COVID-19 in pediatric patients: A case series

The COVID-19 pandemic outbreak has affected the global health system with an urgent need for more sophisticated studies. One of the prominent aspects of COVID-19 is the picture of the disease in pediatric population. Our case series study includes 4 Babyboy patients in a referral children's hospital with different clinical outcomes

Anesthesia Depth Measurement with Bispectral Index Monitoring during Minor Surgery among Children With and Without Cerebral Palsy

Introduction: Unfortunately, few studies have been performed on the pharmacodynamic effects of anesthesia in children suffering cerebral palsy(CP).Patients were candidates for surgeryfor various reasons. Due to the lower need for anesthesiain these children, side effects of various anesthetic agents, adverse drug reactions, delayed awareness and higher costs can be prevented in these children. The present study aims to evaluate and compare the depth of anesthesia in minor surgeries using Bispectral Index (BSI) in children sufferingCP. Materials and Methods: This cohort study was performed on 64 children aged two to ten years in two groups with and without cerebral palsy inMofid Hospital, Tehran, Iran in 2020. BIS index, mean arterial blood pressure and heart rate were measured before and after anesthesia induction, every ten minutes during operation, after extubation and when being able to respond to verbal stimulation. Results: This studyexamined 64 patients equally divided into two study groups “with and without cerebral palsy”. The mean BIS level in children suffering CP was lower than children without cerebral palsy. The dosage of isoflurane gas used for anesthesia in CPpatientswas meaningfully lower than itsdosage in children without cerebral palsy. Conclusion: Monitoring of anesthesia in this study, showed that use of BIS could reduce the use of anesthetic agents and related side effects to provide the appropriate depth of anesthesia

Associated Factors of In-hospital Outcomes in Emergency Department's Cardiopulmonary Resuscitation; a Cross-Sectional Study

Introduction: Even though the basic principles of cardiopulmonary resuscitation (CPR) are simple, the patients' outcome remains inconsistent. This study aimed to investigate the CPR outcomes and associated factors in the emergency department. Method: This cross-sectional study was conducted on patients who underwent in-hospital CPR following a cardiac arrest in the emergency department for one year. The patient's baseline characteristics and CPR outcomes were recorded from patients' profiles, and the association of patient-related and CPR-related variables with the outcomes was assessed. Results: 220 patients with a mean age of 71.5 ± 16.9 (range: 20-100) years were included (60.5% male). 193 cases of cardiac arrests had occurred in the hospital. Presenting cardiac rhythm in 198 cases (90.0 %) was asystole (not requiring defibrillation). The mean duration of conducted CPR was 43.2 ± 15.6 (5-120) minutes. Only 7 patients (3.2%) achieved the return of spontaneous circulation (ROSC) and were discharged from the hospital, with one suffering from neurological impairment due to CPR. There was a significant association between age (p = 0.047), consciousness status at admission (p = 0.003), presenting cardiac rhythm at CPR initiation (p = 0.0001), and establishment of ROSC under 45 minutes (p = 0.043) with patients' outcomes. Presenting cardiac rhythm at CPR initiation (p = 0.001), ROSC under 45 minutes (p = 0.012), and consciousness status at admission (p = 0.027) were independent predictive factors of survival. The area under the ROC curve for presenting cardiac rhythm and ROSC under 45 minutes was 0.817 (95% CI: 0.617-1.000) and 0.805 (95% CI: 0.606-1.000), respectively. Conclusion: Based on the present study's findings, the survival rate of patients after CPR in ED was 3.2%. Presenting cardiac rhythm, ROSC under 45 minutes, and consciousness status at admission was among the independent predictors of mortality

Intra-Operative Adjunctive Magnesium Sulfate in Pain Management of Total Knee Arthroplasty; a Systematic Review and Meta-analysis

Introduction: There has been growing interest in the potential role of adjunctive magnesium sulfate in improving pain management. This systematic review and meta-analysis aimed to assess the effect of intra-operative adjunctive magnesium sulfate on pain management and opioid consumption in total knee arthroplasty (TKA). Methods: A comprehensive search was conducted in Medline, Embase, Scopus, Web of Science, and Cochrane Library databases, covering studies up to April 2023. The extracted data included pain management outcomes, opioid consumption, and adverse effects from the selected studies. Standardized mean differences (SMDs) were calculated for continuous outcomes, while risk ratios (RRs) were calculated for dichotomous outcomes. Meta-analysis was conducted employing random-effects models in STATA 17. Results: In this meta-analysis of 8 randomized controlled trials involving 536 patients, adjunctive magnesium sulfate in TKA was found to significantly reduce opioid consumption during the first 24 hours after operation (SMD: -1.88, 95% confidence interval (CI): [-3.66 to -0.10]; p = 0.038). It also resulted in lower pain scores at rest 24 hours after surgery (SMD: -1.53, 95% CI: [-2.70 to -0.37]; p = 0.010). There were no significant differences in time to first rescue analgesic and adverse effects between the groups. The included studies were assessed to have low to high levels of risk of bias. Conclusion: This study presents evidence at low to moderate levels supporting the use of intra-operative adjunctive magnesium sulfate in TKA for improved pain management and reduced opioid consumption. However, further research is needed to address the heterogeneity and to explore optimal dosing regimens and routes of administration to maximize the benefits of magnesium sulfate in TKA

بررسی ارزش تشخیصی تست تشخیص سریع SARS-CoV-2 در تشخیص بیماران مبتلا به کووید-19

Title: Evaluation of diagnostic value of SARS-CoV-2 rapid diagnostic test in patients with Covid-19 Introduction: The standard RT-PCR test is a time-consuming diagnostic test with difficult accessibility and high cost, so in order to early diagnose and prevent the spread of Covid-19 disease, access to a quick, inexpensive diagnostic test with easy access is essential. This study aimed to evaluate diagnostic value of SARS-CoV-2 rapid diagnostic test in patients with Covid-19. Materials & Methods: The present study is a cross-sectional study in type of diagnostic value that was performed on 188 patients with symptoms of Covid-19 referred to the emergency department of Imam Hossein and Shohadaye Tajrish hospitals in Tehran. In this study, SARS-CoV-2 rapid diagnostic test was performed immediately after sampling and according to the manufacturer's instructions (reading in 10 minutes). Then chest CT scan was performed less immediately after collecting samples to compare with the results of rapid antigen detection test. Data were collected and analyzed using Spss software V.26 and descriptive-mean and Chi-square statistical tests. Results: Results showed that out of 83 patients who were diagnosed with Covid-19 positively based on rapid diagnostic test, all of them (100%) were also positive based on chest CT scan results, and out of 100 patients diagnosed Covid-19 negative based on rapid diagnostic test, 42 patients (42%) were true negative and 58 were positive base of chest CT scan results. The sensitivity of the rapid diagnostic test compared to chest CT scan was 100%, its specificity was 42%, its positive predictive value was 58.86% and its negative predictive value was 100%. Conclusion: Due to the high accuracy and rapid diagnostic of rapid diagnostic test (SARS-CoV-2), this test is a valid and reliable tool for rapid diagnosis of Covid-19 disease in emergency cases.Introduction: Rapid antigen tests have gained importance during the COVID-19 pandemic due to low prices and availability. The present study investigated the performance of the SARS-CoV-2 rapid diagnostic test in diagnosing patients with COVID-19 referred to the emergency department. Method: In this diagnostic accuracy study, patients with suspected COVID-19 referred to Imam Hossein and Shohadaye Tajrish Hospitals, Tehran, Iran, were examined. All patients were subjected to a rapid corona test according to the manufacturer's guide and a chest computed tomography (CT) scan as the standard test. The screening characteristics of the rapid test compared to CT scan were calculated and reported. Results: 183 people with an average age of 46.83 ± 14.26 (range: 21-83) years entered the study. 141 suspected cases of COVID-19 (77%) had evidence of lung involvement in CT, and the rapid test was positive in 83 (45%) cases. Out of 83 patients who tested positive for COVID-19, all (100%) had positive chest CT findings. Out of the 100 patients who tested negative, 42 patients (42%) had negative chest CT findings, and 58 patients (58%) had positive CT scans. The sensitivity, specificity, and accuracy of the mentioned test were 58.86, 100.00, and 68.30 percent, respectively. Conclusion: Due to the relatively low sensitivity, the Rapid SARS-CoV-2 antigen test fails to screen for SARS-CoV-2 infection. However, it can be used to confirm the presence of the disease in symptomatic individuals and reduce virus transmission during the COVID-19 pandemic

Failure Mode and Effect Analysis in Increasing the Revenue of Emergency Department

Introduction: Successful performance of emergency department(ED) is one of the important indications of increasing the satisfaction among referees. The insurance of such successful performance is fiscal discipline and avoiding from non-beneficial activities in this department. Therefore, the increasing revenue of emergency department is one of the interested goals of hospital management system. According to above-mentioned, the researchers assessed problems lead to loss the revenue of ED and eliminate them by using failure mode and effects analysis (FMEA).Methods: This was the prospective cohort study performed during 18 months, set in 6 phases. In the first phase, the failures were determined and some solutions suggested to eliminate them. During 2-5 phases, based on the prioritizing the problems, solutions were performed. In the sixth phase, final assessment of the study was done. Finally, the feedback of system’s revenue was evaluated and data analyzed using repeated measure ANOVA.Results: Lack of recording the consuming instrument and attribution of separate codes for emergency services of hospitalized patients were the most important failures that lead to decrease the revenue of ED. Such elimination caused to 75.9% increase in revenue within a month (df = 1.6; F = 84.0; p<0.0001).  Totally, 18 months following the eliminating of failures caused to 328.2% increase in the revenue of ED (df = 15.9; F = 215; p<0.0001).Conclusion: The findings of the present study shows that failure mode and effect analysis, can be used as a safe and effected method to reduce the expenses of ED and increase its revenue

تعیین کارایی روش "حالات شكست و تحليل آثار آن" در ارتقاء درآمد بخش اورژانس

Introduction: Successful performance of emergency department(ED) is one of the important indications of increasing the satisfaction among referees. The insurance of such successful performance is fiscal discipline and avoiding from non-beneficial activities in this department. Therefore, the increasing revenue of emergency department is one of the interested goals of hospital management system. According to above-mentioned, the researchers assessed problems lead to loss the revenue of ED and eliminate them by using failure mode and effects analysis (FMEA).Methods: This was the prospective cohort study performed during 18 months, set in 6 phases. In the first phase, the failures were determined and some solutions suggested to eliminate them. During 2-5 phases, based on the prioritizing the problems, solutions were performed. In the sixth phase, final assessment of the study was done. Finally, the feedback of system’s revenue was evaluated and data analyzed using repeated measure ANOVA.Results: Lack of recording the consuming instrument and attribution of separate codes for emergency services of hospitalized patients were the most important failures that lead to decrease the revenue of ED. Such elimination caused to 75.9% increase in revenue within a month (df = 1.6; F = 84.0; p<0.0001).  Totally, 18 months following the eliminating of failures caused to 328.2% increase in the revenue of ED (df = 15.9; F = 215; p<0.0001).Conclusion: The findings of the present study shows that failure mode and effect analysis, can be used as a safe and effected method to reduce the expenses of ED and increase its revenue.مقدمه: عملکرد موفق بخش اورژانس هر بیمارستان از شاخص های مهم افزایش رضایتمندی در دریافت کننده گان خدمات می باشد. ضامن حفظ این عملکرد موفق انضباط مالی و پرهیز از زیان ده بودن این بخش از نگاه اقتصادی است. بنابراین درآمد بخش اورژانس یکی از معیارهای عملکرد موفق این بخش از نگاه سیستم مدیریتی بیمارستان است. بر این اساس محققین پژوهش حاضر اقدام به بررسی میزان درآمد بخش اورژانس با بکارگیری روش FMEA نمودند. روش کار: مطالعه حاضر یک پژوهش کوهورت آینده نگر با پیگیری 18 ماهه می باشد که در 6 فاز تنظیم گردید. در فاز اول با استفاده از روش حالات شکست و تحلیل آثار آن اقدام به شناسایی نواقصی شد که موجب کاهش درآمد بخش اورژانس می گردید و سپس راهکارهایی برای رفع آن پیشنهاد گردید. در فازهای 2 تا 5 مطالعه بر اساس اولویت بندی مشکلات، اقدام به اجرای راهکارهایی به منظور رفع نواقص گردید. فاز ششم نیز ارزشیابی نهایی مطالعه در نظر گرفته شد. در پایان هر ماه بازخورد درآمد سیستم ارزیابی شد و با استفاده از آزمون Repeated measure ANOVA اقدام به آنالیز داده ها گردید. يافته ها: عدم ثبت وسیله مصرفی و عدم تخصیص کد‎نهایی جداگانه برای خدمات اورژانس در بیماران بستری شده مهمترین نواقصی بود که باعث کاهش درآمد اورژانس گردید. رفع این نواقص باعث افزایش 75/9 درصدی در درآمد بخش اورژانس طی یکماه گردید (0/0001>p؛ 84/0=F؛ 6؛1=df). در کل طی 18 ماه پیگیری رفع نواقص موجب افزایش 328/2 درصدی در درآمد بخش اورژانس شد (0/0001>p؛ 215=F؛ 90، 15:df). نتيجه گيری: یافته های پژوهش حاضر نشان داد مدل حالات شکست و تحلیل آثار آن، میتواند به عنوان روشی مطمئن و کارا در کاهش هزینه ها بخش اورژانس و افزایش درآمد آن مورد توجه قرار گیرد