Aim. Regional analgesia has been introduced as better analgesic technique compared to using systemic analgesic agents, and it may decrease the adverse effects of them and increase the degree of satisfaction. Several additives have been suggested to enhance analgesic effect of local anesthetic agents such as opioids and steroids. We designed this randomized double-blind controlled study to compare the analgesic efficacy of the dexamethasone and fentanyl added to lidocaine using axillary block in patients undergoing operation of forearm fracture. Materials and Methods. Seventy-eight patients 20–60 years old were recruited in a prospective, double-blinded, randomized way. Axillary block was performed in the three groups by using 40 mL lidocaine and 2 mL distilled water (L group), 40 mL lidocaine and 2 mL dexamethasone (LD group), and 40 mL lidocaine and 2 mL fentanyl (LF group). The onset time of sensory and motor block, duration of sensory and motor block, the total analgesic dose administered during 6 hours after the surgery, and hemodynamic variables were recorded. Results. The duration of sensory and motor block was significantly longer in LD group compared to other groups (P < 0.001). Similarly, the total analgesic consumption in LD group was smaller compared to other groups (P < 0.001). Comparison of hemodynamic consequences of axillary block and surgery failed to reveal any statistically significant differences between all groups. Conclusion. Addition of dexamethasone to lidocaine significantly prolonged the duration of analgesia compared with fentanyl/lidocaine mixture or lidocaine alone using axillary block in patients undergoing forearm fracture surgery. This trial is registered with IRCT2012120711687N1.

Introduction Despite the high prevalence of hypocalcemia in patients with COVID-19, very limited studies have been designed to evaluate etiologies of this disorder. This study was designed to evaluate the status of serum parameters involved in calcium metabolism in patients with COVID-19 and hypocalcemia. Materials and methods This cross-sectional study was conducted on 123 hospitalized patients with COVID-19. Serum concentrations of PTH, 25 (OH) D, magnesium, phosphate, and albumin were assessed and compared across three groups of moderate/severe hypocalcemia (serum total calcium < 8 mg/dl), mild hypocalcemia (8 mg/dl ≤ serum total calcium < 8.5 mg/dl) and normocalcemia (serum total calcium ≥ 8.5 mg/dl). Multivariate analyses were performed to evaluate the independent roles of serum parameters in hypocalcemia. Results In total, 65.9% of the patients had hypocalcemia. Vitamin D deficiency was found in 44.4% and 37.7% of moderate/severe and mild hypocalcemia cases, respectively, compared to 7.1% in the normal serum total calcium group ( P = 0.003). In multivariate analysis, vitamin D deficiency was independently associated with 6.2 times higher risk of hypocalcemia ( P = 0.001). Only a minority of patients with hypocalcemia had appropriately high PTH (15.1% and 14.3% in mild and moderate/severe hypocalcemia, respectively). Serum PTH was low/low-normal in 40.0% of patients with moderate/severe low-corrected calcium group. Magnesium deficiency was not associated with hypocalcemia in univariate and multivariate analysis. Conclusion Vitamin D deficiency plays a major role in hypocalcemia among hospitalized patients with COVID-19. Inappropriately low/low-normal serum PTH may be a contributing factor in this disorder.

Background and Aims: To date, different methods have been invented to risk-stratify critically ill patients, however, there is a paucity of information regarding assessing the severity of poisonings. This study was designed to determine the comparative efficacy of Simplified Acute Physiology Score-II (SAPS-II) and Acute Physiology and Chronic Health Evaluation-II (APACHE-II)score with cardiac troponin I (cTnI) in predicting severe intoxication outcomes. Methods: This was a prospective study conducted on patients who fulfilled defined severe intoxication criteria necessitating intensive care unit (ICU) admission over a period of 6 months. SAPS-II and APACHE-II scores were calculated and cTnI concentrations were measured. These indicators were compared to determine which has the better ability to prognosticate mortality and complications. Results: A total of 55 cases (median age, 35 [24-49] years) were enroled. Eight patients (14.5%) died. Mean SAPS-II, median APACHE-II score and median cTnI concentrations were 32.05 ± 11.24, 13 [10-17] and 0.008 [0.002-0.300] ng/ml, respectively, which were significantly different between the survivors and non-survivors. Receiver operating characteristics curve results of SAPS-II, APACHE-II score and cTnI concentrations in predicting mortality were 0.945, 0.932 and 0.763 and in predicting complications were 0.779, 0.739 and 0.727, respectively. High cTnI concentration (>0.37 ng/ml) correlated with soft clinical outcomes, including length of ventilatory support, length of ICU stay and length of hospital stay (LOS) (r: 0.928, 0.881 and 0.735 respectively; all P < 0.001). Conclusion: SAPS-II scores were superior in predicting death and complications, while cTnI correlated more closely with soft clinical outcomes, such as the length of ventilator support, length of ICU stay or LOS.

Aim The aim of this study was to explore the perceptions of nurses, patients and attendants of humanistic care in the intensive care unit. Design The present study was a qualitative conventional content analysis conducted in the intensive care unit in a hospital in Iran, in 2019. Methods Data were collected using semi‐structured interviews and field notes through purposive sampling with 17 nurses who worked in an adult ICU in a teaching hospital, 4 attendants and 4 alert patients, and then analysed using the Elo‐Kyngäs method in 2008. Results Analysis of the data led to the extraction of Four main themes as follows: (1) Insufficient understanding of nurses and patients' families of each other's roles, needs and expectations; (2) The use of personal and situational reasoning rather than ethical principles; (3) Caring stagnation; and (4) Satisfaction with care.

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Purpose This study aimed to compare mortality rate, length of stay (LOS) and hospitalization costs at different priority levels for a patient admitted to an intensive care unit (ICU) at a public tertiary hospital in Qazvin, Iran. This study also aimed to predict influencing factors on patients’ mortality, ICU LOS and hospitalization costs in different admission groups. Design/methodology/approach The authors conducted a retrospective cohort study among patients who mainly suffered from internal diseases admitted to an ICU of a public hospital. This study was conducted among 127 patients admitted to ICU from July to September 2019. The authors categorized patients into four groups based on two crucial hemodynamic and respiratory status criteria. The authors used a logistic regression model to predict the likelihood of mortality in ICU admitted patients during hospitalizations for the four prioritization groups. Furthermore, the authors conducted a multivariate analysis using the “enter” method to identify risk factors for LOS. Findings Results showed a statistically significant relationship between the priority of being admitted to ICU and hospitalization costs. The authors’ findings revealed that age, LOS and levels of consciousness had a predictability role in determining in-hospital mortality. Besides, age, gender, consciousness level of patients and type of the disease were mentioned as affecting factors of LOS. Originality/value This study’s findings emphasize the necessity of categorizing patients according to specific criteria to efficiently use available resources to help health-care authorities reduce the costs and allocate the budget to different health sectors.

Background: Nurses working in intensive care units do their main part of the job using medical equipment. Nursing scholars have raised concerns about the decline and lack of attention to humanistic care in nursing. One of the threatening factors can be the high attention of nurses to the use of technology, especially in intensive care. Up to now, there has been little investigation of the nurses' perceptions of this phenomenon. The aim of the study was, therefore, to explore the perceptions of nurses and attendants of humanistic care in the intensive care unit.Methods: The present study was a qualitative conventional content analysis (COREQ guidelines) conducted in. an intensive care unit in a hospital in Qazvin, Iran, in 2019. Data was collected using unstructured interviews and field notes and then analyzed using the Elo-Kyngäs method in 2008. Findings: Continuous and comparative analysis of the data led to the extraction of 4 main themes as follows: 1) Insufficient understanding of nurses and patients’ families of each other's roles, needs, and expectations; 2) The use of personal and situational reasoning rather than ethical principles; 3) Caring stagnation, and 4) Satisfaction with care.Conclusion: The findings of the study indicated that due to insufficient equipment, high workloads, and anxieties, nurses and attendants might not be able to understand each other’s roles and expectations. If it is not resolved properly, this situation will end in conflicts and stagnation in healthcare. Patients admitted to an intensive care unit are usually in critical health conditions. However, nurses feel satisfied with the outcome of their jobs when those patients are discharged from the hospital with a stable health condition. Shedding more light on the humanistic care status in intensive care units in Iran, the results of this research can be applied to health professionals and nursing managers.

Acute respiratory distress syndrome (ARDS) is a clinical syndrome consisting of tachypnea, refractory hypoxemia, and diffuse opacities on chest radiographs after infection or trauma which ultimately leads to respiratory failure. The principles of treatment are based on patient care in ICU, mechanical ventilation and medical treatments. By using lower plateau, less tidal volume, higher positive end-expiratory pressure, fluid restriction, treatment of infections and avoiding any high-dose steroids can improve the survival of these patients. In this paper, we present a case of ARDS in a patient with suspected influenza.