The Effect of the Type of Hemodialysis Buffer on the QTc Interval in Patients on Chronic Hemodialysis

Background: Identifying the sources of variation in QTc measurementsis important for preventing arrhythmias during and afterhemodialysis. The present study was designed to determine thecorrelation between the type of hemodialysis buffer and thechanges in QTc interval in patients on chronic hemodialysis.Methods: Fifty-nine patients on chronic hemodialysis whoreferred in winter 2007 to hemodialysis centers of Ghaem andHashemi Nejad hospitals, in Mashhad, Iran, were divided intotwo groups according to their last dialysate buffer: acetate orbicarbonate. Electrocardiography, arterial blood gas parameters,serum K+, Na+, ionized calcium, and albumin levels weremeasured prior to and after hemodialysis in all patients.Results: All arterial blood gas parameters and serum electrolytesconcentrations were increased except K+ levels that weresignificantly decreased with hemodialysis. PCO2 and QTc intervalswere slightly increased in all patients, however thisincrease was not statistically significant. We found that thetype of dialysate affected the QTc interval, HCO3, base excess,base excess of extra cellular fluid, and base bufferchanges with no effect on ionized calcium, pH, PCO2, andserum albumin concentration. QTc interval was prolonged byusing bicarbonate and shortened by using acetate dialysatebuffer. We found no correlation between the variations of QTcinterval and serum electrolytes or arterial blood gas parametersin either group.Conclusion: Bicarbonate buffer use in hemodialysis prolongedQTc interval and acetate buffer shortened it. This effectis independent of serum electrolytes and pH changes duringhemodialysis. The effect of bicarbonate buffer is probablydue to more tolerability of ultra filtration, more effectiveedema reduction and augmented body electro-conductivity

Sex difference in clinical outcome of patients with implantable cardioverter-defibrillator

Background: Indications for the use of the Implantable Cardioverter-Defibrillator (ICD) have been greatly expanded in recent years, but the influence of sex on the efficacy of the ICD in eligible patients has still been remained unknown. Objectives: The aim of this study was to determine the impact of sex on the effectiveness of the ICD intervention for mortality and appropriate events. Materials and Methods: This retrospective study was conducted on the outcome of the ICD therapy in 443 patients, including 341 men with a mean age of 55 ± 16 years and 102 women with a mean age of 54 ± 17 years, in our center between April 2001 and February 2007. Sex-specific cumulative probabilities of outcomes concerning mortality and appropriate ICD intervention were evaluated for the patients. Results: Among the 443 patients, enrolled in this study, the women and men had a mean left ventricular ejection fraction of 35 ± 14.8% and 30 ± 13.5%, respectively (P = 0.03). Ischemic heart disease was more frequent in the men than the women (P = 0.0001).The average follow-up period was 3 years. Test for an interaction between sex and the ICD treatment regarding total mortality was not significant (23 men and 6 women). Additionally, there was no significant difference in appropriate events between the women and men (129 men and 33 women). Conclusions: While women were significantly less likely than the men to receive the ICD therapy, no conclusive evidence could be found for the impact of sex factor on the effectiveness of the ICD intervention with respect to mortality and appropriate events

Non-administration of thrombolytic agents in acute myocardial infarction patients in Hajar hospital, Shahrekord, Iran: prevalence rate and causes

BACKGROUND: Cardiovascular diseases are the major causes of mortality worldwide and acute myocardial infarction (AMI) is the leading cause of mortality among cardiovascular diseases. Thrombolytic therapies, especially during the first few hours after the disease onset, can significantly reduce AMI-related mortality. METHODS: The current study aimed to determine the prevalence and causes of non-administration of thrombolytic therapy for AMI patients admitted to Hajar Hospital, Shahrekord, Iran, from May until November 2000. Non-probability convenient sampling method was used to select 106 subjects with Q-wave AMI. Data was collected by completing a questionnaire, reviewing medical records, and interviewing with patients. SPSS7.5 was for data analysis. RESULTS: A total number of 106 AMI patients were studied among whom 62 (59%) individuals received thrombolytic therapy. Delayed referral to the hospital was the major cause of failure to provide thrombolytic therapy. The cause of non-treatment could not be identified in 15 (19.5%) subjects eligible to receive therapy. CONCLUSION: Training general practitioners and individuals involved in this regard along with accelerating the process of patient referral to hospitals can reduce AMI-related mortality. &nbsp; Keywords: Acute Myocardial Infarction, Thrombolytic, Therapy</div

Role of lactate level in predicting admission need to intensive care unit and short term outcomes in patients with acute gastrointestinal bleeding

Abstract Background One of the most common emergencies seen in emergency departments is acute gastrointestinal bleeding (GIB). It’s associated with more disease burden and mortality. Increased venous lactate levels are common in critically ill patients, and it has been used as a possible predictor of patients’ outcomes in many critical cases, but not much is known about its predictive role in patients with acute GIB. With increasingly limited health care resources, there has been such an interest in coast saving measures and measuring lactic acid through venous blood gases is such a simple bedside test which can be easily done to patients with acute GIB at emergency department. Objective This study assessed the predictable value of lactate level on hospital admission on resource use, including length of hospital stay and admission to the intensive care unit (ICU), as well as other patient-oriented outcomes, including the need for blood transfusions and endoscopy. Patients and methods A prospective cohort hospital based study that included 300 patients with acute GIB who presented to emergency department (ED) of Assiut University Hospital between September 2019 and June 2022 were subjected to venous blood lactate through venous blood gases. Results The current study enrolled 300 patients with acute GIB. Two hundred of those patients had elevated blood lactate and 100 patients had normal blood lactate. It was found that patients with elevated blood lactate had significantly prolonged hospital stay (7.38 days ± 2.05 days vs. 3.96 days ± 1.74 days; (P < 0.001). Also they had higher frequency of blood transfusion (98% vs. 72%), ICU admission (95% vs. 67%) and mortality (9% vs. 3%) in comparison to those with normal lactate level. Conclusion It was found that venous lactate level is an effective predictor for patient’s outcomes among patients with acute GIB

The roles of the nurses in family physician team: A qualitative systematic review

Background: There are various approaches in primary health care regarding the key role of nurses. This systematic review investigates the roles of nurses, as part of the family medicine team. Materials and Methods: All published articles related to the role of nurses in the family medicine team from January 2000 to March 2022 were the subjects of this study. The eligibility criteria included original articles published in English or Persian in the last two decades. International credible scholarly databases (PubMed, Scopus, Magiran, IranMedex, and SID) were searched using keywords and syntax. Some of the keywords included “Family Health Nurse,” “Nurses in Primary Care,” “Family Medicine,” “Family Physician Care Program,” “General Physician Program,” “Role,” and “Nurse.” Data were extracted based on Sample, Phenomenon of Interest, Design, Evaluation, Research type (SPIDER) technique and reported based on the structure of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Results: Of 147 identified publications by the search strategy, eight eligible empirical studies were included. The results showed that besides providing nursing care, nurses play vital roles in communication and teamwork, assessment, securing health services relevant to communities' needs, education, empowerment, clinical practice, health promotion, prevention, reflective research practice, and counseling. Conclusions: This study identified different roles nurses could play in providing primary health care. These findings are helpful for the replanning or reform of primary health care in countries, which aimed to expand the Family Physician Program (FPP) in their countries, including Iran

Depression, Anxiety, and Stress Among Patients with COVID-19: A Cross-Sectional Study

© 2021, The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG. Aim: Patients with confirmed COVID-19 infection can develop several psychological consequences. Epidemiological data on mental health and psychological disorder inpatients infected with COVID-19 pneumonia are not available in Iranian patients. The purpose of this study was to evaluate the anxiety, stress, and depression of patients with COVID-19. Material and Methods: This cross-sectional survey was conducted in 2020. All confirmed patients with COVID-19 were included in the study by census sampling. Assessment of depression, stress, and anxiety was performed using the DASS-21 questionnaire. All statistical analyses were performed using R version 3.5.1. Results: The questionnaires were completed by 221 patients with COVID-19 infection (204 males, 17 females). The mean age was 45.90 ± 7.73 years. Our results indicated that the mean scores of depression and anxiety were at “extremely severe” levels, while stress levels were “severe.” The prevalence of “extremely severe” symptoms of depression and anxiety was 54.29% and 97.29%, respectively. The prevalence of severe stress was 46.61%. Conclusion: In this study, patients infected with COVID-19 reported severe and extremely severe experience psychological distress. Further studies should focus on the combined use of psychological and molecular biomarker testing to increase accuracy. Overall, the findings demonstrate the necessity of special intervention programs for the confirmed patients with emerging infectious disease COVID-19 to promote mental health needs

Applying Multivariate Analysis and Machine Learning Approaches to Evaluating Groundwater Quality on the Kairouan Plain, Tunisia

In the Zeroud basin, a diverse array of methodologies were employed to assess, simulate, and predict the quality of groundwater intended for irrigation. These methodologies included the irrigation water quality indices (IWQIs); intricate statistical analysis involving multiple variables, supported with GIS techniques; an artificial neural network (ANN) model; and an XGBoost regression model. Extensive physicochemical examinations were performed on groundwater samples to elucidate their compositional attributes. The results showed that the abundance order of ions was Na+ > Ca2+ > Mg2+ > K+ and SO42− > HCO3− > Cl−. The groundwater facies reflected Ca-Mg-SO4, Na-Cl, and mixed Ca-Mg-Cl/SO4 water types. A cluster analysis (CA) and principal component analysis (PCA), along with ionic ratios, detected three different water characteristics. The mechanisms controlling water chemistry revealed water–rock interaction, dolomite dissolution, evaporation, and ion exchange. The assessment of groundwater quality for agriculture with respect IWQIs, such as the irrigation water quality index (IWQI), sodium adsorption ratio (SAR), sodium percentage (Na%), soluble sodium percentage (SSP), potential salinity (PS), and residual sodium carbonate (RSC), revealed that the domination of the water samples was valuable for agriculture. However, the IWQI and PS fell between high-to-severe restrictions and injurious-to-unsatisfactory. The ANN and XGBoost regression models showed robust results for predicting IWQIs. For example, ANN-HyC-9 emerged as the most precise forecasting framework according to its outcomes, as it showcased the most robust link between prime attributes and IWQI. The nine attributes of this model hold immense significance in IWQI prediction. The R2 values for its training and testing data stood at 0.999 (RMSE = 0.375) and 0.823 (RMSE = 3.168), respectively. These findings indicate that XGB-HyC-3 emerged as the most accurate forecasting model, displaying a stronger connection between IWQI and its exceptional characteristics. When predicting IWQI, approximately three of the model’s attributes played a pivotal role. Notably, the model yielded R2 values of 0.999 (RMSE = 0.001) and 0.913 (RMSE = 2.217) for the training and testing datasets, respectively. Overall, these results offer significant details for decision-makers in managing water quality and can support the long-term use of water resources