During the late adolescence, it can be reached the highest level of mental operative functions and other intelligent human manifestations. Abstract mental operations can be done at this level: synthesis of syntheses, generalization of generalizations, abstraction of abstractions. Students go through many attempts to find which is their personal style of learning new materials, new contents. The study was conducted on a number of 31 participants. The group was divided into two subgroups: 16 students in the 5th year at Faculty of General Medicine and 15 master students in the second year at University of Sports, Sports Performance program. The used instrument consists of 21 questions (11 questions are about the individual studying process of the participants and 10 are about their beliefs about the teaching process of academics in courses), along with 4 more questions related to personal data. It is an opinion questionnaire. The teaching style of academics differs: those of Faculty of General Medicine are focusing on a lecture type style (75%), and University of Sports on an interactive style (67%). We discovered differences in the process of self-learning: between continuous and discontinuous style. For medical students, there was a longer distribution of the self-taught learning process; instead, University of Sports students organize their learning time in the last part of the semester. University of Sports students are more concerned with on the development and refinement of their personal practical skills, but also of the subjects they work with (kids or athletes), their goal being to accumulate their own experience as rich as possible from working with as many individuals and less to take from the experience of other colleagues. The coach-athlete/sports teacher-pupil relationship is more personalized and longer-lasting than the doctor-patient relationship.
The accident at Chernobyl occurred in April 1986 at the Chernobyl Nuclear Power Plant in Soviet Union. The incident occurred during a scheduled safety test. A combination of inherent reactor design flaws and operators’ mistakes resulted in reactor’s No.4 disaster and the emission of a large quantity of radiation. The immediate actions involved the fire extinguishing, the cleanup of radioactive residues and the prevention of a new explosion. For this purpose, plenty of people worked with self-sacrifice. The people who lived nearby were removed. As far as the socio-economic impact for the Soviet Union is concerned, it was quite serious. Moreover, the environmental and human health consequences were also alarming with thyroid cancer being the most studied. Useful conclusions, especially for the safety both of reactors and nuclear power, as well as for the impact of radiation at ecosystems have been drawn. The debate about the use of nuclear power has remained open ever since.
Aims: Mechanical bowel obstruction is a frequent surgical emergency and a frequently confronted burden in abdominal operation. This study aimed to find out the model of mechanical bowel obstruction in the Iranian population. Methods and materials: In this study, all patients with clinical and radiological evidence of mechanical bowel obstruction that admitted to the Department of Surgery of Baqiyatallah Hospital with a diagnosis of mechanical bowel obstruction from January 2012 to December 2015 were included. The age, gender, symptoms operative details, postoperative complications, outcome, and mortality, were recorded. Results: 193 patients with mechanical bowel obstruction were admitted in our study. Regarding the clinical presentation of the patients, the absence of passage of flatus and/or feces with abdominal pain (65.8%) were the most common presenting symptoms. Adhesions, colonic volvulus, hernias, different types of colorectal cancer were the most frequent causes of obstruction (54.9%, 15.54%, 7.2%, and 9.8%, respectively). Twenty-one patients died, resulting in a mortality rate of 10.9%. In the 19 patients with colorectal cancer, 7 (31.6%) patients have died and cause of death in all them related to cancer disease. Conclusion: The results showed that the most common mechanisms of intestinal obstruction were adhesions, volvulus, cancers, and hernias, respectively, and the most common risk factors were appendectomy history, herniation surgery history, and cholecystectomy history, respectively. About 21 patients (10.8%) underwent obstruction surgery with a diagnosis of malignancy, which was confirmed in 19 cases of tumor pathology, of which about one third had recurrence within 3 years.
Background: This study aimed to investigate the effects of tranversus abdominis plane (TAP) block placed postoperatively using ultrasound guidance for patients with caesarean section, myomectomy, and hysterectomy under general anesthesia by eliminating additional pain caused by surgical incision. Methodology: The study has been planned to investigate the postoperative analgesia of 50 patients with TAP blocks applied and non-applied between the ages of 18-65, who will pass abdominal surgery. The study has been conducted in a prospective, randomized and controlled manner. Patients have been classified as those who have undergone TAP block (group: I) and those without block (group: II). Results: Mean age of the patients in the TAP block group was 35.52 years, the mean age of the other group was 32 years and there was no statistically significant difference. The patients' visual analog scale (VAS) was evaluated at the 30th minute, 1st, 2nd, 6th, 12th, and 24th hours in the postoperative period. For patients with TAP blocks, the VAS score was found to be lower for all hours than patients without TAP blocks (p<0.05). Beginning at the 30th minute and 1st-hour analgesic needs of the block patients were compared with the other group (p<0.05). Conclusion: TAP, that can be easily and safely placed provides effective analgesia and reduces the additional disruptions caused by the pain.
The asthma obstructive sleep apnea overlap is a clinical entity relatively new and the association with a dysfunctional plasma lipid profile is not known. Aim. In this study, we compared the serum lipid profile in asthma-obstructive sleep apnea overlap syndrome to those in asthma and obstructive sleep apnea patients. Methods. A cross-sectional study of 97 cases of which 26 patients had only asthma, 51 were diagnosed with OSA, and 20 were identified with A-OSA overlap. The lipid profile included the total cholesterol, HDL-cholesterol, triglycerides, the LDL- cholesterol. The Casteli indexes I and II and the atherogenic plasma index were calculated. Results. The patients with asthma- obstructive apnea overlap were older (55.55 years vs 53,73 years in obstructive sleep apnea and 51,04 years in asthmatics), mostly obese (95%), and had a significantly higher average of BMI (38.11 vs. 35.64 and 28.8, respectively). Asthma- obstructive apnea overlap was at higher risk of cardiovascular disease than asthmatics, in respect to the lipid profile: the levels of HDL-cholesterol were lower, triglycerides were higher, and the values of Castelli index I and II were higher. Conclusions. Based on our results, we confirm that age and BMI contribute to the risk of A-OSA overlap. The major differences in the common markers of the serum lipid profile are lower HDL-C and higher triglycerides. As a clinical implication, both Castelli indexes could provide additional value for cardiovascular risk and should be monitored in A-OSA overlap.
Background: Non-Alcoholic Steatohepatitis (NASH) is an aggressive form of Non-Alcoholic Fatty Liver disease (NAFLD), with liver inflammation and scarring. Due to a lack of clinical biomarkers and asymptomatic nature, NASH is often under-diagnosed. It is the most common cause of chronic liver disease in the USA. Liver biopsy is the gold standard to diagnose NASH, but it is invasive and life-threatening and histologic evaluation of a liver biopsy sample is imperfect as a reference because of sampling variability due to the irregular distribution of fibrosis. Aim: Validating AST/ALT ratio as a stand-alone scoring system in NASH is scarce and so this study aims to establish a correlation between FibroScan values and AST/ALT ratio. Methodology: All NASH patients, who underwent FibroScan were included. Their demographics, FibroScan, AST, ALT values were recorded in M S Excel and Pearson correlation between FibroScan values and AST/ALT ratios of 150 NASH patients was calculated using SPSS. Results: Out of 150 NASH patients, 72% were males and 57.33% belonged to 40-50 years age group. FibroScan values and AST/ALT ratio showed positive Pearson correlation of 0.245, (p value=0.003). FibroScan values and splenic size also showed a positive Pearson correlation of 0.289 (p value<0.001). Conclusion: Males of 40-50 years age group had higher distribution of NASH, so middle aged males should be screened routinely as they are at a higher risk. FibroScan value with AST/ALT ratio and splenic size showed a positive correlation, thus showing that AST/ALT ratio and splenic size increases with increase in liver stiffness.
Nowadays, a wide range of natural and man-made disasters, disease outbreaks and pandemics give rise to health emergencies at a global level. Thus, a health security strategy is urgently required through central planning. At the national level, that vision can be implemented with a properly organized and fully functional Emergency Health Operation Center (EHOC). The main executive sections of an EHOC are Command, Planning, Operations, Logistics, Administration, Communications/Intelligence, and Reporting/Briefing. Each of the above sections has several functions and sub-functions, all operating according to a concrete legal basis and detailed operating procedures.
Background: A few studies compared the vitamin D deficiency condition between the patients with the acute coronary syndrome (ACS) and those with stable coronary artery disease. The present comparative study aimed to assess the vitamin D deficiency status between the patients with ACS and those with stable coronary artery disease. Methods: This cross-sectional study was performed on 200 consecutive patients with the diagnosis of ACS or stable coronary artery disease. Serum Vitamin D level was measured by immunoassay and its serum level was categorized as normal (> 30 ng/ml), insufficient (20 to 30 ng/ml), and deficient (< 20 ng/ml). Results: Overall, 103 patients were categorized as stable angina group, 74 had unstable angina, 10 had STEMI, and 13 had NSTEMI. There was no difference in serum vitamin D3 level across the four groups including stable angina group (13.81 ± 15.13 ng/ml), unstable angina group (15.13 ± 11.11 ng/ml), STEMI group (21.58 ± 19.87 ng/ml), and NSTEMI group (18.67 ± 13.07 ng/ml) (p = 0.276). No difference was also found in the mean vitamin D3 level between the groups with new MI (15.98 ± 12.44 ng/ml versus 14.01 ± 15.31 ng/ml, p = 0.318). In total, 8.5% had normal vitamin D levels and 9.0% had vitamin D insufficiency, while the majority of patients (82.5%) were vitamin D deficient. The vitamin D deficiency was comparable in the patients with stable angina compared to those in ACS groups. According to ROC curve analysis, measuring serum vitamin D3 had a moderate value to discriminate stable angina from ACS (AUC = 0.651). In this regard, the best cutoff point for serum vitamin D3 level to discriminate stable angina from ACS was 9.0 ng/ml yielding a sensitivity of 70.1% and a specificity of 57.3%. Conclusion: The measurement of vitamin D and thus the presence of vitamin D deficiency have no sufficient power to discriminate ACS from stable coronary artery disease
Background: Dexmedetomidine facilitates patient communication with the ICU nurses, and is a valuable drug for use in patients undergoing mechanical ventilation due to a reduction in the duration of mechanical ventilation and prevalence of delirium. Objectives: In this study, investigators aimed to compare the effect of Dexmedetomidine with placebo on sedation in patients undergoing open-heart surgery. Methods: In this double-blind clinical trial, 69 patients with open-heart surgery who underwent a cardiopulmonary bypass pump, were randomly assigned into two groups of Dexmedetomidine (group D) and placebo (group P). At the end of the operation, patients in groups D and P respectively received 1 µ / kg infusion of Dexmedetomidine and normal saline in 10 minutes. In case of a lack of proper sedation, midazolam with the doses of 1 mg titration was used up to reaching the goal of sedation. Also, for pain relief, morphine titrated at a dose of 1 mg was Injected, and dosage was recorded in both groups. In each shift, patients were examined for delusions by the nurse involved in their care, using the “Confusion Assessment Method for the ICU (CAM-ICU)”. For patients with delirium, 1 to 5 mg of Haloperidol was used. Also, the length of stay in the ICU was recorded. Results: There was no significant difference between the two groups in systolic blood pressure, diastolic blood pressure, and heart rate at different stages of treatment (p<0.05). comparison of the two groups in terms of the length of stay in ICU, duration of mechanical ventilation, staff satisfaction, and occurrence of Delirium after surgery indicated that there were significant differences between the two groups (p<0.05). There was a significant difference between the two groups in the dose of morphine and midazolam (p<0.05). Conclusion: This study showed that sedation with Dexmedetomidine significantly reduced the incidence of postoperative delirium, the length of stay in ICU, the duration of mechanical ventilation, the satisfaction rate of ICU staff, and the dose of analgesic and sedative medication. As there were no reported hemodynamic complications as well, it seems that it can be indicated as a safe and appropriate drug for sedation of patients in the ICU.
Clinicians, professors of medicine in general, students, and professionals from the health sciences tend to focus their efforts on technical training related to their discipline in practice as well as activities that produce some benefit direct or personal satisfaction. It is unusual to devote time and effort to training in areas such as teaching or expand their skills in sociological and organizational aspects. Would you like to take a course on strategic planning if not a director or officer of the hospital? Manage time in your schedule for a workshop on communication and conflict management? Have room in your schedule for educational activities on leadership, organizational change, and diffusion of innovations, science or science complexity of implementation? Generally, doctors and teachers do not spend much time on these activities (at least voluntarily) because we feel that what we have learned from these topics on personal experience is enough [1]. Effective teamwork, not only in the operating room but also throughout the perioperative route is considered an important and critical component of the safety and effectiveness of surgical care and leads to good results and quick recovery of surgical patients. Therefore, considerable efforts have been made to understand how teams work within the route of surgical care and to improve teamwork [2]. The simple act of bringing together some experts does not guarantee that turned out an expert team. Given the evidence suggests that teamwork in the operating room sometimes is far from harmonious and effective, the importance of training the surgical team to work effectively is receiving international acceptance as a key strategy to maximize safety in surgery. This systematic literature review aims to present a review of literature that focuses on the importance and role of leadership skills in the surgeon and how these skills can play a significant role in increasing the quality of care and patients’ safety in operating room (OR) settings.
