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Background & objective: Patients in the intensive care unit have a high prevalence of vitamin D deficiency (VDD). In the present study, clinical outcomes in the ICU were analyzed with vitamin D status. Materials and methods: In this prospective, multicenter study, sampling was conducted on seven ICUs in three hospitals. Within the first 24 h of ICU admission, patient's serum vitamin D levels were measured, and their disease severity was monitored using the scores of acute physiologic assessment and chronic health evaluation II (APACHE II), sequential organ failure assessment (SOFA), and the modified Nutrition Risk in Critically ill (mNUTRIC) score. Results: A total of 236 patients were enrolled in this study, of which 163 (69.1%) had lower vitamin D levels than 20 ng/ml upon ICU admission. The patients with VDD had higher APACHE II scores)P = 0.02), SOFA scores (P < 0.001), and mNUTRIC scores (P = 0.01). Patients with sufficient levels of vitamin D (> 30 ng/ml) had a shorter stay at ICU (P < 0.001). VDD was independently associated with 28-day mortality (OR: 4.83; 95% CI: 1.63–14.27; P = 0.004). Conclusion: The data showed that VDD was common among the critically ill and was related to a more severe course of illness and a higher mortality rate. [ABSTRACT FROM AUTHOR]

Introduction: Most Ramadan fasting studies are usually conducted over one-year periods and show the short-term effects of Ramadan fasting. There is no standard tool or questionnaire to evaluate people's fasting habits and Ramadan fasting long term effects. For the first time, we designed a study to develop and validate a questionnaire to evaluate people's fasting habits as a tool for the determination of shortterm and long-term Ramadan fasting effects. Methods: After designing the questionnaire, it was sent to 10 experts in this field for judging and commenting (content validity). The validity of the questionnaire was evaluated using the Content Validity Ratio (CVR) index> 0.62, which includes the questionnaire's essentiality, relevancy, clarity, and comprehensiveness. In order to check the questionnaire reliability, the "test-retest method" was applied among 10 individuals. Results: After multiple drafts, the questionnaire contained 16 items, categorized into "Basic information on fasting (demographic information)", and "Fasting nutritional habits" including 13 and 3 questions, respectively. The overall CVR for relevancy, clarity, and comprehensiveness of the tool were 0.92, 0.95, 0.97, and 0.95, respectively. The Pearson correlation coefficient of the test-retest stage was 0.85. Conclusions: This Ramadan fasting habits questionnaire demonstrated strong content validity and testretest reliability. It can be an appropriate instrument for the evaluation of Ramadan fasting basic information and nutritional habits in research or practice-oriented settings for the determination of short-term and long-term Ramadan fasting effects. [ABSTRACT FROM AUTHOR]

Inflammation plays an important role in the outcome of patients with cystic fibrosis (CF). It may develop due to cystic fibrosis transmembrane conductance regulator protein dysfunction, pancreatic insufficiency, or prolonged pulmonary infection. Fecal calprotectin (FC) has been used as a noninvasive method to detect inflammation. Therefore, the aim of the current metaanalysis was to investigate the relationship between FC and phenotype severity in patients with CF. In this study, searches were conducted in PubMed, Science Direct, Scopus, and Embase databases up to August 2021 using terms such as "cystic fibrosis," "intestine," "calprotectin," and "inflammation." Only articles published in English and human studies were selected. The primary outcome was the level of FC in patients with CF. The secondary outcome was the relationship between FC and clinical severity. Statistical analysis was performed using Comprehensive Meta-Analysis software. Of the initial 303 references, only six articles met the inclusion criteria. The mean (95% confidence interval [CI]) level of FC was 256.5 mg/dL (114.1-398.9). FC levels were significantly associated with pancreatic insufficiency (mean, 243.02; 95% CI, 74.3 to 411.6; p=0.005; I2=0), pulmonary function (r=-0.39; 95% CI, -0.58 to -0.15; p=0.002; I2=60%), body mass index (r=-0.514; 95% CI, 0.26 to 0.69; p<0.001; I2=0%), and Pseudomonas colonization (mean, 174.77; 95% CI, 12.5 to 337.02; p=0.035; I2=71%). While FC is a reliable noninvasive marker for detecting gastrointestinal inflammation, it is also correlated with the severity of the disease in patients with CF. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to determine the efficacy of using 3D printing models in the learning process of orbital anatomy and pathology by ophthalmology residents. Methods: A quasi-experimental study was performed with 24 residents of ophthalmology at Mashhad University of Medical Sciences. Each stratum was randomized into two groups. The educational booklets were distributed, and various forms of orbital 3D models were printed from orbital computed tomography (CT) scans. Knowledge enhancement on the topics was measured by comparing pretest and posttest scores. Results: Thirteen residents who were trained using traditional methods were deemed the control group; while 11 residents who were trained using the 3D printed models were classed as the intervention group. The control group was younger than the intervention group (P = 0.047). The results showed that there was a statistically significant difference in the total posttest scores between the two groups. Based on the repeated measures of the analysis of variance (ANOVA), score variables were significant between the two groups (P = 0.008). Interestingly, the use of the 3D educational model was more effective and statistically significant with the year one residents as compared to the year two residents (P = 0.002). Conclusion: This study is the first one in Iran quantifying the effects of learning using 3D printed models in medical education. In fact, 3D modeling training is seemingly effective in teaching ophthalmic residents. As residents have never encountered such technology before, their experience using 3D models proved to be satisfactory and had a surprising positive effect on the learning process through visual training. [ABSTRACT FROM AUTHOR]

Appendectomy is accepted as the standard treatment of acute appendicitis, but in complicated cases, the treatment of choice is not straightforward. In this prospective study, we compared failure rate, complications, and recurrence rate of three different approaches to complicated appendicitis. In a 5-year prospective cohort study, patients with appendicular phlegmon were studied in three groups based on the treatment protocols. Group A included patients who underwent an appendectomy; patients of group B were treated by interval appendectomy; and in group C, conservative management was performed without interval appendectomy. Data analysis was performed using SPSS version 11.5. In total, 3896 patients with acute appendicitis were admitted, and 127 patients with complicated appendicitis were treated. Fifty-four patients were excluded from the study. Differences in age, gender, weight, and duration of symptoms were not statistically significant in the three groups. In group A (N = 23), appendectomy was impossible in 4 patients and 5 patients experienced complications. In group B (N = 24), two patients underwent exploration and appendectomy. In another two patients, a recurrent episode of acute appendicitis with mild signs and symptoms occurred after discharge from the hospital. In group C (N = 25), three patients experienced a recurrent appendicitis. Interval appendectomy is not indicated in all patients and continuous non-operative management may be appropriate in some patients. As the epidemiology of colorectal cancer and inflammatory bowel diseases is different in Iran, we recommend other researchers to perform a cost-effectiveness analysis on colon and appendicular neoplasms workup after non-operative management of complicated appendicitis. [ABSTRACT FROM AUTHOR]

Introduction: Psychiatric disorders are gaining top rank in causing the burden of diseases. Certainly understanding the risk factors and their trends can help prevent and control them. This study aimed to investigate the epidemiologic characteristics of psychiatric disorders leading to hospitalization in Mashhad city. Materials and Methods: This cross-sectional study was carried out at the Ibn-e-Sina Psychiatric Hospital in Mashhad, Iran, from March, 21th, 2010 to March 19th, 2016. All of the recorded data for admitted patients during this period have been included. SPSS software version 16 was used for data analysis. Results: In this study, 43770 hospital admissions had occurred which was reduced to 4333 cases after aggregating readmissions. The mean age was 42.2 ± 12.5 years, and the highest prevalence rate was observed in the age group of 50- 59 years (352 in 100000 of the population). Most admitted patients were male (75%, 3234), married (60%, 2523) and unemployed (71%, 2740). The most common admission cause was mood disorders in both genders (51% of females and 37% of males, P<0.001). The prevalence of psychiatric disorders leading to hospitalization was declining during the study period. Conclusion: The decreasing level of the psychiatric hospitalization can imply the proper functioning of the health system. The continuation of existing activities, focusing on mood disorders (as the most common cause of admission) and designing targeted interventions for high-risk groups (married unemployed men) can increase their effectiveness. [ABSTRACT FROM AUTHOR]

Background: Enteral feeding intolerance, energyprotein malnutrition, and muscle wasting are common conditions in the critical care setting. The primary aim of this study was to investigate the effect of synbiotic supplementation on enteral feed volume, energy and protein homeostasis, and muscle mass maintenance in critically ill adult patients. Methods: A consecutive of 42 patients admitted to the Edalatian Medical ICU, requiring enteral nutrition (EN) were prospectively randomized to receive the synbiotic capsule (containing a combination of Lactobacillus, Bifidobacterium, Streptococcus, and fructooligosaccharides) or placebo (21 patients in each group) for a maximum of 14 days. Results: Mean EN volume, energy, and protein intake were 962.5±533.82 ml, 770±427.05 kcal and 38.5±21.35 g (fourth day) vs. 590±321.1 ml, 472±256.81 kcal, and 23.6±12.84 g (first day) in the synbiotic group (p<0.05). Changes in the placebo group were not statistically significant. On day 1 nitrogen balance (NB) was -19.84±8.03 in the synbiotic vs. -10.99±9.12 in the placebo group (p=0.003). On day 14, NB was -14.18±13.05 in the synbiotic and -9.59±7.71 in the placebo group (p=0.41). Mid-arm circumference (MAC), 24-hour urine creatinine, and creatinine-height index were almost steady in the synbiotic group, while they decreased in the placebo group. Conclusion: Overall, it can be concluded that enteral nutrition supplemented with synbiotics may increase enteral feed volume, energy and protein intake during the first four days. It is also associated with nitrogen balance improvement and muscle mass maintenance of critically ill adult patients. [ABSTRACT FROM AUTHOR]

Background: Gut microbiota dysbiosis, endotoxemia, and systemic inflammation are major contributing factors to disease pathophysiology in critically ill patients. The present study aimed to assess the effects of synbiotic supplementation on the serum endotoxin and inflammation of critically ill adult patients. Materials: This double-blind, randomized, controlled trial was conducted at the intensive care unit (ICU) of Imam Reza Hospital in Mashhad, Iran. In the intervention group, 20 patients received synbiotic capsules (containing a combination of Lactobacillus, Bifidobacterium, Streptococcus, and fructooligosaccharides) twice per day for a maximum of 14 days. In the control group, 18 patients received placebo capsules. The serum levels of endotoxin and C-reactive protein (CRP) and the neutrophil-to-lymphocyte ratio (NLR) were measured before and after the intervention. In addition, clinical outcomes and the scores of Acute Physiology and Chronic Health Evaluation (APACHE II) and Sequential Organ Failure Assessment (SOFA) were recorded. Results: Basic characteristics were similar in the intervention and control groups. The NLR and serum endotoxin levels significantly reduced in the synbiotic group (7.83 [4.58-12.57]-6.01 [4.25-9.38]; P= 0.04 and 11.98 [10.64-12.65]- 10.58 [9.41-12.34]; P=0.03, respectively). However, no significant changes were observed in the mentioned parameters in the placebo group. The clinical outcomes were also similar in the study groups, such as the length of hospital/ICU stay and hospital/28-day mortality rate. Conclusion: Although synbiotic supplementation (500 mg twice daily for 14 days) could reduce serum endotoxin and inflammatory markers, it had no effects on the clinical outcomes of the patients. [ABSTRACT FROM AUTHOR]

Introduction: Infection is an important cause of mortality in burns. It has been estimated that 75% of all deaths following thermal injuries are related to infections. The rate of nosocomial infections are higher in burn patients due to various factors like nature of burn injury itself, immunocompromised status of the patient, invasive diagnostic and therapeutic procedures and prolonged ICU stay.The study was carried out to determine the bacterial profile and antimicrobial susceptibility of the isolates and to describe the change in trends over the study period. Methods: A retrospective study of major aerobic bacterial isolates from pus/wound swabs taken from patients admitted to the burn intensive care unit (BICU) at Imam Reza Hospital, Mashhad, Iran, over a period of 3 years (March 2012-March 2015) was undertaken The specimens were cultured using aerobic microbiological techniques. Antimicrobial susceptibility testing to different agents was carried out using the disc diffusion method. Results: Of 1163 cultures 145 of them (12.5%) were negative. Acinetobacter spp. was found to be most common isolate (41%) followed by Pseudomonas aeruginosa (17.5%), Klebsiella spp. (16.9%), Proteus spp. (3.3%), Enterobacter spp. (2%), Staphylococcus aureus (1.2%) and others (5.6%). Although Acinetobacter spp. continued to remain the predominant isolate over the three years, a constant and significant increase in the incidence of Klebsiellaspp. and Acinetobacter spp. were found. Colomycin was found to be the most effective drug against gram negative bacteria, however, resistance to it was significantly increased over 3 years. For S.aureus Vancomycin (95.3% Suseptible) found to be the most effective drugs. Most of the isolates showed high level resistance to antimicrobial agents. Susceptibility of P. aeruginosa to ceftazidime has decreased markedly. Conclusion: In-depth knowledge of the bacteria causing infectious complications and of their antibiotic susceptibilities is a prerequisite for treating burn patients. Our study shows shifts in the microbial spectrum and their antibiogram, which mandate frequent reassessments. [ABSTRACT FROM AUTHOR]