Doctor of Philosophy

dissertationMost humans have difficulty performing precision tasks, such as writing and painting, without additional physical support(s) to help steady or offload their arm's weight. To alleviate this problem, various passive and active devices have been developed. However, such devices often have a small workspace and lack scalable gravity compensation throughout the workspace and/or diversity in their applications. This dissertation describes the development of a Spatial Active Handrest (SAHR), a large-workspace manipulation aid, to offload the weight of the user's arm and increase user's accuracy over a large three-dimensional workspace. This device has four degrees-of-freedom and allows the user to perform dexterous tasks within a large workspace that matches the workspace of a human arm when performing daily tasks. Users can move this device to a desired position and orientation using force or position inputs, or a combination of both. The SAHR converts the given input(s) to desired velocit

Effect of telenursing on quality of life of patients with atrial fibrillation referred to the teaching hospitals in Qazvin

Background: Atrial fibrillation is one of the most common cardiac arrhythmias that occurs 1: 100. Long duration of treatment needs continuous education and follow up that can be achieved by modern nursing techniques such as telenursing. Objective: The aim of this study was to determine the effect of telenursing on quality of life of patients with atrial fibrillation. Methods: This quasi-experimental study was conducted in 100 Patients with atrial fibrillation referred to the teaching hospitals affiliated to Qazvin University of Medical Sciences in 2014. The patients were selected by convenience sampling method and were randomly divided into two groups (intervention and control). In the intervention group, phone calls were made to follow up and to educate patients for 12 weeks. Quality of life was measured before and after the intervention using the SF-36 questionnaire. Data were analyzed using paired T-test, Chi-square test, and T-test. Findings: In the intervention group, the mean quality of life score was significantly increased from 64.88±10.8 before the intervention to 76.14±9.2 after the intervention. In the control group, the mean quality of life score was significantly decreased from 62.6±9.7 before the intervention to 60.05±6.95 after the intervention. Conclusion: With regards to the results, it seems that telenursing can increase the patients’ quality of life and can provide better nursing care. Keywords: Telenursing, Quality of life, Atrial Fibrillatio

Effect of vitamin C on coagulation factors and endothelium function in patients with sepsis

Objective: Sepsis is one of the leading causes of mortality in intensive care unit. Despite advances in its management, its mortality rate remains high. Recently, high dose of vitamin C in sepsis treatment has attracted the attention of researchers. In the current study, the impacts of 25 mg/kg of vitamin C every 6 hours as a bolus for 3 days were assessed in septic patients in intensive care unit (ICU). Methods: This was a prospective cohort study that was performed on adult patients with diagnosis of sepsis. Patients were assigned to control group (administration of placebo) or intervention group, i.e., those receiving a 25 mg/kg dose of vitamin C every 6 hours as a bolus for 3 days. Clinical data were recorded before and after the experiment. Also, plasma levels of antithrombin III, syndecan-1, fibrin degradation product (FDP), D-dimer, and C-reactive protein (CRP) were measured at 0, 24, 48, and 72 hours. Results: In septic patients receiving vitamin C, a significant upregulation of antithrombin III and significant decreases in the levels of syndecan-1 (at 48 hours; P-value=0.046 and at 72 hours; P-value=0.007), D-dimer and CRP were observed compared to the control. Reductions in sequential organ failure assessment (SOFA) score, in-hospital mortality, and ICU length of stay were seen in septic patients receiving vitamin C. Conclusion: Prescribing high dose of intravenous vitamin C can reduce the mortality of sepsis patients and reduce the length of stay in the ICU

20-Day Trend of Serum Potassium Changes in Bam Earthquake Victims with Crush Syndrome; a Cross-sectional Study

Introduction: Many of those who survive following an earthquake die in the next phase due to preventable and treatable medical conditions such as hyperkalemia. The present study aimed to evaluate the trend of potassium changes in crush syndrome patients of Bam earthquake. Methods: In this retrospective cross-sectional study, using the database of Bam earthquake victims, which were developed by Iranian Society of Nephrology following Bam earthquake, Iran, 2003, the 20-day trend of potassium changes in > 15 years old crush syndrome patients was evaluated. Results: 135 crush syndrome patients with the mean age of 29.9 ± 9.91 years were evaluated (56.3% male). Mean potassium concentration during the first 3 days of admission was 5.6 ± 1.3 mEq/L. On the day of admission, 43.1% (95% CI: 34.0 - 52.2) had normal potassium concentration, 3.4% (95% CI: 0.1 - 6.8) had hypokalemia, and 53.4% (44.3 - 62.6) had hyperkalemia. During 20-day follow-up, 62.3% (95% CI: 66.7-71.9) of the patients had normal potassium. While, 11.5% (95% CI: 9.7-13.3) had hypokalemia and 19.2% (95% CI: 17.0-21.5) had hyperkalemia. As the days of hospitalization increased, prevalence of hyperkalemia decreased while hypokalemia increased. On the 17th day 21.2% (95% CI: 2.2-39.9) had hypokalemia and 10.5% (95% CI: 0.1 – 24.7) had hyperkalemia. Conclusion: Findings of the present study showed that following urine alkalinization and fluid resuscitation, the prevalence of hyperkalemia reduced, but hypokalemia developed. It seems that the correction of serum potassium level should be accompanied by precise monitoring of intake and output of the patient and prescription of reasonable amount of intravenous fluid

Intra-articular Along with Subacromial Corticosteroid Injection in Diabetic Patients With Adhesive Capsulitis

Background: To compare intra-articular plus subacromial corticosteroid injection with a single intra-articular injection in diabetics with adhesive capsulitis. Materials and Methods: A total of fifty-four diabetic patients were randomized into corticosteroid injection in both intra-articular and subacromial sites (group A) and one intra-articular injection (group B). Pain by a visual analog scale (VAS), shoulder range of motion, and functional state by the American Shoulder and Elbow Score was assessed before injection, and at follow-up months. Results: The pain VAS scores of group A were considerably lower than group B at the first-month follow-up visit (P=0.01). The range of motion in forward-elevation and internal rotation at three-month follow-up visits was significantly higher in group A than in group B (P=0.035, P=0.04, respectively). No notable differences in the range of motion in forward-elevation, internal rotation, and external rotation between groups at the final follow-up visit were seen. Though a significant difference in the ASES between groups at the third-month follow-up visit (P=0.03), the ASES score at the final sixth-month follow-up was similar in both groups (P=0.7). Conclusion: In diabetic adhesive capsulitis of the shoulder, subacromial combined with intra-articular steroid injections has superior subjective outcomes compared to single intra-articular corticosteroid injection

Efficacy and Safety of Laser Lithotripsy in Pregnancy

Introduction: The aim of our study was to assess the efficacy and safety of laser lithotripsy in pregnant patients.Methods: In this retrospective study, we reviewed the 15 pregnant women who have been treated for ureteral stones with semi-rigid ureteroscope and holmium laser at our center between Januarys 2007and April 2015.Results: The mean age of patients and mean gestational age was 29.3 years old 27.3 weeks respectively. Mean size of stones was 7.84 mm. Twelve patients had renal colic, and hematuria was found in 3 cases. Irritative urinary symptoms such as frequency and urgency detected in 6 ones and 2 patients had fever. The stone of all patients were fragmented by using holmium laser lithotripter. In 5 patients stone residual fragments were removed by grasper while other 10 patients were left to pass fragments spontaneously. No intraoperative and postoperative urological or obstetric complication was seen.Conclusion: Laser lithotripsy is safe and efficacious in pregnant patients who have ureteral stone that does not respond to conservative management

Is preoperative serum creatinine a reliable indicator of outcome in patients undergoing coronary artery bypass surgery?

ObjectiveEvaluating renal function by calculating creatinine clearance as an alternative measure to serum creatinine may give a better estimation of postoperative renal function in patients undergoing coronary artery bypass grafting.MethodsUsing our database, we conducted a retrospective review of the records of all 11,884 patients aged 21 years or older undergoing pure bypass grafting who required cardiopulmonary bypass. Preoperative renal function was categorized as normal renal function (serum creatinine ≤1.1 mg/dL and creatinine clearance > 60 mL/min), occult renal insufficiency (serum creatinine ≤ 1.1 mg/dL and creatinine clearance ≤ 60 mL/min), mild renal insufficiency (1.1 mg/dL < serum creatinine ≤ 1.5 mg/dL and creatinine clearance ≤ 60 mL/min) or moderate renal insufficiency (serum creatinine > 1.5 mg/dL and creatinine clearance ≤ 60 mL/min).ResultsOut of 11,884 patients in the sample, 7856 (66.1%) had normal renal function, and 706 (5.9%) had occult renal insufficiency. The rate of postoperative mortality, renal failure, atrial fibrillation, prolonged ventilation, intra-aortic balloon pump usage, and prolonged hospital stay (>7 days) was higher in patients with occult renal insufficiency than in the normal group in univariable analysis. Multivariable logistic regression analysis demonstrated that patients with occult renal insufficiency compared with the group with normal renal function were at higher risk for mortality (odds ratio = 2.59, 95% confidence interval 1.15–5.86; P = .022) and prolonged hospital stay (>7 d) (odds ratio = 1.30, 95% confidence interval 1.08–1.57; P = .005).ConclusionsTo identify higher-risk patients requiring special intensive care, and in whom new interventions can be performed to improve outcome, we recommend the preoperative calculation of creatinine clearance, especially in older women with a lower body mass index

Evaluation of the Effects of Melatonin Supplementation on Coagulation in Patients with Haemorrhagic Stroke; A Randomized, Double-Blind, Controlled Trial

Introduction: Considering that hemorrhagic stroke patients are at higher risk for bleeding, administration of higher doses of melatonin with a controversial coagulation profile is a serious concern.&nbsp;Objective: This study aimed to investigate the possible effects of high doses of melatonin on bleeding parameters and blood hemostasis in hemorrhagic stroke patients.&nbsp;Methods: This study is a randomized, double-blind, prospective, controlled trial. Confirmed hemorrhagic stroke patients were divided into two groups. Participants were randomly assigned into the melatonin group (30 mg daily via gastric tube gavage for 5 consecutive days) or the control group. Each patient was monitored for 5 days, and 2 blood samples were taken and the effect of the intervention on coagulation factors and blood hemostasis were investigated.&nbsp;Result: In total, 30 patients were randomly assigned to melatonin (n=15) or control groups (n=15). there was no significant difference between the two groups in demographic and clinical characteristics. There was a significant decline in prothrombin time (PT) and fibrinogen levels in the melatonin group (p=0.011 &amp; p&lt;0.001, respectively). P-values for VII and VWB factors showed a significant increment in these two factors in the melatonin group after the intervention (p=0.035 &amp; p=0.002, respectively). No significant changes in serum levels of D-dimer factor, APACHE II, and GCS scores were evident in the two groups after the intervention (p&gt;0.05).&nbsp;Conclusion: Considering the favorable changes in coagulation parameters observed in this study, it could be concluded that melatonin can have both procoagulant and antithrombin properties

A comparative study of Tacrolimus versus Cyclosporine as immunosuppression for kidney transplant recipients

Kidney transplantation is the most common transplantation in the world. Annually, a large number of patients that have chronic renal failure are undergoing renal transplantation and the major subject about these patients is the rejection of graft that should be controlled by immunosuppressive agents.  The aim of this study is investigation of the effect of Cyclosporin against Tacrolimus in patients with kidney transplantation. This study was performing between 2010 and 2012 on all patients who had kidney transplantation and refer to Imam Reza hospital from Kermanshah University of Medical Sciences. 100 patients, aged 18–60 years, with end-stage renal disease were administered either Tacrolimus (n=49) or Cyclosporine (n=51). In both groups, Cellept could be discontinued from day 92 onwards. Corticosteroid treatment comprised methylprednisolone boluses followed by a rapid prednisone taper from 20 mg (day 2) to 5 mg (day 43 and thereafter). Patients followed up 12 months. In the Tacrolimus treatment group, 7 grafts (14%) were lost and 8 (16%) grafts were lost in the Cyclosporine treatment group between months 0 and 12 and there is no significant different between these groups (P= 0.845). No cases were diagnosed with biopsy-proven chronic rejection at months 0 and 12. Mean serum creatinine concentrations were 1.8 ± 1.5 mg/dl in the Tacrolimus group and 2.3 ±2.9 in the Cyclosporine group by month 12 (P= 0.348). these data are consistent with previously published observations and confirm that Tacrolim us is a highly efficacious baseline immunosuppressant for patients undergoing kidney transplantation. Tacrolimus-based immunosuppression may promote long-term benefits with regard to graft functio n and graft survival

Relationship between parenting styles, identity styles and students’ internet addiction in Kerman University of Medical Sciences

Introduction: Improper use of the internet and its subsequent effects has recently started to be considered as an important issue. Students are among the most vulnerable groups regarding this phenomenon. Although internet addiction can be related to different parenting styles, but the use of internet provides an opportunity to seek individual’s identity. Therefore, the present study aimed to investigate the relationship between parenting styles, identity styles and students’ internet addiction in Kerman University of Medical Sciences.Methods: In this descriptive correlational type of research, the study population included all students who were addicted to the internet at Kerman University of Medical Sciences in 2014. The research sample consisted of 375 subjects selected through multi-stage cluster sampling method. All participants completed the questionnaires on internet addiction, parenting and identity styles.Results: Findings showed that among different identity styles, there was a negative correlation between informational identity style and internet addiction. Moreover, there was a positive significant correlation between diffuse/avoidant identity style and internet addiction. Concerning different parenting styles, we could observe a positive significant correlation between permissive parenting style and internet addiction, while there was a negative significant correlation between authoritative parenting style and internet addiction. Additionally, regression analysis results illustrated that students’ internet addiction level could be predicted regarding their identity styles and their parents’ parenting styles.Conclusion: It seems that applying proper parenting styles and providing the requirements of successful identity achievement can lower the incidence of internet addiction