Nurses' performance in using the APACHE score: Its effect on outcomes of patients with cardiac surgery

The Acute Physiology and Chronic Health Evaluation (APACHE) score was developed to assess disease severity. Once organ failure develops, laboratory values and hemodynamic parameters should be monitored to assess the degree of impairment. This study aimed to assess nurses' performance regarding using the APACHE scoring system and its effect on the outcomes of patients with cardiac surgery. A quasi-experimental research design (one group pretest and post-test) was used to achieve the aim of this study. The convenience sample consisted of all available nurses (n=50) working in intensive care units of cardiac surgery at Ain Shams Specialized Hospital and in the Cardiovascular and Thoracic Academy affiliated with Ain Shams University hospitals. Additionally, a purposive sample of 130 patients with cardiac surgery was included in this study. Data was collected using nurses' self-administered questionnaires, observation checklists for nurses, attitude scales of nurses, patient assessment questionnaires, and nursing-sensitive patient outcomes measuring scales. The findings showed a highly statistically significant difference between the mean score of total nurses' level of knowledge, practice, and attitude before and after the educational program. Also, a highly statistically significant difference was observed in the total score of patient outcomes before and after the implementation of the educational program. Implementing an educational program positively affected nurses' performance; the APACHE score has an efficient and comparable discriminative ability to predict the outcomes of patients undergoing cardiac surgery. The study recommends conducting periodic training programs for nurses in cardiac surgery intensive care units to equip them with the latest knowledge and skills in using the APACHE scoring system to predict patient outcomes and complications within the first 24 hours.

The toxic effects of anabolic steroids "nandrolone decanoate" on cardiac and skeletal muscles with the potential ameliorative effects of silymarin and fenugreek seeds extract in adult male albino rats

BACKGROUND

Anabolic steroids (AS) are commonly abused by body builders and athletes aiming to increase their strength and muscle mass but unfortunately, the long-term use of AS may lead to serious side effects. Nandrolone Decanoate is one of the Class II anabolic androgenic steroids which quickly spread globally and used clinically and illicitly. Our research was directed to assess the toxic effects of anabolic steroids on cardiac and skeletal muscles in male albino rats and to evaluate the potential ameliorative effects of fenugreek seeds extract and silymarin.

METHODS

Our research was done on 120 male albino rats that were allocated into 6 groups; group I: Served as a control group, group II: Received the anabolic steroid Nandrolone Decanoate, group III: Received silymarin orally, group IV: Received fenugreek seeds extract orally, group (V): Received the anabolic steroid Nandrolone Decanoate and silymarin and group (VI): Received the anabolic steroid Nandrolone Decanoate and fenugreek seeds extract. By the end of the study, rats were sacrificed, and blood samples were collected for biochemical analysis and autopsy samples for histopathological examination.

RESULTS

The anabolic steroids toxic effects on rats showed a significant decrease in serum High Density Lipoprotein (HDL) level and increase in cholesterol, triglycerides, and Low-Density Lipoprotein (LDL) levels. There was a significant elevation in cardiac troponin I level. As regards to histopathological examination of the cardiac and skeletal muscles, the study showed marked degenerative changes and necrosis. Both silymarin and fenugreek seeds extract provided a protective effect on the biochemical and histopathological changes. The antioxidant effects of silymarin and fenugreek seeds extract were evaluated on the heart, skeletal muscles and showed that, the tissue levels of Superoxide dismutase (SOD), Catalase and reduced glutathione (GSH) decreased in AS treated rats compared to the control group. On the other hand, the tissue Malondialdehyde (MDA) levels were elevated.

CONCLUSIONS

Anabolic steroids have a toxic effect on the cardiac and skeletal muscles of albino rats with improvement by treatment with fenugreek seeds extract and silymarin.

Levels of evidence and journal impact factor in oral and maxillofacial surgery: a 15-year follow-up

This study was performed to assess changes over time in the quality of research in oral and maxillofacial surgery (OMS) by examining the level of evidence of published articles. A secondary aim was to determine the relationship of the journal impact factor to these levels of evidence. The four major OMS journals with an impact factor were assessed. Articles published in 2017 and 2018 were categorized based on their level of evidence, and their correlation with the 2019 journal impact factor was investigated using Spearman's rank correlation coefficient (rho). The total number of published articles increased by a factor of 2.4 over a 15-year period, from 932 in 2002-2003 to 2253 in 2017-2018. The percentage of articles increased by 1.0% for level I evidence, 3.4% for level II, 8.2% for level III, and 4.1% for level IV. Non-evidence articles reduced by 16.7%. All journals showed an increase in impact factor, and a significant correlation was noted between the proportion of published higher-level evidence articles and the impact factor over time (rho=0.811, P=0.001). It is concluded that OMS journals currently display a higher proportion of good quality articles leading to a better impact factor than 15 years ago.

Non-pulsatile traumatic pseudoaneurysm of the internal maxillary artery following trauma to mandible

Traumatic pseudoaneurysm involving the maxillary artery is rare. Owing to its anatomic location, internal maxillary artery is usually protected by its surrounding structures. Formation of pseudoaneurysm usually takes place after several weeks to months of the initial injury. In this case, we reported a pseudoaneurysm arising from left internal maxillary artery following blunt injuries within 3 hours after a road accident and the treatment with endovascular embolization with titanium coils prior to open reduction and internal fixation of the fractured mandibles.

The impact of case reports in oral and maxillofacial surgery

This review examines the effect of publishing case reports on journal impact factor and future research. All case reports published in the four major English language oral and maxillofacial surgery journals in the two year period, 2007-2008, were searched manually. The citation data of each case report were retrieved from the ISI online database. The number, percentage and mean citations received by case reports and their relation to the 2009 journal impact factor were analysed. Case reports which received more than 5 citations were also identified and all of the citing articles retrieved and analysed. Thirty-one percent of all articles published in major oral and maxillofacial journals in 2007-2008 were case reports. Case reports had a low citation rate with a mean citation of less than 1. There were 38 (7.2%) case reports with more than 5 citations and 30% of the citing articles were also case reports. The publication of case reports negatively affected journal impact factor which correlated directly with the percentage of case reports published within a journal. Case reports reporting recent topics, describing new treatment/diagnosis method and with a literature review were more likely to receive citations.

[Post-partum cerebral thrombophlebitis: three cases]

Post-partum cerebral thrombophlebitis is a rare accident (1/3000 to 1/10000 births). Symptoms vary and may be misleading. We report three cases of cerebral thrombophlebitis occurring during the pospartum period where diagnosis was based on clinical signs and imaging data (computed tomography and cerebral angiography). Heparin therapy led to good outcome in all three cases. Heparin therapy has been controversial for these patients but recent work has shown improvement in this severe conditions with very poor prognosis.

[Pregnancy in patients with Behçet's disease]

INTRODUCTION

Behçet's disease is particularly frequent in the Mediterranean countries and in the Far East. Its predominance in men is the reason why its association with pregnancy has rarely been reported in the literature.

OBSERVATIONS

Three pregnancies occurred in two patients with Behçet's disease. In the first case the disease was diagnosed post partum. The second pregnancy in a stabilized patient was complicated by depression and abortion at 16 weeks of amenorrhea. The second patient presented with an articular episode after delivery, requiring an increase in dose of corticosteroids.

COMMENTS

The interventions between pregnancy and Behçet's disease are obscure. The progression of the disease varies from one women to another and from one pregnancy to the next in the same woman. The observations reported here add to those describing aggravation of Behçet's disease during or after pregnancy.

[Norplant. Experiences at the maternity services of Orangers in Rabat during two years]

Norplant is a pure progestative method which couples efficaciousness, reversibility and a period of prolonged action. We have counted 189 insertions since March 1993, the date of the introduction of this contraceptive method in the center of family planning at the university maternity of Orangers. The analytical study of different parameters collected in admission files and preestablished control allowed to draw the epidemiologic profile of the patients as well as acceptability, the tolerance and the efficiency of this method.

[Struma ovarii. A case report]

Struma ovarii is a rare ovarian tumor composed entirely or in part of thyroid tissue. Pathogenesis is unclear. Diagnosis rests on the histologic study. A case is reported. Specific features of struma ovarii are discussed based on a review of the literature. The treatment is surgical and the outcome generally favorable.