Ali Morad Heidari Gorji

Implementing benson's relaxation training in hemodialysis patients: Changes in perceived stress, anxiety, and depression

Background: Hemodialysis patients usually experience high levels of psychological stress, anxiety, and depression. Reducing these matters in patients provides more psychological resources to cope with their physical situation. Aim: The present study aimed to explore the efficacy of Bensons relaxation technique for stress, anxiety, and depression of patients with hemodialysis. Materials and Methods: Eighty hemodialysis patients were selected from two hospitals as an intervention and control groups. Then Benson relaxation training was implemented in the intervention group for 15 min twice a day during 4 weeks. The patients were assessed by depression, anxiety, and stress scale; which was completed before and after the intervention. Results: There were significant differences between stress and anxiety levels in case group before and after intervention (P > 0.001) and there is no meaningful difference between the mean of depression value in case group before and after intervention (P > 0.22). Conclusion: Instructing Bensons relaxation technique is accompanied by reducing stress and anxiety level of hemodialysis patients. Reducing stress and anxiety levels can provide more calmness for the patients so that pursuing medical therapy would be accompanied with more tranquility. Authors have suggested to improve and prevent the patients’ psychological problems as well as other chronic disorders by applying this practice.

Fasting in pregnancy: A survey of beliefs and manners of Muslim women about Ramadan fasting

Background: Fasting during Ramadan is compulsory in the Muslim faith. Although pregnant women may be exempted, many still choose to fast because of a confluence of social, religious and cultural factors. Objective: Little is known about the physiological effects of fasting during Ramadan on the mother or unborn baby, and thus nurses and other health-care providers are faced with the difficult task of providing appropriate medical advice to Muslim women regarding the safety and impact of their fasting. In this study, we examined the practice of fasting among pregnant Muslim women in Amol/Iran, and examined their beliefs on fasting during the holy month of Ramadan 2011. Materials and Methods: This is a retrospective study of all Muslim women in Amol who were pregnant and received antenatal care in healthcare center during the month of Ramadan. Exclusion criteria were all women with any problem in pregnancy. A questionnaire was tool of study. Data were analyzed with Statistical Package for the Social Sciences software (SPSS) (P < 0.05). Results: From 250 questionnaires, 215 were responded and collected. 31.8% pregnant women fasted during Ramadan. The average time of fasting was 9.88 days. There was a significant relationship between parity (0.035) and gestational age (0.049) and fasting. 85% of women believed that fasting during pregnancy is a ritual. 71.7% women did not change their prenatal care. 73.5% of pregnant women consulted the obstetrician about fasting. The most common complication in mother was fatigue and weakness. The average size of the head circumference and length of newborn was normal. Conclusion: Midwifes and other health workers need to learn as much as possible about the multicultural best practices and research-driven information about fasting in order to help Muslim women make informed decision.

Which score should be used in intubated patients' Glasgow coma scale or full outline of unresponsiveness?

Background and Aims: Today Glasgow coma scale (GCS) is the most well-known and common score for evaluation of the level of consciousness and outcome predict after traumatic brain injuries in the world. Regarding to some advantages of the full outline of unresponsiveness (FOUR) score over GCS in intubated patients, we’re going to compare the precision of these two scores in predicting the outcome predict in intubated patients. Methods: This research was a diagnostic-based study, which was conducted prospectively on 80 patients with Traumatic brain injury who were intubated and admitted to Intensive Care Unit (ICU) of Educational Hospitals of Mazandaran University of Medical Science during February 2013 to August 2013. The scores of FOUR and GCS were measured by the researcher in the first 24 h of admission in ICU. The informations recorded in the check list including the mortality rate of early and late inside of the hospital interred to excel. The findings were analyzed using SPSS software, through descriptive statistics and regression logistic. Results: The results showed of 80 patients 21 patients (20%) were female and 59 patients (80%) were male. The age average of the samples was 33.80 ± 12.60 ranging from 16 to 60 years old. 21 patients (26.2%) died during treatment. Of 21 patients, 15 patients died during first 14 days (18.7%) and 6 patients died after 14 years (7.5%). The area under curve (AUC) of FOUR score in early mortality was 0.90 (C1 = 0.95, 0.88–0.90). The amount AUC for GCS was 0.80 (C1 = 0.95, 0.78–0.84), which in delayed mortality it was ordered as 0.86 (C1 = 0.95, 0.84–0.90) and 0.89 (C1 = 0.95, 0.78–0.88). Conclusion: The research results indicated that FOUR score is more exact and more practical in intubated patients regarding lack of verbal response factor in early mortality prediction in GCS. Hence, it is recommended for health professionals to use the FOUR score to predict the early outcome of intubated patients with traumatic brain injuries.

Physiological and psychosocial stressors among hemodialysis patients in educational hospitals of northern Iran

Background and Aims: The hemodialysis (HD) patients are experiencing high biopsychosocial stress on all levels. Therefore, this study was designed to survey on physiologic and psychosocial stressors among HD patients in two educational hospitals of Northern Iran. Materials and Methods: This cross-sectional study included 80 HD patients who were referred to Khomeini and Fatemeh Zahra hospitals in Mazandaran (Northern Iran) during the year 2011. Data were collected using a demographic information record sheet and Baldree Hemodialysis Stress Scale. Finding: The following physiologic stressors were noted: Fatigue (51.25%), limited time and places for enjoyment (46.25%), and physical activation limitation (32.5%). Similarly the following psychosocial stressors were observed: Fistula (58.75%), limitation of drinking water (47.5%), low quality of life (47.5%), travelling difficulties to the dialysis center (45%), treatment cost (41.5%), and low life expectancy. The stress level was high in women who were married, younger, less dialysis vintage, and belonged to a low education level. Conclusion: This study reports that HD patients have with significant physical and psychosocial problems and they need education, family, and social supports.

Health, safety and environment conditions in primary schools of Northern Iran

Background: People spend a considerable part of their childhood time in the schools, a phase that coincides with their physical and mental growth. A healthy educational environment is vital to students health and wellbeing. Materials and Methods: This study is a descriptive study conducted in 100 primary schools (both state and nonprofit schools) from Saris Districts 1 and 2 in Iran. Sampling was performed by census and data were collected using the standard questionnaire by direct interview. Data were analyzed by Excel and SPSS software (Version 20.0. IBM Corp, Armonk), NY: IBM Corp using independent numerical T2 testing. Results: Significant relationship was observed between the kind of schools (P = 0.045) and their locations (P = 0.024), however the health, safety and environment (HSE) ratings among boys only versus girls only schools were similar (P = 0.159). Interestingly private and nongovernment schools and primary schools from Saris districts one had consistently higher HSE ratings. Conclusion: The differential and higher HSE ratings in primary schools run by Private organizations and primary schools from Saris districts one could be due to managers awareness and implementation of recommended HSE standards, schools neglecting and overlooking these standards had lower HSE ratings. It is necessary that schools with lower HSE ratings are made aware of the guidelines and necessary infrastructures allocated to improve their HSE ratings.

Substance dependence and mental health in northern Iran.

BACKGROUND Today, substance dependence and illegal trading of narcotics is considered as a global issue. Since mental disorder has been reported in about 90% of the substance dependents, this study aimed at determining the rate of mental health in the substance dependents in Sari Township in 2011. MATERIALS AND METHODS In this study, 500 substance-dependent patients were selected using convenience sampling method. To collect data, SCL-90-R was used for the evaluation of their mental health and a demographic questionnaire was employed for identifying their personal information. The obtained data were analyzed by descriptive and inferential statistics using the SPSS software. RESULTS It was found that 90.4% of the participants were susceptible to mental disorder. Most of them suffered from depression, psychoticism, interpersonal sensitivity, anxiety, and paranoia. Also, there was significant relationship between the mental health of single, divorced and married addicts (P < 0.21). CONCLUSION Due to the presence of mental disorder in the substance-dependent patients, it is recommended to help treat them by providing them with education, psychotherapy, and psychiatric medication.

Conservative care in successful treatment of abamectin poisoning

Human intoxication with abamectin is an uncommon but potentially fatal cause of pesticide poisoning. In this study a 42-year-old man was intoxicated with 3600 mg abamectin orally. On admission patient was fully alert with the smell of the poison from the mouth. Vital signs were normal and conjunctiva was hyperemic. Conservative cares such as gastric lavage was performed and charcoal was administered. After 2.5 hours, the patient gradually developed altered mental status as drowsiness, hypotension, tachycardia and dermal erythema. He was treated with H 1 and H 2 blockers and vasoactive agents and after 2 days was discharged in good condition. In comparison with organophosphates, abamectin intoxication has less risk in humans. However, consumption of large amounts in human can be fatal. Altered mental status could be considered as the first sign of abamectin intoxication. Normal level of consciousness is the best indicator of improvement of the condition. Conservative treatment is recommended.

Serum uric acid level in relation to severity of the disease and mortality of critically ill patients

Aim: This study was conducted to evaluate the validity of serum uric acid (UA) in prediction of mortality among patients in the emergency department. Materials and Methods: This is a prospective cohort study which was conducted during 2014. In this study, 120 critically ill patients who required Intensive Care Unit care services were included. For evaluation of severity of the disease, mortality in emergency department score (MEDS) in the first 24 h of admission, the requirement of using mechanical ventilation, taking vasopressor during the hospitalization time and severity of the disease based on MEDS score were measured. The patients were divided into two groups: Patients with serum UA level lower than 7.3 mg/dl and patients with serum UA level of equal or more than 7.3 mg/dl. For comparison of the mortality rate in groups, Chi-square and fisher exact tests were applied. Results: In patients, who needed mechanical ventilation, average of serum UA was 7.82 ± 2.82; however, in the patients who did not need mechanical ventilation this amount was 6.16 ± 2.7, a difference was statically significant. We found a statically meaningful difference between serum UA level with requiring mechanical ventilation and the predictive level of UA 6.95 ± 0.73 (F = 8.52; P≤ 0.004). In the evaluation of MEDS, most patients with serum UA levels lower than 7.3 mg/dl had lower MEDS points (on average 4.6 ± 3.21) in compared to patients with serum UA level higher than 7.3 mg/dl (on average 12 ± 2.99). This difference was found to be statistically significant which indicates the patients whose serum UA was 7.3 mg/dl or higher, were at higher risk of mortality. Conclusion: The serum UA level in the 1st day of hospitalization of a critically ill patient is not an independent indicative factor in relation to mortality. High level of UA reveals critical status of the patient and requires mechanical ventilation.

Myocardial infarction following a bee sting: A case report of Kounis syndrome

In this case report study a 41-year-old man envenomed by a bee sting and diagnosed as Kounis syndrome secondary to hymenoptera envenomation. The patient developed a typical course of myocardial infarction, but the electrocardiogram changes were reversed to almost normal limits. He had a nonsignificant mild lesion in the proximal port of right coronary artery in coronary angiography. The case recovered and discharged after 6 days hospitalization. The clinical implications and pathophysiology of this dangerous association are discussed.

Job burnout and life satisfaction among nurses and midwives of medical institutions in Northern Iran: A cross-sectional study

Background and Aim: Less information is available about the role of job burnout and life satisfaction relationship among nurses and especially midwives in Iran. Therefore, we set out to analyze the relationship between life satisfaction and occupational burnout among Iranian nurses and midwives of medical institutions. Materials and Methods: A cross-sectional survey was conducted in 2013 on 260 subjects in Mazandaran, northern Iran. The questionnaires assessed the socio-demographic characteristics, life satisfaction, and job burnout. Data analyzed by SPSS software through statistical methods such as description and Pearson correlation. Results: The respondents had medium scores in job burnout and in life satisfaction. Subscales of job burnout was significantly and negatively related to life satisfaction scale. Conclusion: Our study reveals that all dimensions of both life satisfaction and burnout syndrome are relevant factors affecting nurses and midwives. We hope that these findings will offer some suggestions for health sector managers to keep their nurses and midwives motivated and stable.