Background:Usually the chest tube removal (CTR) has been described as one of the worst experiences by patients in the intensive care unit.Aim:This study aimed to compare the effects of cold therapy and relaxation on pain of CTR among the patients undergoes coronary artery bypass graft surgery.Materials and Methods:This single-blinded clinical trial was done on 80 post-cardiac surgery patients in the heart hospital of Sari-Iran. The patients were assigned to three randomized groups that included cold therapy, relaxation, and control groups. Data analysis was done by T-test, Chi-square, generalized estimating equations and repeated measures analysis variance tests.Results:The groups had no significant differences in pain intensity before CTR (P = 0.84), but immediately after CTR there was a significant difference between the treatment (cold application and relaxation groups) and control groups (P = 0.001). There was no significant difference between relaxation and cold therapy groups.Conclusion:Regarding the relaxation and cold application methods showed relatively equal effects on reducing the pain owing to CTR. Thus, the use of relaxation because of economics, without side effects, easy to use and effective is recommended by the authors to the practitioners.

BackgroundTraumatic brain injury (TBI) is a common cause of mortality and disability worldwide. Choosing an appropriate diagnostic tool is critical in early stage for appropriate decision about primary diagnosis, medical care and prognosis.ObjectivesThis study aimed to compare the Glasgow coma scale (GCS), full outline of unresponsiveness (FOUR) and acute physiology and chronic health evaluation (APACHE II) with respect to prediction of the mortality rate of patients with TBI admitted to intensive care unit.Patients and MethodsThis diagnostic study was conducted on 80 patients with TBI in educational hospitals. The scores of APACHE II, GCS and FOUR were recorded during the first 24 hours of admission of patients. In this study, early mortality means the patient death before 14 days and delayed mortality means the patient death 15 days after admitting to hospital. The collected data were analyzed using descriptive and inductive statistics.ResultsThe results showed that the mean age of the patients was 33.80 ± 12.60. From a total of 80 patients with TBI, 16 (20%) were females and 64 (80%) males. The mortality rate was 15 (18.7%). The results showed no significant difference among three tools. In prediction of early mortality, the areas under the curve (AUCs) were 0.92 (CI = 0.95. 0.81 - 0.97), 0.90 (CI = 0.95. 0.74 - 0.94), and 0.96 (CI = 0.95. 0.87 - 0.9) for FOUR, APACHE II and GCS, respectively. In delayed mortality, the AUCs were 0.89 (CI = 0.95. 0.81-0.94), 0.94 (CI = 0.95. 0.74 - 0.97) and 0.90 (CI = 0.95. 0.87 - 0.95) for FOUR, APACHE II and GCS, respectively.ConclusionsConsidering that GCS is easy to use and the FOUR can diagnose a locking syndrome along same values of subscales. These two subscales are superior to APACHI II in prediction of early mortality. Conversation APACHE II is more punctual in the prediction of delayed mortality.

Introduction: Patients admitted to the intensive care unit express the chest tube removal as one of their worst experiences. In spite of scientific advances, no effective action is taken to reduce the pain due to it. Therefore, the aim of this study was to investigate the effect of respiratory relaxation on the severity of pain resulting from the removal of chest tube after coronary artery bypass graft. Methods: This single blind randomized trial was performed in 2016 on 80 patients with open heart surgery with only one mediastinal chest tube. Patients were randomly divided into case and control groups. In the case group, relaxation and relaxation breathing exercises were used for 5 minutes before the tube was exhausted. The severity of pain was measured by visual analog scale before, immediately and 15 minutes after the removal of the chest tube. Data analysis was performed using common tests. Results: The results showed that there was no significant difference between the severity of pain in both groups before the removal of the chest tube (P=0.84). It was also found that there was a significant difference between the severity of pain immediately after the discharge of the tube in the case group (P=0.0001), but there was no significant difference between the intensity of pain 15 minutes after the withdrawal of the tubes in the case and control groups (P=0.21). Conclusion: Respiratory relaxation is an effective technique for the pain intensity of postoperative chest tube after open heart surgery. It is recommended to use this method before tubing, due to lack of cost, ease of use and effectiveness.

It can be challenging to create a safe airway in maxilla facial fracture and some skull surgeries. In this case study, the patient experienced jaw fractures that disturbed the dental occlusion and associated fracture of the base of the skull. Neither nasal nor oral intubation was possible based on the side effects of tracheotomy; therefore, submental intubation was applied successfully. The procedure and results are presented in the text.

New coronavirus disease 2019 , as a pandemic disaster, has drawn the attention of researchers in various fields to discover suitable therapeutic approaches for the management of COVID-19 patients. Currently, there are many worries about the rapid spread of COVID-19; there is no approved treatment for this infectious disease, despite many efforts to develop therapeutic procedures for COVID-19. Emerging evidence shows that mesenchymal stromal/stem cell (MSC) therapy can be a suitable option for the management of COVID-19. These cells have many biological features (including the potential of differentiation, high safety and effectiveness, secretion of trophic factors and immunoregulatory features) that make them suitable for the treatment of various diseases. However, some studies have questioned the positive role of MSC therapy in the treatment of COVID-19. Accordingly, in this paper, we will focus on the therapeutic impacts of MSCs and their critical role in cytokine storm of COVID-19 patients.