CONTEXT The primary goal of discussing patient cases during the morning report is to teach appropriate clinical decision making. In addition, the selection of the best diagnostic strategy and application of evidence-based patient care are important. Reducing hospital costs is fundamental to controlling inflation in health care costs, especially in university hospitals that are subject to budget constraints in developing countries. The goal of this study was to explore the effect of morning report case presentation on length of stay (LoS) and hospitalisation costs in a university teaching hospital.METHODS A total of 54 patients whose cases had been presented at morning report sessions in the department of internal medicine during a 3-month period (presented group) were selected and their medical records reviewed for data on final diagnosis, hospital LoS and detailed hospital costs. A control group of 104 patients, whose cases had not been presented, were selected on the basis that their final diagnoses matched with those of the presented group. In addition, the groups were matched for age, sex, occupation, comorbidities and insurance coverage. Final diagnoses were based on International Classification of Disease 10 (ICD-10) diagnostic code criteria. RESULTSThe mean AE standard deviation (SD) hospital LoS was 8.32 AE 4.11 days in the presented group and 10.46 AE 4.92 days in the control group (p = 0.045). Mean AE SD hospitalisation costs per patient were significantly lower in the presented group (US $553.43 AE 92.16) than the control group (US $1621.93 AE 353.14) (p = 0.004). Although costs for paraclinical services were similar, there were very significant reductions in costs for medications used during hospitalisation and bed-days (p = 0.002).CONCLUSIONS Discussing clinical aspects of patient cases in morning report sessions facilitates the management process and has a significant effect on LoS and hospitalisation costs in patients admitted to hospital.
Background: A hydatidiform mole or molar pregnancy is the most prevalent gestational trophoblastic disease (GTD). About 55%-60% of women with trophoblastic diseases have overt hyperthyroidism at the time of diagnosis, which may have severe manifestations. This study examined the relationship between gestational hypertension and the level of thyroid hormones with beta human chorionic gonadotropin (β-HCG) in patients with a hydatidiform mole. Materials and Methods: This cross-sectional study enrolled 65 patients with a hydatidiform mole admitted to Khalij-e Fars hospital, Bandar Abbas, Iran. Patients were divided into three groups of clinical hyperthyroidism, subclinical hyperthyroidism, and healthy. The serum levels of thyroid-stimulating hormone (TSH), T4, T3, and β-HCG were checked in all subjects, and the relationship between gestational hypertension and the level of thyroid hormones with β-HCG in patients with a hydatidiform mole was examined. Results: The mean age of patients was 29.93 ± 9.04 years, and their mean gestational age was 11.09 ± 4.2 weeks. In this study, 12.3% of the patients had subclinical hyperthyroidism, 41.5% had clinical hyperthyroidism, and 46.2% were healthy. A significant relationship was found between the serum level of β-HCG and thyroid function in patients with clinical and subclinical hyperthyroidism compared to the healthy group (P= 0.001). No significant relationship was found between systolic/ diastolic blood pressure and the serum level of β-HCG. Conclusion: A significant relationship was observed between the serum levels of β-HCG and TSH, free T3, and free T4 in patients with a hydatidiform mole and thyrotoxicosis. Thus, early diagnosis of hyperthyroidism can help treat these patients more quickly.
Background: Today, various drugs have been investigated as the primary or complementary treatment for coronavirus disease 2019 (COVID-19). N-acetylcysteine (NAC) has been used as a mucolytic in pulmonary diseases. This drug apparently contributes to the retrieval of the intracellular antioxidant system. Objectives: This study aimed to determine the efficacy of NAC in severe COVID-19 patients admitted to the intensive care unit (ICU). Methods: This single-blinded randomized controlled phase III clinical trial included 40 patients with confirmed COVID-19 (based on polymerase chain reaction) admitted to the Shahid Mohammadi Hospital’s ICU, Bandar Abbas, Iran, in 2020. All cases had severe COVID-19. They were allocated randomly to two equal groups. Patients in the control group received standard drug therapy based on the treatment protocol of the national COVID-19 committee, while those in the NAC group received a single dose of intravenous NAC (300 mg/kg) upon admission to the ICU in addition to standard drug treatment. Clinical status and laboratory tests were done on admission to the ICU and then 14 days later or at discharge without knowing the patient grouping. Results: The two groups were comparable regarding age, gender, and other baseline laboratory and clinical parameters. At the final evaluation, respiratory rate (21.25 ± 4.67 vs. 27.37 ± 6.99 /min) and D-dimer (186.37 ± 410.23 vs. 1339.04 ± 2183.87 ng/mL) were significantly lower in the NAC group (P = 0.004 and P = 0.030, respectively). Also, a lower percentage of patients in the NAC group had lactate dehydrogenase (LDH) ≤ 245 U/L (0% vs. 25%, P = 0.047). Although the length of ward and ICU stay was shorter in the NAC group than in controls, the difference was statistically insignificant (P = 0.598 and P = 0.629, respectively). Mortality, on the other hand, was 75% in the control group and 50% in the NAC group, with no statistically significant difference (P = 0.102). Concerning the change in the study parameters, only the decrease in diastolic blood pressure (DBP) was significantly higher with NAC (P = 0.042). The intubation and mechanical ventilation rates were higher, while oxygen with mask and nasal oxygen rates were lower with NAC, but the difference was statistically insignificant. Conclusions: Based on the current research, NAC is related to a significant decrease in RR, D-dimer, and DBP in severe COVID-19. Also, LDH was significantly lower in the NAC group than in the controls. More research with larger sample sizes is needed to validate the current study results.
Background: Heart failure is one of the most important public health problems with an increasing prevalence and identifying its contributing factors is imperative. This study was conducted to evaluate the iron status in patients with chronic systolic heart failure in Shahid Mohammadi Hospital of Bandar Abbas. Materials and Methods: A total of 80 patients with chronic left ventricular failure participated in this cross-sectional study. Data were collected using a researcher developed checklist containing demographic details and echocardiographic data (left ventricular ejection fraction, LVEF%). Additionally, the frequency and distribution of iron status were measured in the research population. Results: The results showed that the prevalence of anemia was significantly high in patients with chronic heart failure (77.3%). The prevalence of iron deficiency (ID) was 77.33% based on iron level (<60 μg/dL), and it was 82.66% based on the mean ferritin level (ferritin<100, or ferritin of 100 to 299 ng/mL, and transferrin saturation<20%). The prevalence of total iron binding capacity (TIBC)>360 μg/dL was 26.66%, and the prevalence of mean corpuscular volume (MCV)<80 fL was 60%. Age less than 60 years, glomerular filtration rate (GFR) less than 60, and body mass index (BMI) less than 18.5 were also found to increase the risk of anemia in these patients. Conclusion: Our study showed that the prevalence of anemia was significantly high in patients with chronic heart failure. Due to the high prevalence of anemia in patients with chronic systolic heart failure and the impact of anemia on the prognosis of the disease in these patients, effective treatment is necessary in high-risk patients to reduce the severity of their disease, compensate for their heart failure, and reduce their mortality.
Background: Today, people all over the world are suffering from COVID-19 pandemic. Certainly, exploring the characteristics of the corona virus and making an effective vaccine are important efforts in preventing and controlling the disease. At the same time, it is necessary to conduct studies to identify high-risk groups and protect them against disease. Method: This study's research population was 281 people with fever, coughing, and respiratory disorder admitted to an educational hospital affiliated with the Hormozgan University of Medical Sciences in the south of Iran. If RT-PCR test was positive, the patients were considered infected. Infected patients were hospitalized if they had impaired respiratory function. The main kinds of lifestyle information collected from patients were: physical activity data, emotional or spiritual status, tobacco/opium/alcohol use status, sleep, and nutritional data, comorbidity disease data. Multivariable OR (95% CI) regression tests were applied to detect the relation between some important lifestyle variables with the probability of infection by coronaviruses and hospitalization due to respiratory disorder findings. Results: it was identified that 22 from 28 covariates had significant associations with the risk of infection and hospitalization.
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