Plenary survey on incidence of cardiac complications among transfusion-dependent thalassemia patients

Introduction: Cardiac complications are the leading cause of mortality amongst transfusion-dependent thalassemia (TDT) patients. The multifactorial etiology of cardiac disorders has made their management quite challenging. Therefore, in addition to evaluating the incidence of heart failure (HF) and pulmonary hypertension (PHT), the associated factors were assessed amongst 737 TDT patients, aiming to achieve a plenary perspective of their cardiac disorders and relative factors. Material and methods: In this cross-sectional, we evaluated the incidence of HF and PHT amongst 737 TDT patients while considering imperative factors such as endocrinopathies, iron status, and serum vitamin D level. Results: Incidence of total heart failure and pulmonary hypertension were estimated at 12.3% amongst participants, however, the rate of cardiac iron overload was about 40%. Splenectomy, serum vitamin D, low bone mass, age, gender, hypoparathyroidism, hypogonadism, and diabetes were significantly impairing the cardiac function of our patients. The latter results were concluded by univariate analysis and only the frequency of blood transfusion proved to have a risk effect on left ventricle ejection fraction. Conclusions: Cardiac iron overload has the highest impact on the incidence of cardiac disorders amongst TDT patients. Even though the significant statistical association between studied disorders and iron chelation regimen, endocrinopathies, splenectomy, serum vitamin D, and total body iron status were not observed, however about clinical practice, their effect could not be ignored and require further studies to achieve efficient management of thalassemia patients with cardiac disorders

Serum Folate and Vitamin B12 Levels in Survivors of Childhood Malignancy in Southern Iran

Background: Folate and vitamin B12 have a number of biologic roles that make them important in hematological disorders and malignancy. In the present study, we have assessed serum folate and vitamin B12 levels and their associated variables in patients with leukemia, lymphoma, and solid tumors. Methods: This cross-section study investigated 98 patients (57 with leukemia, 16 lymphoma, and 25 solid tumors) between April 2015 and March 2016 in Southern Iran. Complete blood counts and serum levels of folate, vitamin B12, lactate dehydrogenase, and homocysteine were measured. Clinical characteristics of the patients were also gathered from their medical records. Results: Patients had the following mean serum levels: serum folate (12.27±6.69 ng/ml), vitamin B12 (331.81±183.22 pg/ml), and homocysteine (11.74±26.67 μmole/L). Vitamin B12 showed a significant negative correlation with homocysteine levels (r= -0.223, P=0.043). Overall, there were 21(21.9%) vitamin B12 and 9 (9.8%) folate deficient patients. Vitamin B12 patients had a longer remission time (time from off therapy until study entry) of 18±16.97 months compared to those with normal vitamin B12 levels (8.81±8.08 months, P=025). However, logistic regression analysis showed that only mean corpuscular volume had a significant correlation with vitamin B12 deficiency (B= -0.105, odds ratio=0.9, 95% CI: 0.819-0.990, P=0.03). None of the variables showed significant correlation with folate deficiency (P>0.05). Conclusion: Vitamin B12 and folate deficiency are frequently seen in survivors of childhood malignancy, mainly due to the effects of chemotherapy. These vitamins have important roles in hematopoiesis, as well as development and maintenance of the nervous system; therefore, timely detection of their deficiencies is of utmost importance. It is highly recommended to check the serum levels of these vitamins in children who successfully survive their cancer treatments

Epidemiology of Hereditary Coagulation Bleeding Disorders: A 15-Year Experience From Southern Iran

Background: Data on the frequency of hereditary bleeding disorders (HBDs) and associated mortality and morbidities during a long-term follow-up from Iran are scarce. Objective: This study evaluated the epidemiologic features among patients with HBD in one of the largest referral centers in southern Iran. Methods: In this cross-sectional study, 619 patients with HBD were evaluated during the period 1996 to 2011. Aside from baseline characteristics and type of factor deficiency, associated morbidities including viral infections, neurological disorders, asthma, thalassemia, glucose-6-phosphate dehydrogenase (G6PD) deficiency, diabetes, hypertension, cardiac and renal diseases were evaluated. Furthermore, among patients who died, the underlying disease and etiology of death were also evaluated. Results: Patients’ mean age was 24.4 ± 13.5 years. Factor VIII deficiency was the most prevalent type (50.4%) of HBD, and combined Von–Willebrand and factor XIII deficiency (2.3%) was the most prevalent type of combined factor deficiency. A total of 0.5% had hepatitis B and 11.5% had hepatitis C. Cardiac disease was seen in 1.5%, hypertension in 0.2%, renal disease in 0.2%, and diabetes in 1.3% of patients. Overall, 5.2% had intracranial hemorrhage, 2.1% had epilepsy, and 0.8% had mental retardation. During the 15-year follow-up, 22 patients died; car accident was the leading cause of death in this population. Conclusion: Associated morbidities were seen in 24.3% of patients with HBD. Most prevalent morbidities were HCV infections (11.5%) and neurological disease (7.3%). The mortality rate among patients with HBD was 3.4%, and the most common cause of death was accident, which is similar to that of normal Iranian populations

Parameters of tissue iron overload and cardiac function in patients with thalassemia major and intermedia

BackgroundNoninvasive T2* magnetic resonance imaging (MRI) assessment can stratify the risk of subsequent cardiac dysfunction in β-thalassemia major (TM) and β-thalassemia intermedia (TI) patients. The normal level of N-terminal pro B-type natriuretic peptides (NT-proBNP) can rule out acute heart failure. AimWe aim to investigate the relation of NT-proBNP level, T2* MRI, and echocardiographic findings in TM and TI patients. Materials and methodsIn this cross-sectional study, 41 TM patients, 41 TI patients, and 41 healthy individuals (HI) were enrolled. NT-proBNP level, T2* MRI, and two-dimensional echocardiography were assessed for all patients and controls. ResultsThere was statistically significant correlation between NT-proBNP levels and mitral inflow late diastolic velocity ( = −0.538; = 0.006) in TM group. There was statistically significant correlation between NT-proBNP levels and tricuspid annulus systolic velocity ( = −0.438; = 0.028), systolic velocity of septum ( = −0.472; = 0.020), and mitral inflow early-to-late diastolic wave ratio ( = 0.592; = 0.002) in TM group. ConclusionEarly diagnosis and treatment of myocardial iron overload are likely to prevent the mortality in patients with established ventricular dysfunction. Since NT-proBNP levels were not significantly increased in documented left ventricular (LV) diastolic dysfunction, this factor may not be sensitive for the detection of latent LV diastolic dysfunction in the early stages of disease progression

Continuous evaluation of midwives as to professional standards

Introduction: Implementation of professional standards as well as evaluation and assessments of providers has an important role in health promotion of each society. The purpose of this study was to assess the midwives working at midwifery offices as to performance of professional standards and effectiveness of continuous evaluation and education on them. Methods: This is an interventional study in which all of midwifery offices (110) were evaluated. The study was done in three stages using standard checklist observation and interview in each step. Based on detected errors, appropriate education was done and their performance was reevaluated in the next step of supervision. Finally total scores in each step as well as scores in different subjects were compared among three evaluated stages. Results: Overall mean score of faults at midwifery offices decreased from step 1 to step 3 in the following fields: environmental health and infection control (P<0.0002), personal and patient care (P=0.0005), individual health (P=0.003) and adherence to laws and rules (P<0.0001). Conclusion: Continuous evaluation is essential for assessing the effectiveness and improvement of our educational program. With continuous evaluation, correction of observed defects will be done at an early stage by appropriate intervention and education. So our medical and health programs will attain the planned goals

Impact of clinical supervision on field training of nursing students at Urmia University of Medical Sciences

Introduction: Obtaining clinical competency in clinical education is one of the problems in nursing and use of the new methods of clinical training is very important. Clinical supervision is one of the methods used as a mechanism to promote knowledge and skill for promoting professional performance in nursing students. This study is carried out to determine the impact of clinical supervision on field training of nursing students at Urmia University of Medical Sciences. Methods: In the present experimental study, 32 nursing students were enrolled in the study based on census and randomly assigned into two groups of experimental and control by block randomization. Clinical supervision was used in the experimental group and the control group received routine clinical trainings in the field. The students’ clinical skills were assessed using a researcher-made checklist, the validity of which was confirmed through content validity method by 13 faculty members and its reliability was approved by test-retest method on 20 nursing students in the form of a pilot study and through Cronbach’s alpha (87%). Data were analyzed using SPSS, version 14. Results: There was a significant difference between the experimental and control groups in clinical skills such as recognition and administration of medication, team participation, patients and their relatives’ education, considering the safety, infection prevention and nursing process (p<0.005). Conclusion: The study demonstrated that in clinical supervision process, students have a better communication and cooperation with their instructor and with each other and their confidence and understanding and the amount of learning in practical skills was enhanced more than routine clinical training. The implementation of this clinical training method for students of nursing and other fields of medical sciences is recommendable

Comparison of the Effects of Attachment Training for Mothers on the Behavioral Responses of Premature Infants: A Randomized Clinical Trial

Background: Premature infants are among high-risk groups in community who need to be hospitalized at intensive care units for survival and receiving basic or special care. Hospitalization at neonatal intensive care units (NICUs) unsettles the family and leads to the separation of parents from their infants. This study aimed to determine the effects of maternal attachment behaviors on the behavioral responses of premature infants, hospitalized at NICUs. Methods: In this randomized clinical trial, 64 premature infants, who were hospitalized at NICUs and were eligible for the study, were randomly allocated to study and control groups. Attachment behaviors including touching, massage and kangaroo care were applied for the study group, while the conventional attachment method was adopted for the control group. Behavioral responses were evaluated two hours before and two hours after training attachment behaviors. Data were analyzed, using Chi-square and student’s t-test. Results: The mean difference in the duration of deep sleep and consciousness was more significant in the study group, compared to the control group. Furthermore, the duration of drowsiness was significantly less in the study group, compared to the control group. Conclusion: The implementation of attachment training at NICUs decreased the time of drowsiness and improved behavioral responses, deep sleep time and consciousness