Sleep quality directly influences mental and physical acts of human. Shift workers, such as nurses are at extreme risk for poor sleep. In this article we have attempt to evaluate how the beliefs of nurses about their sleep quality were. The paper is a cross sectional study among 370 nurses and correlates to demographics. Totally 151 (41%) men and 219 (59%) women participated. All of them had nursing education degree and had work experience. We found the prevalence of sleep disturbances as high as 86% and total mean score of the Persian version of Pittsburg's Sleep Questionnaire Index (PSQI-P) calculated 7.13 ± 2.5 in the study. The most common complaint of shift-work nurses was delay in sleeping initiation. We did not find any significant relation between sleep disorders and gender, age, years of nursing and hospital department of service. Although, inadequate sleep quality is a worldwide problem, but the wide difference between subjective findings of nurses and those of the general population is very significant.

Background Recently the performance rate of one anastomosis gastric bypass (OAGB) bariatric surgery has increased. Bile reflux is on of common considered complication of OAGB challenging surgeon. Methods We searched English full text with keyword “bile reflux” AND “OAGB” OR “one anastomosis gastric bypass” OR “SAGB” OR “single anastomosis gastric bypass” that published from January 1st, 2000 to December 31st, 2020 in PubMed, EMBASE, Google scholar and Cochrane Library. We included prospective or retrospective systematic review, review, clinical, and meta-analysis human article that its full text was available and focused on bile reflux after OAGB/SAGB as the fundamental performed bariatric surgery. Results A total of 1259 articles were analyzed, of which 5 were included. Analysis of number articles by year revealed that 2019 and 2020 was the highest number of published articles (n = 232; 68%). Study type analysis revealed that review studies and clinical research (n = 62; 18.2%) were the most frequent study types. Reported data on bile reflux after OAGB had diversity. Implicitly, postoperative incidence of bile reflux differed from 7.8 to 55.5%. General consensus was not existed among authors to consider the OAGB as the first suspect leading to postoperative bile reflux among other bariatric surgery types. Conclusion Although surgeons prefer to conduct OAGB procedure because of its easier surgical approach needing just one anastomosis formation it is not virtually clear that is the procedure costly benefitted regarding bile reflux outcomes.

Background: Breast fibrocystic changes (FCC) is the most common benign breast lesion among females in productive age. Cyclical pain is the most common symptom of the lesion which decreases life quality and worsens stress disorders of sufferers. The study aimed to evaluate effects of oral probiotics to confront such pain and stress among females. Method: In this randomised, double-blind controlled trial finally 50 eligible women with cyclical mastalgia due to the FCC aged between 18 and 40 years were enrolled. They were allocated in placebo and probiotic receivers. Subjects in the latter received a daily capsule containing of 2 × 109 colony forming units of probiotic microorganisms. Patients underwent a 12 weeks survey. The Visual analog scaling instrument was applied to measure pain severity. Blood samples were sent to evaluate hs-CRP, total antioxidant capacity (TAC), malondialdehyde and total plasma gluthation. Stress disorders including of depression, anxiety and sleep quality also were investigated by standard relative questionnaires. Results: Probiotic receivers showed meaningful decrease in cyclical mastalgia (p < 0.01) after 12 weeks probiotic consumption. Additionally plasma level of hs-CRP (p = 0.03) decreased concurrently with significant increase in TAC (p = 0.04) level among probiotic receivers. Probiotics helped better recovery from depressive symptoms although influenced positively neither anxiety nor sleep quality. Conclusion: This study showed that oral probiotic consumption should be considered to control the pain in cyclical mastalgia contributing to FCC of the breast. Highlights

Background: No nation-wide data are available on mental disorders in medical students. Such information can be useful for having a proper approach to and intervention for our students' health condition. Aim: To determine the mental health status in all of the students who study in one medical university. Methods: After invitation of all 790 students, 688 accepted to take part in this cross sectional study. We used the 28-items of General Health Questionnaire (GHQ-28) to evaluate mental health status. Results: Over one third (37.8%) of our participants had mental disorders. There was no difference between genders. Emergency medicine students had the most prevalence of mental disorders (51.4%). The increase in the years of education was associated with that of the risk of involvement. Social dysfunction and depression were more prevalent than somatization and anxiety symptoms. Lower level of graduation was associated with higher depressive symptoms and medical students were at higher risk for social dysfunction. Conclusion: Prevalence rates among the students of the medical university are higher in comparison with the population and needs serial evaluation plans to screen and prevent mental disorders in this part of the population.

Since venous microthrombotic and thromboembolic events in end organs have been pathophysiologically confirmed as a component of thrombo-inflammatory cascade in COVID-19 syndrome, anticoagulant prescription with prophylactic or therapeutic goal is recommended. Different guidelines for the above are introduced; however, there is no general consensus on any neither the type of anticoagulant nor for the dosage and duration of prescription. In our medical center, adopted internal guideline was considered for patients COVID-19. We consulted patients with COVID-19 who suffered from concurrent hematoma. Appropriate surgical approach was considered. Finally autopsy study was performed for patients. In this article, we presented a series of seven SARS-CoV-2 confirmed cases faced with bleeding complication following initiation of anticoagulation protocol. The rectus sheath hematoma with extension to pelvic and/or retroperitoneal space, even involving bowel mesentery was seen most commonly. Despite receiving appropriate surgical care, all seven cases died. Finally, in all cases, autopsy studies revealed no evidence for confirmation of DIC/SIC or organ failure as the reason of death although pulmonary involvement with SARS-CoV-2 and bleeding phenomena were approved. The nature of the COVID-19 syndrome makes patients vulnerable to hemorrhagic events following anticoagulant administration which relatively causes or accelerates patient’s expiration.

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Background: Making stable hemodynamic and also durable unawareness is a daily challenge in the setting of general anesthesia in women who undergo surgical delivery of neonate and have limitations to receive opioids derivatives. Objectives: We aimed to evaluate the effects of magnesium sulfate and clonidine on hemodynamic changes and depth of anesthesia and in mentioned mothers and also in neonatal APGAR index. Methods: Current randomized, double-blind controlled trial study was conducted among a total of 360 pregnant females (38 - 41 weeks of gestation) who underwent elective cesarean section. Participants were randomly divided into three drug-receiving groups (equal 120 members): magnesium sulfate (30 mg/kg), clonidine (3 µg/kg), and placebo (0.9% NaCl). Patients’ blood pressure, heart rate, cerebral state index (CSI) in specific time zones, and also late 24-hour recall were recorded. The CSI is an electroencephalographic monitoring method helping to assess the depth of anesthesia. Neonatal parameters, including APGAR score and umbilical venous blood sampling, were measured. Results: Mean patients’ age was 28 ± 4.5. A significant decreasing and stabilizing effect of magnesium sulfate and clonidine on hemodynamic parameters (blood pressure and heart rate) was revealed (P < 0.001). Evidence implied on deeper anesthesia (lower CSI) among drug receivers comparing to placebo (P < 0.001). None of the participants experienced a late 24-hour recall postoperatively. All neonates were healthy, and no decrease was reported in APGAR score at minutes 1 and 5. Umbilical blood gas analysis showed no signs of acidosis and/or hypoxemia. Conclusions: Adjuvant administration of either magnesium sulfate or clonidine is associated with hemodynamic stability and favorable unawareness in the setting of elective surgical delivery.

Introduction Trauma is one of the most common causes of morbidity and mortality worldwide. Since the definition of preventable death has been described many studies like current one were conducted to evaluate this issue. Methods This cohort retrospective study investigated archived medical files of trauma victims from 2017 to 2020 in a referral single-center trauma hospital. Registered demographic data, vital signs, Glasgow coma scale (GCS), timing of trauma and death, executed interventions, type and mechanism of trauma in addition to time errors, clinical mismanagements, and missed injuries were extracted. Injury severity score, revised trauma score, and probability of survival based on TRISS method for each case were calculated. Eventually preventable and non-preventable death were defined and compared. Results Finally from the all 413 trauma deaths 246(54.9 %) files were enrolled. Dead persons were from 18 to 95 years. Of all 189(76.8 %) were males. Analysis manifested 135(54.9 %) of all deaths were potentially preventable and the rest 49.1 % was non-preventable for expiration(p = 0.001). Data showed that from all variables systolic blood pressure ≥80 mmHg, respiratory rate >19 per minute, GCS>8, higher RTS, road traffic accidents and control of external bleeding were contributed to prediction of preventable trauma related mortality. Conclusion This study implied on that frequency of trauma related preventable death was regionally high and associating factors that could influence the number of these mortalities included systolic blood pressure, respiratory rate, GCS, revised trauma score, mechanism of trauma, and external bleeding of trauma patients.