Alzahra Medical and Education Center

<title>Abstract</title> Background Infertility is frequently associated with psychological distress; however, evidence remains limited on mental health outcomes among Lebanese women experiencing infertility. This study aimed to assess the psychological well-being and depression using the World Health Organization Well-Being Index (WHO-5) and the Patient Health Questionnaire-9 (PHQ-9), and to identify factors influencing each outcome. Method A cross-sectional study was conducted between June and September 2024 and included 346 Lebanese women recruited from two fertility centers in Beirut. Participants were randomly selected and completed a structured questionnaire through individual interviews. Descriptive and bivariate analyses were performed, and binary logistic regressions were used to identify the factors influencing each of the well-being and depression indices. Results Among the participants, 50.00% had poor well-being and 37.90% had major depression. Good well-being was significantly associated with exercise frequency per week (OR = 1.260), sleeping seven hours or more (OR = 1.904), being a former water-pipe smoker (OR = 4.039), having a history of previous cesarean section (OR = 2.266), living in rural areas (OR = 0.594), and attending different fertility clinics (OR = 0.564). Moreover, major depression was significantly associated with more frequent water pipe smoking (OR = 1.099), attending different fertility clinics (OR = 2.055), living in central areas (OR = 1.784), and having a past medical history of anxiety (OR = 7.278). However, no major depression was associated with exercise (OR = 0.564), nor with sleeping seven hours or more (OR = 0.399). Conclusion Lifestyle, behavioral, clinical, and demographic factors significantly influence the well-being and depression among Lebanese women experiencing infertility. Integrating psychological support and patient care services into fertility services is essential to improve outcomes.

This research aimed to identify the spectrum of microbial pathogens associated with VAP and the drug resistance patterns at an intensive care unit (ICU) burn center in Iran. We conducted this single-center, retrospective, cross-sectional descriptive study on all burn patients with VAP who were treated in the ICU at Velayat Burn Injuries Hospital in Rasht, northern Iran. In this study, 29 samples were obtained from burn patients, of which P. aeruginosa accounted for 48.3%, Klebsiella for 17.2%, E. coli for 10.3%, coagulase-negative Staphylococci for 6.9%, and unknown pathogens for 17.2% of the bacterial cultures. All the E. coli isolates and most of the Klebsiella isolates (80%) were obtained in the first two days of hospitalization. P. aeruginosa was mainly isolated during the first 2 days of hospitalization (71.4%). The mortality rate was 75.9%, while 24.1% of the patients were discharged. Antibiotic susceptibility patterns of Gram-negative bacteria revealed that Enterobacter and P. aeruginosa were predominantly susceptible to aminoglycosides, with Amikacin exhibiting the highest effective rates of 40% and 66.7%, respectively. A guideline-based approach using the local ICU antibiogram can decrease the likelihood of Multidrug-resistant (MDR) strain occurrence.

Infertility in women, particularly those with a poor response to in vitro fertilization (IVF), poses significant challenges in reproductive medicine. This study aimed to compare the effectiveness of intraovarian versus subcutaneous injection of corifollitropin alfa in the DuoStim protocol among infertile women exhibiting a poor response to IVF, with a specific focus on oocyte retrieval counts and quality. A total of 40 poorly responding infertile women were randomly assigned to two groups: 20 women received corifollitropin alfa via intraovarian injection, and 20 women received it via subcutaneous injection. Key demographic data, cycle duration, gonadotropin dosage, the number of oocytes retrieved, and oocyte quality (specifically Grade B oocytes) were assessed. Demographic analyses revealed no significant differences between the two groups in terms of age (subcutaneous: 37.91 ± 6.11 years; intraovarian: 36.84 ± 5.42 years; p = 0.17) or weight (subcutaneous: 74.15 ± 10.51 kg; intraovarian: 78.24 ± 13.22 kg; p = 0.42). The number of oocytes retrieved during both phases did not significantly differ, but the intraovarian group yielded a notably higher number of Grade B oocytes during the follicular phase (p = 0.02). No significant differences were observed in cycle duration (p > 0.05) or the final dose of gonadotropins administered (p > 0.05). The study revealed that intraovarian injection of corifollitropin alfa may enhance the quality of oocytes retrieved, particularly Grade B oocytes, in women with poor response to IVF under the DuoStim protocol, while both methods exhibited similar outcomes in terms of demographic factors, cycle duration, and gonadotropin dosage.

The study evaluated sensory and motor block onset time, duration, and intensity, as well as pain intensity, sedation levels, and vital signs, showing that adding dexamethasone to bupivacaine improved sensory and motor block onset time, duration, and intensity, enhanced sedation effects. Axillary plexus block is a common type of anesthesia for surgical management of upper extremity injuries. This prospective clinical trial included 72 patients over 18 years of age who were candidates for surgical management of upper extremity injuries with the axillary plexus block approach. The patients were randomly divided into two groups: group BD [30 ml bupivacaine 0.25% with 2ml dexamethasone (n=36)] and group B [30 ml bupivacaine 0.25% with 2ml distilled water (n=36)]. The Pinprick test and Modified Bromage Scale (MBS) were used to evaluate the sensory and motor block levels. Additionally, the Visual Analogue Scale (VAS) and Ramsay Sedation Scale (RSS) were used to assess pain intensity and degree of sedation. All collected data were analyzed using IBM SPSS Statistics version 20 software. The mean age of patients in the B and BD groups was 34.41±11.11 and 36.8±13.3, respectively. According to the results, there was a significant difference in the average time of sensory and motor block onset between two groups, with group BD showing shorter onset time compared to group B (P<0.001). Moreover, the mean duration and intensity of the sensory and motor block were significantly higher in group BD (P<0.05). Additionally, the degree of sedation changes after the block started were more pronounced in group BD. There was no statistically significant difference between the two groups regarding changes in pain intensity, heart rates (HR), mean arterial blood pressure (MABP), and complications (P>0.05). Adding dexamethasone to bupivacaine as a safe adjuvant drug effectively prolongs the axillary plexus block time duration and reduces post-surgery pain. Furthermore, it accelerates the onset time of sensory and motor block.

Background: Identifying risk factors that predict mortality in the intensive care unit (ICU) can lead to improved management of critically ill patients and help reduce mortality rates. Objectives: This study aimed to identify the prevalence and risk factors that potentially contribute to predicting mortality in the ICU. Methods: This cross-sectional study was conducted in the general ICU of an academic hospital in northeastern Iran from April 2019 to March 2023. Demographic and clinical data were retrieved from medical records, including age, gender, marital status, residency, length of stay in the ICU, level of consciousness, duration of mechanical ventilation (MV), and co-morbidities. The outcomes were categorized as death or discharge. Results: Out of 8,650 admitted patients, 62.8% were discharged, and 37.2% died. The factors significantly associated with death included age (59.24 ± 21.9 years vs. 49.63 ± 23.32 years, P &lt; 0.0001), female gender (42.7% vs. 57.3%, P &lt; 0.0001), marital status (41.1% married vs. 58.9% unmarried, P &lt; 0.0001), length of stay in the ICU (5.99 ± 9.09 days vs. 4.13 ± 6.55 days, P &lt; 0.0001), Glasgow Coma Scale (GCS) of 3 - 5 (87.9% vs. 12.1%, P &lt; 0.0001), duration of MV (4.86 ± 8.69 days vs. 1.09 ± 4.85 days, P &lt; 0.0001), and co-morbidities (44.7% vs. 55.3%, P &lt; 0.0001), which were confirmed by logistic regression analysis. Conclusions: The prevalence of death in the ICU was 37.2%. Age, co-morbidities, cerebral vascular accident (CVA), GCS, duration of MV, and marital status were significantly associated with mortality.