan. Imaging results were assessed at a 1-week interval by an experienced musculoskeletal radiologist. Image interpretation results and arthroscopy were recorded in the data collection form.Results: Overall, 35 patients comprised the study. Based on the kappa coefficient, the results indicate that the results of both imaging methods are in agreement with the arthroscopic findings, but the I-MRA consensus rate is higher than that of MRI (0.612±0.157 and 0.749±0.101 vs. 0.449±0.160 and 0.603±0.113). The sensitivity, specificity, negative predictive value, positive predictive value, and accuracy of MRI in detecting labrum tears were 77.77%, 75.00%, 91.30%, 50.00%, and 77.14%, respectively, and those of I-MRA were 88.88%, 75.00%, 92.30%, 66.66%, and 85.71%.Conclusions: Here, I-MRA showed higher diagnostic value than MRI for labral tears. Therefore, it is recommended that I-MRA be used instead of MRI if there is an indication for potential labrum lesions.

Introduction: Palliative care is the science of promoting the patient’s quality of life. It can improve the quality of life of a patient, which is effective not only in patient’s late-life but also useful in dealing with a chronic illness over many years. In this regard, nurses, as the largest providers of health care services, play an important role in palliative care. Objective: This study aimed to investigate the palliative care knowledge of nurses and its contributing factors. Materials and Methods: This cross-sectional study was conducted on 280 nurses working in different departments of hospitals affiliated to Guilan University of Medical Sciences (GUMS). They were recruited using the stratified random sampling technique. Their data were collected by a demographic form and the Palliative Care Quiz for Nursing (PCQN) instrument. The collected data were analyzed by Kruskal-Wallis and Mann-Whitney U tests. Results: The Mean±SD score of palliative care knowledge of study nurses was reported as 7.86±2.16 indicating their imperfect knowledge. Among studied factors, only the personal study about palliative care had a significant association with the nurses’ knowledge (P=0.038). Conclusion: Nurses had poor knowledge of palliative care and its subscales that is one of the main obstacles in providing optimal palliative care. So, increasing their quality of palliative care services by improving their knowledge through in-service education and on the job retraining could promote the quality of palliative care services for the patients.

Fatigue is the commonest symptom in cancer patients; despite high levels of clinically significant persistent cancer-related fatigue, few treatments are currently available. The aim of this study was to evaluate the efficacy of acupressure on fatigue in patients with cancer who underwent chemotherapy. The study was designed as a randomized and controlled trial. Ninety samples were selected using the convenience sampling method, and random block sampling was used for allocation of groups (30 for each group). The three groups were similar by age and gender. The experimental group underwent acupressure at the Zusanli (ST-36), Hegu (LI-4), and Sanyingjiao (SP-6), whereas sham pressure was used in the placebo group and no intervention was applied in the control group; the level of fatigue of participants in three groups was calculated in three phases, before, during, and after chemotherapy. Data were analyzed using SPSS, version 22. The results showed that the mean of visual analog score of fatigue is significantly different in three groups at the end of chemotherapy (p = 0.021). The mean visual analog score of fatigue in the acupressure group was meaningfully lower than that in the control group after chemotherapy (p = 0.028). Results of this investigation showed that acupressure has short-term effectiveness on the cancer-related fatigue of patients undergoing chemotherapy. Keywords: acupressure, cancer patients, cancer-related fatigue, complementary and alternative medicine

Background: Because advance knowledge of fetal sex can satisfy parental curiosity and allay anxiety, attempts at its determination prior to birth have a long history. There may also be reason to determine fetal sex when sex-specific genetic disorders are suspected. The aim of this study was to investigate the association between gestational sac (GS) location and fetal sex. Materials and Methods: This cross-sectional study was conducted on 751 pregnant women. Transvaginal ultrasound was performed during 7-8 weeks of gestation for prenatal care and assessment of pregnancy sac and GS location. Age, parity, gravidity and GS location were recorded. Abdominal ultrasound was performed at 16-20 weeks of gestation to determine fetal health and sex and finally data was analyzed and compared to sex of the fetus after birth using SPSS software version 21. Results: There was a significant relationship between GS location and fetal sex (P

Introduction: Bruising is one of the most common adverse events following administration of enoxaparin sodium, which can lead to unpleasant consequences such as reduced access to various sites for injection, joint complaints, and reduced satisfaction of patients from the treatment and care provided. Therefore, in order to find ways to reduce this complication, the aim of this study was to compare the effectiveness of local combined cold-hot application on bruising caused by subcutaneous injection of enoxaparin sodium. Methods: This randomized controlled trial was conducted from July to December 2018. 74 patients hospitalized in Poursina Hospital in Rasht were selected according to inclusion criteria and assigned to intervention group 1 (37 persons) and intervention group 2 (37 persons) by randomized block design. In each intervention group, the left side of the abdomen was treated as control (without intervention) and the right side was treated with cold pack (intervention group 1) or cold-hot pack (intervention group 2). Data collection was done by two-part tools, including individual and clinical data, and related records of bruising. Evaluation of the incidence and severity of bruising was performed at 24, 48, 72 hours after the first injection. Data were analyzed by SPSS version 22 using descriptive and inferential statistics (Independity Test, Friedman, Wilcoxon, Mann-Whitney, Kolmogorosimerno). Results: The majority of research samples were men (79.7%). The mean age of the patients was 21 ± 48 years. The mean and standard deviation of bruising in intervention group 1 at 24, 48 and 72 hours after injection was 24.44±1.09, 4.49±1.04 and 4.35±1.14, respectively. The mean and standard deviation of bruising in intervention group 2 at 24, 48 and 72 hours after injection was 1.65±0.63, 1.49±0.65, and 0.88±0.43, respectively. Differences in bruising size were statistically significant (P

Background & objectives: Chlamydia trachomatis is a gram negative bacterium and chlamydia infection, as a curable infection, is one of the most common sexually transmitted diseases (STD). With regard to the essential role of chlamydia in infertility, the study of the prevalence of asymptomatic cases is precious. The aim of this study was to determine of the prevalence of chlamydia trachomatis in endocervical samples in infertile women with PCR method. Methods: In this cross sectional descriptive-analytical study, a total of 135 women between 20-40 years old with chief complaint of infertility that referred to Alzahra-Rasht hospital and private clinics were randomly selected. The endocervical specimen was prepared using a sterile swab and was transferred to the laboratory in PBS for performing PCR. . The results of PCR and collected data from checklists were statistically analyzed using SPSS16. Results: Chlamydia trachomatis was detected in 19.3% of infertile women. There were no statistically significant differences between PCR results and the patient's age, type of infertility, obstruction in salpingography, family history and duration of infertility. Conclusion: The results of this study revealed that chlamydia infection has a high prevalence and in order to reduce the complications of this disease, screening tests can be used as a part of the country's health programs.

Background Pain is one of the most common challenging complaints of patients and can lead to significant complications. It is important to identify pediatric nurses’ knowledge about pain control methods and the management in children using clinical practice guidelines. Objectives The purpose of this study was to investigate the relationship between nurses’ knowledge and their perceived practice based on clinical practice guidelines of pediatrics’ pain in the central pediatrics’ hospital of Guilan University of Medical Sciences (GUMS). Methods In an analytical-cross sectional study, 164 nurses were selected by a census method from the central pediatrics’ hospital of GUMS. The study tool was a researcher-made questionnaire developed from the valid pediatrics’ pain guidelines. The data were analyzed by SPSS 21. Results There was no significant relationship between total scores of knowledge and practice. There was a significant relationship between total scores of knowledge and interventions of pain control (P = 0.045, r = 0.157). Also, general knowledge had a significant correlation with total practice (P = 0.003, r = 0.227), intervention of pain assessment (P = 0.002, r = 0.245) and intervention of pain control (P = 0.035, r = 0.165). General knowledge in pain control (P = 0.006, OR = 1.032) was considered as the predictor of the practice. Conclusions The results of this study showed that nurses’ general knowledge about clinical guidelines for pain in children was a predictor for their perceived practice. Also, experience and education were related to higher practice. These findings can provide awareness among nurse managers and health care policymakers to update the nurses’ knowledge of pediatric pain management guidelines.

Background and objective Arthroplasty is the main treatment in patients with advanced knee osteoarthritis. In bilateral lesions, it is frequently performed in two simultaneous or separate surgical procedures. In this regard, the present study aimed to compare the results of knee arthroplasty in two joints simultaneously at two different times. Method In general, all 40–70 years old patients in need of complete bilateral total knee arthroplasty (BTKA) were enrolled in this descriptive cross-sectional study during 2009–2016. They were included in three groups of BTKA as simultaneously (n = 272), staging in the same hospitalization (146), and staging in different hospitalizations (245). To assess the quantitative and qualitative function of the knees, patients’ knees were evaluated before the surgery, and one month, three months, and two years after the surgery using the Knee Society Score (KSS) and Western Ontario and McMaster Universities Arthritis Index (WOMAC). Finally, hospitalization time, anesthesia duration, and medical costs were compared between the three groups. Results Based on the results, knee function improved based on WOMAC and KSS scales in all groups after arthroplasty although no significant differences were observed between the three groups. Patients’ satisfaction in simultaneous BTKA was significantly higher compared to the other two groups (P = 0.013). Eventually, complications demonstrated no significant differences between the three groups except for pulmonary and cerebral embolism which were more prevalent in old patients with a high body mass index in the simultaneous BTKA group (P = 0.035 and P = 0.043, respectively). Conclusion Overall, simultaneous BTKA is a useful approach for reducing costs while increasing patients’ function and satisfaction although it has certain complications such as embolism in older overweight patients.

Objectives Tonsillotomy with radiofrequency (RF) is one of the newest treatments for chronic tonsillitis, but the mechanism of RF effects and complications are still pending. The aim of this study was to evaluate the effects of RF on the histological and bacteriological characteristics of the tonsils (Case-control study). Materials and methods In fifty-two patients with chronic tonsillitis in 2017–2018, immediately after tonsillectomy, the tonsils were divided into 2sections; one sample treated with RF, and the other one considered as control, without intervention. All tonsil samples sent for histological and bacteriological study: morphometric assays made by Digitizer software, and type of bacterial colonies identified by microbiological and biochemical tests. Willcoxon and McNemar tests were used for statistical analysis and level of significance was p ≤ .05. Results Tonsil mucosal thickness (2202.98 ± 323.09 vs. 2463.94 ± 357.61 μm) and size of the tonsil nodule (28,000.42 ± 9608.75 vs. 36,692.81 ± 7040.74 μm2) were significantly lower in the RF+ group than other group (p = .001 and p = .01, respectively). There was no significant differences in thickness of the tonsil epithelium (p = .075), number of lymphoid nodules (p = .860), and the number of reticular tonsil epithelium (p = .813) between the two groups. Bacterial growth in RF- and RF+ groups had no statistically significant difference (p = .06), however, the average colony count of S. aureus in RF+ tonsils were significantly lower, and total number of bacterial colonies were significantly lower in RF+ group(1405 ± 156 vs. 2471 ± 156), (p = .001). Conclusion RF surgery has significant effects on size of the nodules, thickness of the mucous layer and bacteriological characteristics of tonsil tissue. Especially S. aureus seems to be more sensitive to RF effects.

Background and Objectives: A positive childbirth experience is associated with sense of control, power, and satisfaction in mother, which affects mother’s sexual activity with her newborn, her sexual activity and her planning for future pregnancies. This study aimed to determine the childbirth experience and its related socio-demographic factors. Methods: In this descriptive cross-sectional study, 165 mothers who were hospitalized in postpartum ward of AL Zahra hospital in Rasht city (2017), were selected by available sampling method. The data collection tools were socio-demographic and childbirth experience (CEQ) questionnaires. Data were analyzed using Pearson`s correlation coefficient, independent t-, one-way ANOVA, and logistic regression tests. Results: Total mean score of mothers` childbirth experience was 58.13 10.72 (score range, 22-88). The mean standard score (1-4) in professional support domain (3.15±0.7) was higher than other domains, and the mean standardized scores of the mother participation domain (2.0 21.84) was lower than the other domains. Moreover, mode of delivery (p=0.005) and gestational age (p=0.004), were the most important factors that had significant correlation with mother’s childbirth experience. Conclusion: According to the results, the effective communication of health care providers, mother`s active participation during delivery, high gestational age, and normal vaginal delivery are the most important factors associated with positive childbirth experience. Therefore, avoiding unnecessary interventions, such as termination of pregnancy at a low gestational age without the maternal and fetal indications and higher maternal participation in the process of delivery seem necessary.

Background and objectives: Lower levels of health literacy have been associated with adverse health outcomes, especially for elderly. Methods: This cross-sectional study was conducted on 290 retired elder from the Retirement Centers in Rasht city by Convenient sampling during the year 2017. Data collection tools included, Test of Functional Health Literacy in Adults(TOFHLA) and general health standard questionnaire (GHQ-28). The data were analyzed using descriptive and inferential statistics in SPSS. Results: More than half of the participants (54.8%) had adequate health literacy. The highest mean of the health literacy was in the domain of reading comprehension (36.30±7.90) and then in the domain of numeracy (36.11±11.60). There was a significant relationship between the level of health literacy and the level of education, the level of education of the spouse and the history of cancer(P

Vertigo is a common annoying complaint needing emergent treatment. There are various treatment options for this condition with different outcomes and side effects.Assessment and comparison of the effectiveness of Ondansetron and Promethazine in the treatment of acute peripheral vertigo.This clinical trial was conducted in an academic hospital in the north of Iran in 2017. A total of 170 eligible patients were randomly allocated to groups A: received intramuscular (IM) promethazine; and B: received intravenous (IV) Ondansetron, using quadripartite blocks. The severity of vertigo, nausea, blood pressure, heart rate, side-effects, need for re-administration, and the time to become asymptomatic were assessed before the injections, 30 min after and 2 h after the injections.Excellent improvement in vertigo occurred in both groups (P 0.001), with a more significant reduction in the promethazine-treated group (P 0.001). Nausea was reduced more significantly in the ondansetron-treated group (P 0.05). There were more side-effects seen in the promethazine-treated when compared to the group with ondansetron treatment (P 0.001). No significant differences were seen in the blood pressures between groups (P 0.05). Heart rates were reduced in both groups but the changes were insignificant (P 0.05). The ondansetron-treated group showed a greater need for re-administration of the medication (50.6% vs. 27.1%). The relief score was significantly higher in the ondansetron-treated group compared with the group received promethazine (P 0.001). The time to become asymptomatic showed no statistically significant difference between groups (p = 0.28).Our results indicated that while promethazine cures peripheral vertigo more efficiently, ondansetron is more beneficial for the improvement of nausea and vomiting.

Background and objectives: Diabetes is the most common metabolic disease in developing countries. Because the cause of many chronic diseases lies in the human's lifestyle, performing health promotion behaviors is the best way to maintain and improve the health. Hence, this study aimed to compare the health promoting behaviors based on the Pender model in at risk groups of type 2 diabetes in women referred to health centers of Rasht city 2017. Methods: This cross-sectional and analytical-descriptive study was performed on 300 women referring to community health centers of Rasht city and was conducted by stratified random sampling method. Data was collected by Health-Promoting Lifestyle Profile-II (HPLP-II) Questionnaire and the questionnaire evaluating the risk of type 2 diabetes using the FINDRISK tool .Data analysis was performed by SPSS version 21 using ANOVA test, Tukey test and independent T-test. Results: The mean score and standard deviation of health promotion behaviors in this study have been varied from 144.18 ± 19.56 in the low risk group and 129.27±17.86 in the very high-risk group of type 2 diabetes. The difference in score of health promotion behaviors dimensions in the five groups according to the risk of type 2 diabetes, except the interpersonal relationships dimension, was statistically significant (P< 0.05). Conclusion: The high risk and very high risk groups than low risk and very low risk of type 2 diabetes had less scores of health promoting behaviors. In other words, people with a healthier lifestyle were less likely to develop type 2 diabetes .

Background and Aim: Cervical trauma is a major injury and although using cervical collar is the standard measure in trauma patients, it is not usually applied properly. This study aimed to examine the effect of education on the knowledge of paramedic staff regarding cervical collar use in patients with head and neck injuries. Methods and Materials/Patients: In this quasi-experimental study, 100 paramedic staff of Rasht Emergency Medical Services (EMS) participated through census sampling method. First, the knowledge of paramedics about utilizing cervical collar was examined using a researcher-made questionnaire. Then, those with low or intermediate knowledge were trained by the resident of emergency medicine. Instructional CDs, including materials on using the cervical collar were distributed among paramedics, too. After two weeks, their knowledge was tested by written and practical tests. By comparing the scores before and after the education, the effectiveness of the intervention was assessed. Results: All samples were male. Their Mean±SD age and work experience were 38.8±7.5 and 12.6±6.5 years, respectively. The results of pre-education knowledge survey showed that the 71 (69.6%) subjects had a moderate knowledge and 27 (26.47%) individuals had poor knowledge, and only 4 (3.9%) individuals had sufficient knowledge about using the cervical collar. Knowledge survey assessment after education in poor and moderate groups (n=98, 96.1%) showed that 73 (74.5%) subjects had good knowledge and 25 (25.5%) subjects had moderate knowledge. Nobody had weak knowledge. Conclusion: The paramedic staff knowledge of using cervical collar increased after holding an appropriate educational course. Therefore, the staff with low to intermediate knowledge should be trained at least once a year.

Background and Aim: Hydrocephalus can cause ventricular expansion, which if not treated promptly, can result in brain damage. The hydrocephalus-induced damage is not fully improved, even by means of surgical procedures, leading to permanent damages to the brain. Methods and Materials/Patients: The aim of this study was to evaluate the demographic characteristics as well as hydrocephalus in patients with head trauma in Poursina Hospital, Rasht. The information including age, sex, Glasgow Coma Scale (GCS), trauma mechanism and accompanying brain injuries on admission were recorded. Patients with hydrocephalus diagnosed by CT scan underwent further investigation and therapeutic approaches. The treatment-related results were collected based on the GOS scale. Finally, the data were entered into SPSS version 18, and the results were analyzed by Fisher’s exact test, and Independent t-test. Results: Of the 548 patients, hydrocephalus was observed in 14 patients (2.6%). The mean age of the patients was 44.07±24.48 years old. 31.1% of men (14 cases) had hydrocephalus, while none of women suffered from this complication. Car accidents (12 people) and fall (2 people) were identified as causes of incident in hydrocephalus patients. Head injury severity in most patients with hydrocephalus was mild (n=7, GCS=13-15) and moderate (n=6, GCS=9-12), and severe (n=1, GCS=3-8). Subarachnoid hemorrhage (n=5) and then epidural hematoma (n=4) and intracerebral hemorrhage (n=4) had the most severe damage to the skull. Most patients (n=11) were treated by surgery. Three patients recovered completely. Moderate disability, severe disability, vegetative state, and death occurred in 3, 2, 1, and 5 Patients, respectively. According to independent t-test, there is a statistically significant relationship between Glasgow Coma Scale and hydrocephalus (P=0.03). Fisher’s exact test also showed a statistically significant relationship between intracerebral hemorrhage (P=0.045) and intraventricular hemorrhage (P=0.013) on admission with hydrocephalic incidence. Conclusion: This complication was mostly observed in young traumatic patients (younger than 40 years of age) and in patients with mild head injury. Therefore, it is necessary to pay attention to these people in order to detect hydrocephalus, if any, as soon as possible, and these patients be treated appropriately.

Introduction: Poisoning is a major public health problem and one of the most common causes of child mortality, particularly in developing countries. Incidences of poisoning are variable according to the cultural and economic characteristics of particular communities. Objective: The purpose of this study was to analyze cases of poisoning in children under 6 years of age underwent hospitalization in a health center of Rasht. Materials and Methods: This study was conducted as a case-control study. The study included 2160 cases of hospitalized children under 6 years old. The study duration was 4 months. There were 2 groups, 70 children hospitalized because of poisoning (case group) and a control group of 105 people (1.5 times that of the case group) that consisted of children under 6 years of age and , non-hospitalized. Information gathered by questionnaire included; demographic information on individuals and families, as well as method of poisoning and the child's condition after hospitalization. Information was collected from interviews and medical records. Data were analyzed after collection using descriptive statistics (frequency distribution, means and standard deviation) and inferential statistics (chi-square tests, t-test). Results: The findings showed that most children (51.4 %) were between the ages of 1-3 years. Of the total sample 64.3 % were boys and 35.7 % were girls. In 80% of cases, poisoning was accidental and 97.1% were gastrointestinal in nature. In 51.4% cases, the cause was poisoning from medicine; 36.1% of cases were caused by methadone and in 17.1% of cases incidents had occurred in the kitchen. There was significant difference in both case and control groups in terms of father's level of education (P = 0.012) and mother's job (P = 0.025). Conclusion: Results showed that the most common cause of poisoning in children aged 1-3 was from pharmaceutical drugs; determined by the side effects of poisoning. A low rate of parental awareness was considered to have contributed to these cases of poisoning so parental awareness was determined as significantly important for improving childcare in the study region.