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Vahedian-Azimi A, Bashar FR, Jafarabadi MA, Stahl J, Miller AC. Protocolized ventilator weaning verses usual care: A randomized controlled trial. Int J Crit Illn Inj Sci 2020; 10:206-212. [PMID: 33850830 PMCID: PMC8033208 DOI: 10.4103/ijciis.ijciis_29_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 03/27/2020] [Indexed: 11/19/2022] Open
Abstract
Background: Protocolized ventilator weaning (PW) strategies utilizing spontaneous breathing trials (SBTs) result in shorter intubation duration and intensive care unit (ICU) length of stay (LOS). We compared respiratory therapy (RT)-driven PW versus usual care (UC) as it pertains to physiologic respiratory parameters, intubation duration, extubation success/reintubation rates, and ICU LOS. Methods: prospective, multicentric, randomized controlled trial was performed in closed medical and surgical ICUs with 24/7 in-house intensivist coverage at six academic medical centers in a resource-limited setting from October 18, 2007, to May 03, 2014. Extubation readiness was determined by the attending physician (UC) or the respiratory therapist (PW) using predefined criteria and SBT. Physiologic variables, serial blood gas measurements, and weaning indices were assessed including the Rapid Shallow Breathing Index (RSBI), negative inspiratory force (NIF), occlusion pressure (P0.1), and dynamic and static compliance (Cdyn and Cs). Results: total of 5502 patients were randomized (PW 2787; UC 2715), of which 167 patients died without ventilator weaning (PW 90; UC 77) and 645 patients were excluded (PW 365; UC 280). Finally, a total of 4200 patients were analyzed (PW 2075; UC 2125). The PW group displayed improvements in minute ventilation (P < 0.001), Cs and Cdyn(both P < 0.05), P0.1 (P < 0.001), NIF (P < 0.001), and RSBI (P < 0.001). Early re-intubation (≤48 h) rates were lower in the PW group (16.7% vs. 24.8%; P < 0.0001), as were late re-intubation rates (5.2% vs. 25.8%; P < 0.0001). Intubation duration was longer in the PW group (P < 0.001), however, hospital LOS was shorter (P < 0.001). Mortality was unchanged (P = 0.19). Conclusion: PW with RT-driven extubation decisions is safe, effective, and associated with decreased re-intubation (early and late), shorter hospital stays, increased intubation duration (statistically but not clinically significant), and unchanged in-patient mortality.
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Affiliation(s)
- Amir Vahedian-Azimi
- Trauma Research Center, Faculty of Nursing, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Farshid Rahimi Bashar
- Department of Anesthesia and Critical Care, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mohammad A Jafarabadi
- Road Traffic Injury Prevention Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Jennifer Stahl
- Department of Internal Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Vidant Medical Center, East Carolina University Brody School of Medicine, Greenville, NC, USA.,Department of Emergency Medicine, Vidant Medical Center, East Carolina University Brody School of Medicine, Greenville, NC, USA
| | - Andrew C Miller
- Department of Emergency Medicine, Vidant Medical Center, East Carolina University Brody School of Medicine, Greenville, NC, USA.,Department of Emergency Medicine, Nazareth Hospital, Philadelphia, PA, USA
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Salekzamani S, Mehralizadeh H, Ghezel A, Salekzamani Y, Jafarabadi MA, Bavil AS, Gargari BP. Effect of high-dose vitamin D supplementation on cardiometabolic risk factors in subjects with metabolic syndrome: a randomized controlled double-blind clinical trial. J Endocrinol Invest 2016; 39:1303-1313. [PMID: 27400997 DOI: 10.1007/s40618-016-0507-8] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 06/23/2016] [Indexed: 01/10/2023]
Abstract
PURPOSE The evidence in support of the effect of vitamin D deficiency on cardiovascular diseases is inconsistent. The objective of this randomized, controlled, double-blind study was to assess the effect of high-dose vitamin D supplementation on cardiometabolic risk factors in subjects with metabolic syndrome. METHODS Eighty subjects were randomized to receive 50,000 IU vitamin D or matching placebo weekly for 16 weeks. Fasting blood sugar, homeostasis model assessment of insulin resistance, insulin sensitivity (Quicki), serum lipid profiles (low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglyceride (TG) and total cholesterol), anthropometric factors and blood pressure were assessed before and after intervention. Dietary intake and sun exposure were also determined. The trial was registered at http://www.irct.ir (code: IRCT201409033140N14). RESULTS Participants were 40.49 ± 5.04 years and 49 % male. All of the intervention group and 97 % of placebo group were vitamin D deficient or insufficient (25-hydroxyvitamin D <75 nmol/L). After intervention, serum 25(OH)D concentration was increased by 61.93 nmol/L in intervention group, while it was decreased in placebo group (p < 0.001). There was a significant change in TG concentration after 4 months (p < 0.001). Other metabolic or anthropometric factors did not change significantly (p = 0.05). CONCLUSION Supplementation with high-dose vitamin D for 4 months improved vitamin D status and decreased TG levels in subjects with metabolic syndrome. However, it did not have any beneficial effects on other cardiometabolic risk factors; this might be due to the inadequate vitamin D status attained in this study which was conducted in a severely deficient region.
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Affiliation(s)
- S Salekzamani
- Student Research Committee, Faculty of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - H Mehralizadeh
- Student Research Committee, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - A Ghezel
- Student Research Committee, Faculty of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Y Salekzamani
- Physical Medicine and Rehabilitation Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - M A Jafarabadi
- Road Traffic Injury Research Center, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - A S Bavil
- Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - B P Gargari
- Nutrition Research Center, Faculty of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Golgasht St., Attar Neyshapouri Av., 5166614, Tabriz, Iran.
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Vafaei A, Ranjkesh B, Lovschall H, Erfanparast L, Jafarabadi MA, Oskouei SG, Isidor F. Survival of Composite Resin Restorations of severely Decayed Primary Anterior Teeth retained by Glass Fiber Posts or Reversed-orientated Metal Posts. Int J Clin Pediatr Dent 2016; 9:109-13. [PMID: 27365929 PMCID: PMC4921877 DOI: 10.5005/jp-journals-10005-1344] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 12/21/2015] [Indexed: 11/23/2022] Open
Abstract
Aim: The aim of this study was to compare the survival of composite resin restorations retained by glass fiber posts or reversed-orientated (upside-down) metal posts in severely decayed primary anterior teeth after 6, 12, and 18 months. Materials and methods: A total of forty-four 3- to 5-year-old children with bilateral severely decayed primary maxillary canines were included. Patients were treated under general anesthesia. After pulpectomy, an intracanal post was seated in the primary maxillary canine on each side: either a glass fiber post or a metallic post in reversed orientation and teeth restored with light-cured composite. Survival rate of each technique was evaluated at predetermined follow-ups and data were analyzed with McNemar’s test (α = 0.05). Results: The difference in survival of restorations retained by two types of posts was not statistically significant in clinical and radiographical evaluations after 6, 12, and 18 months. The survival rate of reversed-orientated metal and glass fiber posts after 18 months was 81.1 and 67.6% respectively (p = 0.14). Conclusion: Reversed-orientated metal post did not show lower clinical survival compared with glass fiber posts in 18-month follow-up. Hence, reversed-orientated metal post can be considered as a potential method to obtain retention for composite restorations in severely decayed primary anterior teeth. How to cite this article: Vafaei A, Ranjkesh B, L0vschall H, Erfanparast L, Jafarabadi MA, Oskouei SG, Isidor F. Survival of Composite Resin Restorations of severely Decayed Primary Anterior Teeth retained by Glass Fiber Posts or Reversed-orientated Metal Posts. Int J Clin Pediatr Dent 2016;9(2):109-113.
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Affiliation(s)
- Ali Vafaei
- Assistant Professor, Department of Pediatric Dentistry, School of Dentistry, Tabriz University of Medical Sciences, East-Azarbayjan, Tabriz, Iran
| | - Bahram Ranjkesh
- Fellow, Section of Dental Pathology, Operative Dentistry and Endodontics, Department of Dentistry, Aarhus University-Health, Midtjylland, Aarhus, Denmark
| | - Henrik Lovschall
- Associate Professor, Section of Dental Pathology, Operative Dentistry and Endodontics, Department of Dentistry, Aarhus University-Health, Midtjylland, Aarhus, Denmark
| | - Leila Erfanparast
- Assistant Professor, Department of Pediatric Dentistry, School of Dentistry, Tabriz University of Medical Sciences, East-Azarbayjan, Tabriz, Iran
| | - Mohammad A Jafarabadi
- Assistant Professor, Department of Statistics and Epidemiology, Tabriz University of Medical Sciences, East-Azarbayjan, Tabriz, Iran
| | - Sina Ghertasi Oskouei
- Dentist, School of Dentistry, Tabriz University of Medical Sciences East-Azarbayjan, Tabriz, Iran
| | - Flemming Isidor
- Professor, Section of Prosthetic Dentistry, Department of Dentistry Aarhus University-Health, Midtjylland, Aarhus, Denmark
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Milani AS, Zand V, Abdollahi AA, Froughreyhani M, Zakeri-Milani P, Jafarabadi MA. Effect of Topical Anesthesia with Lidocaine-prilocaine (EMLA) Cream and Local Pressure on Pain during Infiltration Injection for Maxillary Canines: A Randomized Double-blind clinical trial. J Contemp Dent Pract 2016; 17:592-596. [PMID: 27595728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVES This study compared the effect of local pressure and topical lidocaine-prilocaine (EMLA) cream on pain during infiltration injection for maxillary canine teeth. MATERIALS AND METHODS A total of 140 volunteer students participated in this split-mouth design randomized clinical trial. The subjects were randomly divided into four groups (n = 35). Before administration of anesthesia, in each group, one side was randomly selected as the experimental and the opposite side as the control. In group 1, finger pressure was applied on the alveolar mucosa on the experimental side and on the tooth crown on the control side. In group 2, 5% EMLA cream and placebo; in group 3, finger pressure and 5% EMLA cream; and in group 4, 5% EMLA cream and 20% benzocaine gel were applied. In all the groups, a buccal infiltration procedure was carried out. Pain during injection was recorded with visual analog scale (VAS). Wilcoxon and McNemar tests were used for statistical analysis of the results. Statistical significance was set at p < 0.05. RESULTS The results showed that EMLA reduced the injection pain significantly more than benzocaine (p = 0.02). Also, injection pain was significantly lower with the use of EMLA in comparison to placebo (p = 0.00). Application of local pressure reduced the injection pain, but the difference from the control side was not significant (p = 0.05). Furthermore, the difference between application of local pressure and EMLA was not statistically significant (p = 0.08). CONCLUSION Topical anesthesia of 5% EMLA was more effective than 20% benzocaine in reducing pain severity during infiltration injection. However, it was not significantly different in comparison to the application of local pressure.
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Affiliation(s)
- Amin S Milani
- Dental and Periodontal Research Center, Faculty of Dentistry Tabriz University of Medical Sciences, Tabriz, Islamic Republic of Iran
| | - Vahid Zand
- Dental and Periodontal Research Center, Faculty of Dentistry Tabriz University of Medical Sciences, Tabriz, Islamic Republic of Iran
| | - Amir A Abdollahi
- Postgraduate Student, Dental and Periodontal Research Center, Department of Endodontics, Student Research Committee, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Islamic Republic of Iran, Phone: +989144091317, e-mail:
| | - Mohammad Froughreyhani
- Dental and Periodontal Research Center, Faculty of Dentistry Tabriz University of Medical Sciences, Tabriz, Islamic Republic of Iran
| | - Parvin Zakeri-Milani
- Department of Pharmaceutics, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Islamic Republic of Iran
| | - Mohammad A Jafarabadi
- Department of Biostatistics, Department of Statistics and Epidemiology, Faculty of Health and Nutrition, Tabriz University of Medical Sciences, Tabriz, Islamic Republic of Iran
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Roshanaei S, Shaghaghi A, Jafarabadi MA, Kousha A. Measuring unintended pregnancies in postpartum Iranian women: validation of the London Measure of Unplanned Pregnancy. East Mediterr Health J 2015; 21:572-8. [PMID: 26446528 DOI: 10.26719/2015.21.8.572] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 06/01/2015] [Indexed: 11/09/2022]
Abstract
Research suggests a relatively sizable rate of unintended pregnancies in some subgroups of Iranian women, but there is no concise, standard scale to measure the pregnancy intention of Iranian women. Therefore, the psychometric properties of the Persian version of the London Measure of Unplanned Pregnancy (LMUP) were investigated. The Persian version of the LMUP was tested on randomly selected married women aged 15-49 years in the city of Ajabshir, East Azerbaijan province, north-west of Islamic Republic of Iran. The scale's face validity and internal consistency was examined and its construct validity was tested by exploratory factor analysis. The internal consistency of the scale was acceptable (Cronbach alpha coefficient 0.87). Structural indicators of the Kaiser-Meyer- Olkin measure (0.85) and Bartlett test of sphericity (P < 0.001) verified interpretability of the exploratory factor analysis output. Applicability of the Persian version of the LMUP is accepted. Further investigation is needed to understand cultural norms that might influence Iranian women's responses to queries about pregnancy intentions.
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Affiliation(s)
- S Roshanaei
- Health Education and Promotion Department, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Islamic Republic of Iran
| | - A Shaghaghi
- Health Education and Promotion Department, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Islamic Republic of Iran
| | - M A Jafarabadi
- Road Traffic Injury Research Centre, Tabriz University of Medical Sciences, Tabriz, Islamic Republic of Iran
| | - A Kousha
- Health Education and Promotion Department, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Islamic Republic of Iran
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