Evaluation of parenteral nutritional support in the surgical and medical wards of a referral teaching hospital

BACKGROUND AND PURPOSE: Malnutrition is a common problem in patients who are hospitalized in surgical and medical wards. Surgical patients, geriatric populations and individuals with severe illness are more vulnerable to malnutrition during their hospitalization course. The purpose of this study was evaluation of parenteral nutrition services in a referral teaching hospital, Tehran, Iran. METHOD: Medical records of 72 patients who received parenteral nutrition during one year period in different surgical and medical wards of Imam Khomeini hospital were reviewed retrospectively by clinical pharmacists. Criteria for initiation of parenteral nutrition, selection of appropriate formulation and monitoring parameters were assessed based on the American Society of Parenteral and Enteral Nutrition recommendations. RESULTS: Based on the patients' anthropometric parameters and serum albumin levels, 4.2%, 75% and 20.8% of the patients were well-nourished, moderately malnourished and severely malnourished respectively at the hospital admission and before nutritional support. Adequate calorie, protein, carbohydrate and lipid supports were achieved in 21.1%, 32.4%, 23.7% and 10.5% of the patients respectively. About 91% of the patients experienced at least one complication of the nutritional support. CONCLUSION: In this evaluation, several errors in assessment, establishing goals, and monitoring of parenteral nutrition regimens have been detected. Approximately all of the patients did not receive to the trace elements supports goals

Investigating the mental health status of infertile women

Letter to Editor The stressful experience of infertility is associated with a wide range of psychological damage (1), so infertility affects people’s mental health and all aspects of an individual’s life (2). Since women in the family are considered to be the main pillars of the community and they are also more vulnerable to illnesses, therefore consideration of their health is also very important (3). The objective of the current letter is investigating the mental health status of infertile women and its related factors as predictors of mental health ininfertile women. This is a descriptive study conducted on 100 infertile women referred to the infertility treatment centers in Mazandaran province, North of Iran. The General Health Questionnaire was provided to the infertile women. The questionnaire is a self-reporting questionnaire that is used clinically to track those who are prepared for mental illness(4).Based on the findings, Total Scale of General Health Questionnaire was 33.18 ± 10.27 that was according to the cut-off point of 22, 85% of the infertile women in this study are in the disorder condition. Also, in terms of subscales: physical complaints was 8.65 ± 3.97, anxiety and insomnia was 8.69 ± 5.58, disruption of social function was 12.73 ± 3.34, and depression was 3.10 ± 3.79. The most common disorder was related tosocial disorder subscale and the least common subscale was related to the depressiondisorder. The subscales of physical symptoms and sleep disturbance and anxiety areranked almost at one level, and they are classified between the two subscales that werealready mentioned. Therefore, based on our findings and the level of women’s mental health, there isa need for a psychologist or midwifery counselor in the infertility treatment centers to improve the mental health of women. In addition, since the mental disease may also affect the outcome of the treatment, attention to the mental health of infertile women is really importance

The efficacy of group counselling on perceived stress among infertile women undergoing in vitro fertilization treatment: An RCT

Background: One of the stressful and critical experiences that threat the individual, family, marital, and social stability is infertility. Objective: To identify the effects of midwifery-led counselling programs on the perceived stress of the women undergoing assisted reproductive treatment. Materials and Methods: In this randomized clinical trial, 50 infertile women who underwent in vitro fertilization treatment for the first time were enrolled in two groups. The intervention group received six sessions of group counselling by M.Sc. midwifery of counseling student and the control group received only the routine care. All participants filled Newton’s standard questionnaire before and at the time of puncture, embryo transfer and the pregnancy test. Results: The mean ± SD scores for the perceived infertility stress before the intervention in the control and the intervention groups were 167.92 ± 12.14 and 166.75 ± 13.27, respectively. The mean of perceived stress after intervention at the time of oocyte puncture in the control and case group were 177.12 ± 19.37 and 115.75 ± 13.88, at the time of embryo transfer were 179.40 ± 18.34 and 118.08 ± 15.37, and at the time of pregnancy test was 183.76 ± 14.97 and 120.50 ± 16.24, respectively. The perceived stress of infertility after intervention were statistically significant in the two groups (p ≤ 0.001). Conclusion: Group counselling is one of the effective methods for reducing the perceived stress in women undergoing assisted reproductive treatment. Key words: Infertility, Group counselling, Perceived infertility stress

Relationship between coping/attachment styles and infertility-specific distress in Iranian infertile individuals: A cross-sectional study

Background: Infertility has been recognized as a stressful clinical condition, significantly affecting couples’ emotional functioning. Objective: To investigate the relationship between coping/attachment styles and infertility-specific distress (ISD) in infertile participants. Materials and Methods: A total number of 240 infertile participants (120 women and 120 men) who attend the Outpatient Infertility Clinic in Sari, Iran between February and October 2017 were selected using the convenience sampling method. Data were collected using a questionnaire addressing sociodemographic variables. In addition, coping and attachment styles were evaluated via the Coping Strategies Questionnaire and the Revised Adult Attachment Scale by Collins and Read (1990); respectively. Ultimately, the Infertility Distress Scale was used to assess ISD. Results: The mean ISD score was 42.53 ± 9.63. Secure and insecure attachment styles were observed in 37.9% and 62.1% of the cases, respectively. There was a significant difference among ISD and different groups of attachment styles (p = 0.001) and emotion-focused coping style (p = 0.021). However, no significant relationship was found between problem-focused coping style and ISD (p = 0.985). Conclusion: Considering the relationship between coping/attachment styles and ISD, it was recommended to implement stress prevention and coping education within the framework of coping/attachment theories for infertile individuals. Key words: Infertility, Attachment, Copying, Distress

Adherence to Empiric Antibiotic Therapy Guideline in a Referral Teaching Hospital, Tehran, Iran

Antibiotic guidelines have proven to be a simple and effective intervention to guide the choice of appropriate empiric antibiotic regimens. The goals of this study were to evaluate adherence to guidelines and streamlining of antibiotics. Hospital records of hospitalized patients in infectious diseases ward Imam Khomeini Hospital, Tehran, Iran, from May 2008 to September 2009 were reviewed. Adherence to guideline was defined as the use of empiric antibiotic in accordance with the clinical diagnosis and local guideline recommendations. In this study, 528 patients with a confirmed infectious disease diagnosis were considered for analysis. The four most frequent diagnoses were skin and soft tissue infections, tuberculosis, respiratory tract infections, and HIV associated opportunistic infections. The most frequent prescribed antibiotic was ceftriaxone. Overall adherence to guideline was 70.8% and the adherence for the most frequent diagnosis was 68%. Frequency of compatibility with the guidelines for were administrated regimes on the basis of drug selection, dosage form and drug dosing were 86.2%, 97% and 84.7%, respectively. The mean lag time between patients' hospital admission and starting empiric therapy was 1.69±4.9 days. In general, physicians' adherence with guidelines for empiric antibiotic therapy was high in infectious disease ward with a justified delay. Larger studies are required to establish these conclusions

Evaluation of the Correlation between the rs4918 Polymorphism of AHSG Gene and Coronary Artery Calcification in Patients with Coronary Artery Disease

Objectives: Fetuin-A is a circulating calcification inhibitor that prevents coronary artery calcification (CAC) by increasing calcium phosphate solubility and inhibiting VSMC differentiation and apoptosis. In this study, we investigated the correlation between rs4918 and CAC in patients with coronary artery disease (CAD). Methods: Forty-two healthy individuals and eighty-one CAD patients were recruited in the present study. The CAC score (CACS) was measured by CT angiography and the genotype analysis of rs4918 single-nucleotide polymorphism SNP was performed by the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) technique. Results: The CACS was significantly higher in CAD patients compared to healthy individuals (p < 0.001); however, there was no significant difference between the mean CACS in the presence and absence of rs4918 (p = 0.792). The mean calcium score of the left main coronary artery (LMCA) was significantly lower in carriers of the rs4918 allele (p = 0.036). The frequency of rs4918 SNP was almost similar in the control group and CAD patients (p = 0.846). Conclusions: in patients with CAD, we found no significant association between rs4918 SNP and CACS, indicating that carriers of this allele are not at increased risk of developing cardiovascular diseases compared with those without

The Role of Antioxidants in the Management of Obsessive-Compulsive Disorder

Obsessive-compulsive disorder (OCD) is a chronic neuropsychiatric disorder that has a significant effect on the quality of life. The most effective treatment for OCD is the combination of selective serotonin reuptake inhibitors (SSRI) with cognitive behavior therapy (CBT). However, several adverse effects have been linked with this usual pharmacotherapy, and it is unsuccessful in many patients. The exact pathophysiology of OCD is not completely known, though the role of oxidative stress in its pathogenesis has been proposed recently. This review presents an overview of animal and human studies of antioxidant treatment for OCD. The use of antioxidants against oxidative stress is a novel treatment for several neurodegenerative and neuropsychiatric disorders. Among antioxidants, NAC was one of the most studied drugs on OCD, and it showed a significant improvement in OCD symptoms. Thus, antioxidants could be promising as an adjuvant treatment for OCD. However, a limited number of human studies are conducted on these agents, and for better judgment, human studies with a large sample size are necessary

Complex factors related to marital and sexual satisfaction among couples undergoing infertility treatment: A cross-sectional study

Objectives: This study assesses complex factors related to marital and sexual satisfaction among couples undergoing infertility treatment. Methods: This cross-sectional study was conducted with 140 couples who visited fertility centers in Iran, between September 2015 and July 2016. Data collection was done by Marital and Sexual Satisfaction Questionnaires and were analyzed by the IBM SPSS 26 software. Results: There was a significant difference between wives and husbands in the MSQ total scores (p = 0.027). However, there was no significant difference between wives and husbands in the SSQ total scores (p = 0.398). Sexual satisfaction and decision-maker in life among wives and husbands were significant predictors of MSQ. The kind of treatment, cause of infertility and BMI among wives and kinds of treatment, cause of infertility, and decision-maker among husbands were also significant predictors of SSQ. Conclusion: The findings of this study showed that there is a difference between the understanding of marital and sexual satisfaction in wives and their husbands. Healthcare providers need to pay more attention to these differences

Prospective Drug Use Evaluation of Meropenem in a Teaching Referral Hospital, Mashhad, Iran

Introduction: Inappropriate use of antibiotic, leads to microbial resistance, nosocomial infections and increased hospital costs. Therefore, it is necessary to control and evaluate the use of these medications, especially broad-spectrum antibiotics. This study evaluated the pattern of meropenem utilization in Imam Reza hospital, Mashhad, Iran. Methods: First, a guideline for proper indications of meropenem was designed and finalized based on the clinical pharmacists and infectious disease specialist’s comments. One hundred patients were chosen randomly from different wards of the hospital and their data were recorded in predesigned questionnaires. Then, the pattern of meropenem consumption was analyzed according to the guideline. Results: This study was performed in 100 patients, including 48 women and 52 men. In 13 cases (13%), patients had no approved indication for meropenem. The initial regimens were changed in 6 cases (6%) based on culture results and in 73 cases (73%) relied on clinical response. In 64 cases (64%), administrated doses were compatible with prepared guideline. Renal dose adjustment was acceptable based on guideline only in 30% of patients with renal impairment (30 patients out of 100). Hyper-sensitivity reaction, one of the adverse reactions of meropenem, was seen in 1 patient (1%). Conclusion: According to the results, considerable errors occurred in meropenem administration and dosing. Therefore, it is necessary to design and implement a localized guideline for meropenem consumption in Imam Reza hospital of Mashhad, Iran