Prophylactic antibiotic for prevention of posttraumatic meningitis after traumatic pneumocephalus: design and rationale of a placebo-controlled randomized multicenter trial [ISRCTN71132784]

BACKGROUND: The purpose of this study is to compare the efficacy of prophylactic antibiotic for prevention of meningitis in acute traumatic pneumocephalus patients. METHODS: In this prospective, randomized controlled clinical trial, 200 selected head injury patients with traumatic pneumocephalus are randomly assigned to receive intravenous antibiotics (2 grams Ceftriaxone twice a day), oral antibiotics (Azithromycin) or placebo for at least 7 days after trauma. The patients will be followed for one month posttrauma. CONCLUSION: The authors hope that this study helps clarifying the effectiveness and indications of antibiotics in prevention of meningitis in traumatic pneumocephalus after head injury and in specific subgroup of these patients

The Relationship between Job Burnout and Quality of Life of Nurses in Khatam-ol-Anbia, Gonbad-e-Kavoos Hospital in 2017

Introduction: Job burnout, in addition to the adverse effects of physical and psychological health and the various dimensions of the quality of personal and professional life of nurses, has a lot of costs for the organization. The aim of this study was to determine the relationship between job burnout and quality of life of nurses. Methods: In this descriptive-analytical study, 175 nurses working in Khatam-ol-Anbia Gonbad-e-Kavous Hospital were included in the study by the available method. The data gathering tool was a three-part questionnaire including demographic information, 26-item quality of life (WHOQOL), and Maslach burnout. The collected data were analyzed using SPSS22 and t test, Chi-Square and analysis of variance tests. Results: The mean age and work experience were 38.34 and 13.81, respectively. In this study, 92.54% of the participants had bachelor degree, 88.81% were married, 62.69% were women, 88.06% were in shift working and 26.12% were in the emergency department. The highest and lowest mean scores of quality of life dimensions were related to physical and environmental health (66.78 and 63.26, respectively). There was a negative correlation between environmental health and overall quality of life with overtime hours (r= -0.193, r= -0.169). The highest and lowest mean scores of occupational burnout dimensions were related to emotional exhaustion and involvement (frequency: 68.7 and 16.4, severity: 75.4 and 19.4). All dimensions of life quality were not correlated with personality frequency and severity of emotional exhaustion. Conclusion: Regarding the inverse relationship between job burnout and quality of life, by presenting and implementing various management solutions and identifying effective factors in improving the quality of life of nurses, job burnout can be reduced which will lead to increase productivity. &nbsp

Factors affecting outcome of primary percutaneous coronary intervention for acute myocardial infarction

BACKGROUND: Primary percutaneous coronary intervention (PCI) is the main treatment for patients with ST-segment elevation myocardial infarction (STEMI). We investigated factors affecting the major complications of this procedure. METHODS: This case-control study assessed 200 patients receiving primary PCI for STEMI. Effects of some factors including age, sex, coronary artery risk factors, left ventricular function, thrombolysis in myocardial infarction (TIMI) flow, and number of involved vessels on major adverse cardiac events (MACE) were studied. RESULTS: Two thirds of patients were male but sex had no significant effect on MACE. Similarly, age, hypertension, and hyperlipidemia did not significantly affect the incidence of MACE. However, Killip class, left ventricular ejection fraction, diabetes, TIMI flow, and type of involved vessels had significant relations with the incidence of MACE. CONCLUSION: According to our findings, factors such as diabetes, left ventricular function, left anterior descending artery involvement, and low TIMI flow are risk factors of MACE. &nbsp; Keywords: Primary Percutaneous Coronary Intervention, ST-Segment Elevation Myocardial Infarction, Major Adverse Cardiac Events&nbsp;</p

Therapeutic effects of diaphragmatic plication for acquired unilateral non-malignant diaphragm paralysis in twenty patients

Background: Acquired paralysis of the diaphragm is a condition caused by trauma, surgical injuries, (lung cancer surgery, esophageal surgery, cardiac surgery, thoracic surgery), and is sometimes of an unknown etiology. It can lead to dyspnea and can affect ventilatory function and patients activity. Diaphragmatic plication is a treatment method which decreases inconsistent function of diaphragm. The aim of this study is to evaluate the outcome of diaphragmatic plication in patients with acquired unilateral non-malignant diaphragmatic paralysis. Methods: From 1991 to 2011, 20 patients with acquired unilateral diaphragmatic paralysis who underwent surgery enrolled in our study in Ghaem Hospital Mashhad University of Medical Science. Patients were evaluated in terms of age, sex, BMI, clinical symptoms, dyspnea score (DS), etiology of paralysis, diagnostic methods, respiratory function tests and complication of surgery. Some tests including dyspnea score were carried out again six months after surgery. We evaluated patients with SPSS version 11.5 and Paired t-test or nonparametric equivalent. Results: Twenty patients enrolled in our study. 14 were male and 6 were female. The mean age was 58 years and the average time interval between diagnosis to surgical treatment was 38.3 months. Acquired diaphragmatic paralysis was mostly caused by trauma (in 11 patients) and almost occurred on the left side (in 15 patients). Diagnostic methods included chest x-ray, CT scan, ultrasonography and sniff. Test prior to surgery the average FVC was 41.4±7 percent and the average FEV1 was 52.4±6 percent and after surgery they were 80.1±8.6 percent and 74.4±1 percent respectively. The average increase in FEV1 and FVC 63.4±4, 61.1±7.8. Performing surgery also leads to a noticeable improvement in dyspnea score in our study. Conclusion: In patients with acquired unilateral non-malignant diaphragm paralysis diaphragmatic plication is highly recommended due to the remarkable improvement in respiratory function tests and dyspnea score without mortality and acceptable morbidity

A Comprehensive Review on Pulp and Paper Industries Wastewater Treatment Advances

The pulp and paper industry generates vast amounts of wastewater, and its character heavily depends on various factors (raw material, the undertaken process, the final product, etc.). The wastewater from this sector, which originates from several sources in each mill and are mostly combined, is polluting and hazardous. This paper presents a state-of-the-art review of the physical, chemical, biological, and advanced hybrid treatment techniques, concerning their effectiveness in removing specific pollutants, namely, chemical oxygen demand, lignin, color, and adsorbable organo-halogens. Throughout the manuscript, at the end of each section, a conclusive comparison has been presented and the proper method is introduced. Furthermore, numeric data regarding the effectiveness of each technique toward each pollutant are gathered from the literature and are available in the Supporting Information of the paper. Biological treatment processes using anaerobic-aerobic treatment mostly cure organic biodegradable contaminants (75-90% COD removal). Moreover, biological treatment using a consortium of microorganisms can potentially increase color removal efficiency (from 65 to 97%). Hybrid treatment is also among the candidates for color removal. To treat complex matters (lignin and AOX), physical and chemical treatments have shown promising performance, but they are generally expensive and impractical to treat huge amounts of wastewater. For the treatment of high molecular weight contaminants (lignin) advanced oxidation processes (AOPs), including ozonation and Fenton-based treatment, have shown great performance (90-99%); however, they are limited due to their maintenance and operation costs. To overcome these challenges, source separation of the wastewater streams in the pulp and paper industry is recommended. AOPs or membrane technologies or hybrid processes are suggested for the bleaching effluent (80% AOX removal), which is relatively low in amount, and a combination of conventional treatment processes would be preferred to treat wastewater streams that are more biodegradable. The biological performance can also be enhanced using granular activated carbon on the sequence. Finally, for treating black liquor, adsorption processes have proven to be the prime candidate