Postgraduate Trainees’ Perception of the Clinical Learning Environment at an Iranian Medical Sciences University

AbstractBACKGROUND and PURPOSE: Clinical learning environment is an influential component of the educational experience. This study measures the learning environment across all of resident physicians at Guilan University of Medical Sciences (GUMS) in Iran by using Postgraduate Hospital Educational Environment Measure (PHEEM), and identifies areas for change to enhance residents experiences. METHODS: This cross-sectional study was conducted at GUMS during summer 2011. The 40-item PHEEM is an evaluation tool consisting of a validated questionnaire with 3 subscales: perceptions of autonomy, social support and teaching which are factors perceived to be influencing the educational environment. The questionnaire was distributed to all residents in clinical wards of university hospitals at GUMS. Collected data were analyzed by using SPSS18 software. RESULTS: Trainees’ perception of clinical learning environment was more positive than negative. There were differences in perceptions of the learning environment between the junior and senior trainees but no significant difference between male and female Trainees in educational environment subscales. CONCLUSIONS: The results revealed that the educational climate was generally perceived positively by trainees and trainees were happy with their teaching, their supports and the work they did. The study also showed problematic components of learning environment in our university hospitals which enabled us to adopt some remedial measures

The Biochemical Outcome of two Treatment Protocols in Patients With Opium-associated Lead Poisoning: A Cross-sectional Study in North of Iran

Background: Lead is a potent toxin that targets heme synthesis and some antioxidant enzymes that induce oxidative stress. Lead exposure remains one of the significant health concerns all over the world. Chelating agents have been used as antidotes for acute and chronic lead poisoning. The present study was conducted to evaluate the biochemical outcome of two different chelating therapies. Methods: This descriptive cross-sectional study was performed in the Razi University Hospital, Rasht, Guilan. Fifty-six patients with a history of opium use were enrolled in the study who were treated symptomatically. Blood lead Llevels (BLL), Hemoglobin (Hb), Red Blood Cell (RBC), White Blood Cell (WBC), urea, creatinine, Alanine aminotransferase (ALT), Aspartate aminotransferase (AST), and Alkaline Phosphatase (ALP) were evaluated before and after treatment. The BLL more than 100μg/dl with clinical symptoms was considered as severe lead poisoning (n=34) who received 4 days of DMPS (2,3-dimercaptopropane-1-sulfonate) injection. Other cases with BLL of 20-100μg/dl were considered as those with mild poisoning (n=22) that were treated with oral D-Penicillamine for 14 days.Results: The mean age of patients was 49.73±14.11 years. Data analysis indicated no significant differences between the groups at baseline regarding the demographic variables. A significant reduction was observed in BLL before and after the intervention using the D-Penicillamine from 75.88±26.22 to 44.3±17.51 μg/dl (P=0.0001). The BLL reduced from 105.5±34.04 to 24.51±24.08 μg/dl after treatment with DMSP (P=0.0001). The levels of ALT, AST, and WBC significantly decreased post-treatment following using D-penicillamine and DMPS (P<0.05). The D-Penicillamine-treated group showed an increase in Hb and RBC (P<0.05).Conclusion: According to the results, penicillamine improves low to moderate lead toxicity. Although DMSP decreases BLL significantly and reverses liver enzymes, further investigations on Hb and RBC, are needed

Investigating the prevalence of antibiotics prescription in the toxicology ward of a referral hospital in the North of Iran

Antibiotic resistance of microorganisms is a serious problem in medicine. One of the most common reasons for this issue is the improper prescription of antibiotics by physicians. The purpose of the study was to investigate the prevalence of using antibiotics in the toxicology ward of Razi Hospital. In this retrospective descriptive cross-sectional study, 338 patients admitted to the toxicology ward of Razi hospital were enrolled from March 2018 until March 2019. A checklist of investigated factors including age, gender, fever, paraclinical findings, type of poisoning, and type of antibiotic prescribed was completed for all patients. About 52.1% of the participants were males and 47.9% were females. The mean age of participants was 37.07 ± 17.36 years. Antibiotics had been prescribed for 49 patients. The most common form of poisoning was benzodiazepines. Also, ceftriaxone was the most common antibiotic prescribed to the patients. Fever existed in 69.4% of the patients receiving antibiotics. The most common paraclinical finding was abnormal complete blood count (CBC) in patients (leukocytosis) which was seen in 83.7% of them. The antibiotics mostly had been prescribed in the first two days of hospitalization. In the present study, antibiotics were prescribed in the toxicology ward for only 14.5% of the poisoned patients. Considering that ceftriaxone has been the most commonly prescribed antibiotic, its use has to be based on clinical evidence based on the necessary indications according to scientifically substantiated sources

Evaluation of demographic status and related factors in mortality of patients suspected of COVID-19 admitted to Razi Hospital in Rasht

Introduction: SARS-CoV2 is the third strain from Corona family with zoonotic roots which has spread among humans from the beginning of this century. We conducted this study to examine mortality and its related factors among all patients admitted to Razi Hospital with suspicion of COVID-19 between February and April 2020. Materials and Methods: In this analytical cross-sectional study,after obtaining permission from the ethics committee under the university’s research deputy, the required information such as demographic data, clinical symptoms and imaging study results was collected by reviewing records of all patients with COVID-19 suspicion. Results: From 1792 cases, 1045 patients were male and 747 patients were female. Mortality was 27% in all patients and 30% and 22% in men and women. The highest hospitalization rate was in the age group of 51-60 years and the highest mortality rate was in the age group of 81-90 years. 1472 patients lived in urban areas and 316 patients in rural areas. 997 patients had 93% O2 Saturation and less, of which 36% died. PCR test was performed for 505 patients, of which 69% were positive. Chest CT scan was performed in 96% of patients and chest X-ray was performed in 66% of patients with COVID-19.The most common symptoms were shortness of breath, cough, fever, chills, weakness, nausea and headache, respectively. The highest mortality was in patients with impaired consciousness at the beginning of hospitalization. Conclusion: The results of the present study showed that male gender, older age, history of underlying disease, Chest x-ray involvement, drug use, shortness of breath and lesser O2 Saturation are associated with adverse outcomes, constitutional and gastrointestinal symptoms are associated with better outcomes in patients with COVID-19

Suicide by Fire Extinguisher Powder Ingestion: A Case Report

A 51-year-old man committed suicide by swallowing the contents of a fire extinguisher. A few hours after his suicide attempt, he was referred to the medical center for poisoning. At the time of admission, the patient was conscious with stable vital signs. The patient complained of burning lips and mouth, mentioning diarrhea. Initial treatments included gastric lavage with activated charcoal, while paraclinical measures were requested. The patient had undergone hypernatremia (Na: 152 mEq/l) and metabolic alkalosis. Treatment focused on the adjustment of sodium level and alkalosis. On the first day of hospitalization, the patient experienced recurrent episodes of tonic-clonic seizure along with the loss of consciousness. On the third day of hospitalization, the patient developed respiratory arrest followed by cardiac arrest and death

Mushroom Poisoning in the Southwest Region of the Caspian Sea, Iran: A Retrospective Study

Background: Mushroom poisoning as a medical emergency can be a challengingproblem for physicians. Despite the vast resources of poisonous mushrooms inIran, few studies have been done in this regard, especially in the southwest regionof the Caspian Sea that is very suitable for mushroom growth. Therefore, the aimof this study was to evaluate our experience with mushroom poisoning in thisregion.Methods: This retrospective study reviewed the records of 102 patients who wereadmitted to the Emergency Department of Razi Hospital of Rasht, the only referraldepartment in this region, from May 2006 to May 2011. Data were analyzed byChi-square test, ANOVA, and student’s t-test.Results: The patients’ age ranged from 13 to 75 years and 47 of them were maleand the rest 55 were female. Overall, 57.8% of mushroom poisoning casesoccurred in patients from urban areas. Most incidences were reported betweenSeptember and October, the rainy season in Guilan. Except for four patients withtachycardia, others had stable vital signs. The most frequent symptoms (86.4%)were nausea and vomiting. Complete blood cell count revealed that 28.4% of thepatients had leukocytosis but all of them had platelet counts of less than 100000.Conclusions: This study showed that all cases had mild to moderate symptomsthat were treated by simple supportive therapies. This suggested that mushroomspecies in our region are less dangerous but further studies need to establish whattoxins and species are responsible for mushroom toxicity

Demographic Information and Clinical and Laboratory Findings in Acetaminophen Poisoning Cases in Rasht, Iran, in 2008

Background: Acetaminophen is widely used as an analgesic and antipyretic drug and it is a frequent cause of acute drug poisoning.This study was carried out to investigate the demographic information and clinical and laboratory findings in acetaminophen poisoning patients referred to “17 Shahrivar” and “Razi” educational hospitals, Rasht. Methods: In this retrospective cross-sectional study, 125 patients with acetaminophen poisoning were studied. Descriptive data were analyzed by SPSS software. Results: 90 of the patients were women and the mean age of the patients was 21.5±9.06 years. Also, 72.8% of the patients were from urban areas and most of the patients (67.2%) lived in Rasht. Spring was the most common season for the incidence of poisoning. Suicide was the most common pattern of poisoning (91.2%). The mean time interval between poisoning and use of antidote N-acetylcysteine was 4.94±3.5 hours. The most common cause of delayed administration of antidote was failure in diagnosis of poisoning. Overall, 31.2% of the patients had no significant clinical manifestations. In other patients, nausea (50.4%) was the most common clinical symptom. The most common abnormal laboratory findings were prolonged prothrombin time and international normalized ratio (29%). Liver aminotransferases were elevated only in 18% of the patients. Conclusion: Poisoning with acetaminophen was mainly found in women, 12-20 years of age, in urban areas and spring season. Suicide was the main reason of poisoning. Regarding the most common cause of delay in antidote therapy (failure in poisoning diagnosis), establishment of a toxicology laboratory in Guilan province can help the better management of poisoned patients

Alteration in Liver Enzymes in Aluminum Phosphide Poisoning, A Retrospective Study

Background: Aluminum phosphide (ALP) or rice tablet is a common agent used as pesticides. It is cheap, widely available and highly toxic and responsible for many cases of poisoning in the agricultural communities. There is limited evidence about change of liver enzymes in patients with ALP poisoning in this region. Therefore, we decided to evaluate alteration of liver enzymes in ALP poisoning in Rasht. Methods: In this retrospective cross-sectional study, all documents of patients with ALP poisoning admitted to Razi hospital of Rasht in 2008-2009 were assessed. Inclusion criteria were diagnostic clinical manifestation such as hypotension or metabolic acidosis, history of exposure to ALP during the past 24 hours and progressive signs and symptoms despite treatment (administration of sodium bicarbonate and vasopressor). Patients with past history of hepatic disease were excluded. Collected data were analyzed with SPSS software. Results: Of 104 patients with ALP poisoning, 66 patients (63.5%) were men. The mean age was 33.8±14.69 years, and the mean time of hospitalization was 14.94±18.28 hours. Ninety-five patients (91.3%) needed ventilation and 93 patients (89.4%) died. Statistical analysis demonstrated that elevated liver enzymes were not significantly related with gender, age, time of admission, time of hospitalization, the need for ventilation and mortality. Conclusion: It seems that liver enzymes changes is not seen widely in ALP poisoning and had lower importance than other complications. Because of limited studies in liver enzyme alterations in these patients, it is suggested that more studies with largee sample size is performed to investigate the ALP liver side effects

The Study of Electrocardiographic Findings in Patients with Organophosphate Poisoning

Background: Cardiac manifestations that occur in a majority of patients with organophosphate (OP) poisoning may range from innocuous electrocardiographic manifestations, such as sinus tachycardia, to life-threatening complications, including cardiogenic pulmonary edema and myocardial necrosis. In this study, we evaluated the various electrocardiographic manifestations in patients with OP poisoning. Methods: This retrospective-descriptive study was performed by reviewing the medical records from all patients poisoned with organophosphate admitted to Razi Educational Hospital, Rasht, Iran, from April 2008 to March 2011. Patients with incomplete records were excluded from the study. Histories of all patients were collected and ECG analysis was conducted including the rate, rhythm, ST-T abnormalities, conduction defects, and measurement of PR and QT intervals by a cardiologist. Descriptive statistical analysis was conducted by SPSS software version18. Results: Of the total 100 patients (75 were male) with OP poisoning that referred to the Emergency Ward of Razi Hospital, 63 patients presented ECG abnormalities. The mean age of the patients was 35.78 ± 12.91 years. The causes of poisoning were occupational in 71 patients, suicidal in 26 patients, and accidental in 3 patients. Sinus tachycardia (31%) was the most common ECG abnormality, followed by non-specific ST-T changes (24%). Overall, mortality rate was 5% and all of the deceased patients presented changes in ECG. Conclusion: OP poisoning is associated with significant ECG abnormalities, especially tachycardia and non-specific ST-T changes

Investigation of associations between ABO blood group and the severity of COVID-19 patients admitted to Razi Hospital

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus is the third strain of coronavirus with a possible zoonotic origin, which has been labeled deadly since the beginning of the new millennium. Due to various factors affecting the morbidity and mortality of coronavirus disease 2019 (COVID-19) and its various clinical syndromes, in this study we examined the relationship between the ABO blood group and the severity of COVID-19 patients. In this cross-sectional study, the required information was obtained by studying all records of patients with COVID-19 admitted to Razi Hospital in Rasht from April to May 2020. Information in patients' records including age, gender, clinical signs, blood type, high-resolution computed tomography (HRCT) findings, and nasopharyngeal tests was collected. In total, 548 cases were studied; of which 305 patients were male and 243 patients were female. The mean and standard deviation of patients' age was 58.15 ± 0.7 years. PCR test was performed for 195 patients. ABO positive/negative blood group was not significantly associated with disease severity in patients with COVID-19. The results of the present study showed that gender, age, history of underlying disease, disease severity, and ABO blood group were not significantly associated with disease severity.