The impact of mentorship program on the level of anxiety and pre-internship exam scores among Iranian senior nursing students

BACKGROUND

Mentorship involves a voluntary, collaborative, and non-hierarchical relationship where an experienced individual shares knowledge with a less-experienced individual. This study aimed to evaluate the effects of a mentorship program on anxiety levels and pre-internship exam scores among senior nursing students.

METHODS

This quasi-experimental research was conducted on 37 nursing students in the sixth semester of the School of Medical Sciences in Saveh in the year 2023. Participants were selected based on initial criteria using a census method and were then randomly assigned to two groups: the control group (19 participants) and the intervention group (17 participants). The mentoring program for the intervention group was implemented one month before the pre-internship exam and consisted of six sessions, each lasting two hours, over two weeks (three sessions per week). Data collection tools included a demographic questionnaire, the Sarason Anxiety Questionnaire, and pre-internship exam scores. SPSS software version 23 was utilized for data analysis.

RESULTS

The mean anxiety exam scores in the two control and intervention groups did not exhibit a statistically significant difference before the intervention (P = 0.34). However, the mean anxiety exam score of the intervention group students after the intervention (5.89 ± 15.11) was significantly lower than that of the control group students (7.04 ± 21.42) (P = 0.007). Additionally, the results showed that the mean anxiety exam scores of the intervention group students before (5.77 ± 17.53) and after the intervention (5.89 ± 15.11) had a statistically significant difference (P = 0.013). Furthermore, the mean pre-internship exam scores of the intervention group students (1.71 ± 17.72) were significantly higher than those of the control group students (1.15 ± 16.46) (P = 0.014).

CONCLUSION

The mentorship program resulted in a reduction of exam anxiety in nursing students and improved their performance in the pre-internship exam to the extent that the exam scores of the participating students were higher than those of other students.

Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950-2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021

BACKGROUND

Estimates of demographic metrics are crucial to assess levels and trends of population health outcomes. The profound impact of the COVID-19 pandemic on populations worldwide has underscored the need for timely estimates to understand this unprecedented event within the context of long-term population health trends. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides new demographic estimates for 204 countries and territories and 811 additional subnational locations from 1950 to 2021, with a particular emphasis on changes in mortality and life expectancy that occurred during the 2020-21 COVID-19 pandemic period.

METHODS

22 223 data sources from vital registration, sample registration, surveys, censuses, and other sources were used to estimate mortality, with a subset of these sources used exclusively to estimate excess mortality due to the COVID-19 pandemic. 2026 data sources were used for population estimation. Additional sources were used to estimate migration; the effects of the HIV epidemic; and demographic discontinuities due to conflicts, famines, natural disasters, and pandemics, which are used as inputs for estimating mortality and population. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate under-5 mortality rates, which synthesised 30 763 location-years of vital registration and sample registration data, 1365 surveys and censuses, and 80 other sources. ST-GPR was also used to estimate adult mortality (between ages 15 and 59 years) based on information from 31 642 location-years of vital registration and sample registration data, 355 surveys and censuses, and 24 other sources. Estimates of child and adult mortality rates were then used to generate life tables with a relational model life table system. For countries with large HIV epidemics, life tables were adjusted using independent estimates of HIV-specific mortality generated via an epidemiological analysis of HIV prevalence surveys, antenatal clinic serosurveillance, and other data sources. Excess mortality due to the COVID-19 pandemic in 2020 and 2021 was determined by subtracting observed all-cause mortality (adjusted for late registration and mortality anomalies) from the mortality expected in the absence of the pandemic. Expected mortality was calculated based on historical trends using an ensemble of models. In location-years where all-cause mortality data were unavailable, we estimated excess mortality rates using a regression model with covariates pertaining to the pandemic. Population size was computed using a Bayesian hierarchical cohort component model. Life expectancy was calculated using age-specific mortality rates and standard demographic methods. Uncertainty intervals (UIs) were calculated for every metric using the 25th and 975th ordered values from a 1000-draw posterior distribution.

FINDINGS

Global all-cause mortality followed two distinct patterns over the study period: age-standardised mortality rates declined between 1950 and 2019 (a 62·8% [95% UI 60·5-65·1] decline), and increased during the COVID-19 pandemic period (2020-21; 5·1% [0·9-9·6] increase). In contrast with the overall reverse in mortality trends during the pandemic period, child mortality continued to decline, with 4·66 million (3·98-5·50) global deaths in children younger than 5 years in 2021 compared with 5·21 million (4·50-6·01) in 2019. An estimated 131 million (126-137) people died globally from all causes in 2020 and 2021 combined, of which 15·9 million (14·7-17·2) were due to the COVID-19 pandemic (measured by excess mortality, which includes deaths directly due to SARS-CoV-2 infection and those indirectly due to other social, economic, or behavioural changes associated with the pandemic). Excess mortality rates exceeded 150 deaths per 100 000 population during at least one year of the pandemic in 80 countries and territories, whereas 20 nations had a negative excess mortality rate in 2020 or 2021, indicating that all-cause mortality in these countries was lower during the pandemic than expected based on historical trends. Between 1950 and 2021, global life expectancy at birth increased by 22·7 years (20·8-24·8), from 49·0 years (46·7-51·3) to 71·7 years (70·9-72·5). Global life expectancy at birth declined by 1·6 years (1·0-2·2) between 2019 and 2021, reversing historical trends. An increase in life expectancy was only observed in 32 (15·7%) of 204 countries and territories between 2019 and 2021. The global population reached 7·89 billion (7·67-8·13) people in 2021, by which time 56 of 204 countries and territories had peaked and subsequently populations have declined. The largest proportion of population growth between 2020 and 2021 was in sub-Saharan Africa (39·5% [28·4-52·7]) and south Asia (26·3% [9·0-44·7]). From 2000 to 2021, the ratio of the population aged 65 years and older to the population aged younger than 15 years increased in 188 (92·2%) of 204 nations.

INTERPRETATION

Global adult mortality rates markedly increased during the COVID-19 pandemic in 2020 and 2021, reversing past decreasing trends, while child mortality rates continued to decline, albeit more slowly than in earlier years. Although COVID-19 had a substantial impact on many demographic indicators during the first 2 years of the pandemic, overall global health progress over the 72 years evaluated has been profound, with considerable improvements in mortality and life expectancy. Additionally, we observed a deceleration of global population growth since 2017, despite steady or increasing growth in lower-income countries, combined with a continued global shift of population age structures towards older ages. These demographic changes will likely present future challenges to health systems, economies, and societies. The comprehensive demographic estimates reported here will enable researchers, policy makers, health practitioners, and other key stakeholders to better understand and address the profound changes that have occurred in the global health landscape following the first 2 years of the COVID-19 pandemic, and longer-term trends beyond the pandemic.

FUNDING

Bill & Melinda Gates Foundation.

A five-day-old child with lipid hemihypertrophy: A case report

Key Clinical Message

Lipid hemihypertrophy should be considered in the differential diagnosis of neonatal asymmetry. Early recognition and further evaluation for associated disorders are important for appropriate management and surveillance of potential complications.

Abstract

We present the case of a 5-day-old female neonate who presented with a visibly enlarged right thigh, right labia majora, and below the right mandible. This case report highlights the importance of early identification, comprehensive evaluation, and multidisciplinary management in neonates with lipid hemihypertrophy to optimize their long-term outcomes and quality of life.

A Comparative Study of EEG and aEEG in Seizure Diagnosis in Infants Admitted to the NICU

Objectives

Seizure is a common sign in neonates hospitalized in the neonatal intensive care units (NICU) that may lead to morbidity and mortality. Most neonatal seizures are subclinical. Conventional EEG (cEEG) is the gold standard for detecting and monitoring seizures but is not widely available. Amplitude-integrated electroencephalography (aEEG) has been used for over a decade to evaluate infants with seizures. In this study, we tried to determine the efficacy of aEEG as a widely available diagnostic tool in diagnosing seizures.

Materials & Methods

All cases with seizures or suspicious seizures were admitted to the NICU of the Children's Medical Center for one year. cEEG and aEEG were performed for these infants. aEEG was recorded for at least six hours with a description of the tracing. Clinical information, outcomes, and questionnaires (patient information) were recorded in detail. The obtained data were analyzed with the SPSS version 24 software.

Results

Eleven out of twenty-five aEEG recordings were abnormal; other patients showed normal aEEGs. The most common clinical and neurological manifestations were seizure (68%) and hypotonia (28%); the mortality rate was 12%. No significant correlation was observed between aEEG findings and gender, age, familial relation, outcome, ultrasound result, type of seizure, and underlying disease.

Conclusion

Studies showed variable sensitivity and specificity values for aEEG. aEEG cannot be recommended as the only way to diagnose and manage seizures in neonates. However, Good accessibility and ease of working with aEEG promote a tendency to use this procedure as a screening tool.

Correlation between COVID-19-related health anxiety and coping styles among frontline nurses

BACKGROUND

The long-term epidemic of COVID-19 and its recurrence has exposed frontline nurses to mental disorders such as stress and health anxiety. High levels of health anxiety associated with COVID-19 may lead to maladaptive behaviors. There is no agreement on which coping styles are most effective against stress. Therefore, more evidence is required to find better adaptive behaviors. The present study was conducted to investigate the correlation between the level of health anxiety and the type of coping strategies used by frontline nurses fighting COVID-19.

METHODS

This is a cross-sectional study that was performed on a convenience sample of 386 nurses who are working in the COVID department from October to December 2020, coinciding with the outbreak of the third COVID-19 peak in Iran. Data were collected through a demographic questionnaire, the short version of the health anxiety questionnaire, and coping inventory for stressful situations. Data were analyzed using independent T-test, U-Mann-Whitney, and Kruskal-Wallis statistical tests with SPSS version 23 software.

RESULTS

The mean score of nurses' health anxiety was 17.61 ± 9.26 which was more than the cut-off point for health anxiety and 59.1% of nurses had COVID-19-related health anxiety. The mean score of problem coping style (26.85 ± 5.19), was higher than emotion (18.48 ± 5.63) and avoidance (19.64 ± 5.88) coping styles and nurses mostly used problem-coping strategies to deal with anxiety caused by COVID-19. There was a positive significant correlation between the scores of health anxiety and emotion coping style (r = 0.54; P < 0.001).

CONCLUSION

Based on the findings of this study, COVID-19-related health anxiety was high in front-line nurses and those with high health anxiety were more likely to use emotion-based coping strategies, which are ineffective. Therefore, considering strategies to reduce nurses' health anxiety and holding training programs on effective coping methods in epidemic conditions are recommended.

The Effect of Distance Empowerment Program on Self-efficacy Among Multiple Sclerosis Patients

ABSTRACT

BACKGROUND: Multiple sclerosis (MS) is the most common nontraumatic debilitating disease in young adults. This study aimed to determine the effect of distance empowerment programs on self-efficacy in MS patients. METHODS: Sixty-four MS patients participated in this quasi-experimental study. Patients were first entered into the study using the convenience sampling method and then were randomly allocated to control (32) and intervention (32) groups. The intervention group underwent a distance empowerment program (via WhatsApp, Telegram, and blog) and weekly telephone follow-up for 2 months. Self-efficacy was evaluated before, and immediately after, the empowerment program using the MS Self-Efficacy Scale. RESULTS: Data from 59 participants were analyzed. Before implementation of the empowerment program, the mean scores of self-efficacy in the intervention and control groups were not significantly different. After implementing the empowerment program, the mean score of self-efficacy in the intervention group was higher than that of the control group (P < .05). CONCLUSION: Distance empowerment has an effect on the self-efficacy of patients with MS and may lead to an increase in self-efficacy scores after implementing an empowerment program.

Stress coping strategies of Iranian healthcare staff during the COVID-19 pandemic: A cross-sectional study

The COVID-19 pandemic has exposed healthcare staff to mental distress. Given the importance of applying effective strategies to cope with stress caused by COVID-19, this study aimed to assess the stress-coping strategies of Iranian healthcare providers. This cross-sectional study was performed through a web-based survey. Data collection was done online using a demographic data questionnaire and the short form of Endler and Parker's coping inventory. The mean scores of task-oriented strategies (27.06 ± 5.13) were higher than avoidance-oriented (19.42 ± 5.77) and emotion-oriented strategies (18.45 ± 5.76), and the healthcare workers mainly used task-oriented styles to cope with COVID-19-related stress. There was a significant difference between the score of task-oriented strategy in terms of age groups (P < 0.001), work experience (P = 0.018), level of education (P < 0.001), having children (P = 0.002), and type of hospital (P = 0.028). The score of task-oriented strategies was lower in employees who were in the age group of 20-30 years and had less than 10 years of work experience, and it was higher in employees who had children, worked in private hospitals, and had a master's degree or higher. The score of emotion-oriented strategies in the age group of 51-60 years was significantly lower than other age groups (P < 0.01) and was significantly higher in employees with a bachelor's degree than those with a master's degree or higher (P = 0.017). There was no significant difference between the scores of avoidance-oriented strategies and any socio-demographic variables. According to the findings of this study, young and less experienced employees were more inclined to utilize emotion-oriented coping styles. Therefore, considering appropriate training programs for these employees to apply effective coping strategies is extremely important.

The impacts of head trauma management education on the clinical decision-making of pre-hospital emergency staff

BACKGROUND

The aim of this study was to compare the effectiveness of head trauma management education by the scenario method versus lecturing on clinical decision-making by pre-hospital emergency staff.

MATERIALS AND METHODS

This was an educational trial on 60 pre-hospital emergency staff, performed in Saveh in 2020-2021. The participants fulfilling inclusion criteria entered the study and were randomly allocated to two groups: scenario (n = 30) and lecture (n = 30). Clinical decision-making scores for head trauma patient management were determined at the beginning and end of the study using a researcher-made questionnaire. Data were analyzed using descriptive and inferential statistics and SPSS software version 16.

RESULTS

At post-intervention, the mean score of clinical decision-making was 75.28 ± 11.7 in the scenario group and 68.55 ± 11.91 in the lecture group. The results of the independent t-test showed that the mean score of clinical decision-making was significantly higher in the scenario group compared with the lecture group (p = 0.04). The results of paired t-test showed a significant increase in the mean score of clinical decision-making in both groups after the intervention (p < 0.05); however, the mean of increment was higher in the scenario group (9.77 ± 7.63) than in the lecture group (1.79 ± 3).

CONCLUSION

Regarding the impact of scenario-based education on learners' intellectual abilities and creativity, it seems that this type of education can be an appropriate alternative to traditional educational methods. Therefore, it is suggested to incorporate this method in the training programs of pre-hospital emergency staff.

Posterior reversible encephalopathy syndrome in SARS‐CoV‐2 infection: A case report and review of literature

Consider PRES in SARS‐CoV‐2 infected patients who develop encephalopathy, seizures or impaired vision; especially if the disease is complicated by respiratory distress and need for mechanical ventilation.

Consider PRES in SARS‐CoV‐2 infected patients who develop encephalopathy, seizures or impaired vision; especially if the disease is complicated by respiratory distress and need for mechanical ventilation.

Weaning and extubation from neonatal mechanical ventilation: an evidenced-based review

Mechanical ventilation is a lifesaving treatment used to treat critical neonatal patients. It facilitates gas exchange, oxygenation, and CO2 removal. Despite advances in non-invasive ventilatory support methods in neonates, invasive ventilation (i.e., ventilation via an endotracheal tube) is still a standard treatment in NICUs. This ventilation approach may cause injury despite its advantages, especially in preterm neonates. Therefore, it is recommended that neonatologists consider weaning neonates from invasive mechanical ventilation as soon as possible. This review examines the steps required for the neonate's appropriate weaning and safe extubation from mechanical ventilation.

Serum Hepcidin and Ferritin Have Not Correlation With Inflammatory Markers in Kidney Transplant Patients

In renal transplant patients, increased ferritin is associated with an increased risk of cardiovascular disease, transplant rejection, and mortality. Serum ferritin elevates in renal transplant patients due to blood product transfusion, inflammation, and malignancies. Hepcidin is also a peptide hormone produced in the liver in response to anemia, hypoxia, or inflammation. The aim of this study was to investigate the relationship between ferritin, hepcidin, iron, TIBC, and serum inflammatory markers in renal transplant patients. The cross-sectional descriptive-analytical study was conducted on 60 renal transplant patients referred to Hazrat-Rasool and Imam-Ali clinics and Al-Mahdi Laboratory of Shahrekord selected by convenience sampling method. Serum ferritin, hepcidin, iron, TIBC, and inflammatory markers levels were determined by standard kits by ELISA. Data were analyzed by SPSS software. Serum iron had a significant negative correlation with erythrocyte sedimentation rate (ESR) (r= -0.418, P=0.001) and a negative correlation with C reactive protein (CRP) (r= - 0.243, P=0.061). TIBC had a significantly negative association with ferritin (r= - 0.27, P=0.037). Ferritin, hepcidin, and TIBC were not significantly correlated with inflammatory factors. The results of the study showed no significant relationship between ferritin, hepcidin, and TIBC with inflammatory factors in renal transplant patients.

Predictors of COVID-19-related health anxiety among health care workers: a cross-sectional study

Background

One of the psychological issues that may affect health care workers (HCWs) during the outbreak of COVID-19 is health anxiety. Health anxiety disorder goes beyond normal health concerns and can seriously affect occupational and interpersonal performance. The present study was designed to determine the level of COVID-19-related health anxiety and its predictors in Iranian HCWs.

Methods

This is a cross-sectional study. Data were collected online through a demographic information questionnaire and the short version of the Health Anxiety Questionnaire. The online questionnaires were created via Google Form and the URL link was sent to HCWs via email or social networking applications. In total, questionnaires were sent to more than 1,500 HCWs throughout Iran. Data were analyzed with SPSS software version 23.

Results

Five hundred and fifty-two HCWs completed and sent the questionnaires. The mean scores of health anxiety of HCWs were higher than the cutoff point of health anxiety (17.28 ± 8.84) and 58.1% of HCWs had health anxiety. There was a significant inverse relationship between health anxiety score and age (r = − 0.13; P = 0.002), work experience (r = − 0.16; P < 0.001) and income level (r = − 0.097; P = 0.03). The rate of health anxiety was significantly higher in females (P = 0.03). Based on regression results, age and hospital category were significant risk factors for health anxiety.

Conclusion

Based on the results of this study, employees working in health centers in Iran had high health anxiety. Due to the high level of health anxiety in HCWs, it is important to consider strategies to reduce their health anxiety in the current situation.

Psychometric evaluation of the perceived nursing student's Incivility questionnaire

AIM

Student's uncivil behaviour is one of the most common problems in the educational setting, including nursing schools. It is essential to develop tools for measuring the uncivil behaviour of nursing students to solve this problem. Therefore, this study aimed to evaluate psychometric properties of perceived nursing student's incivility questionnaire among the Iranian community.

DESIGN

In this methodological study, perceived nursing student's incivility questionnaire was completed by 360 nursing students and 121 nursing faculty members.

METHODS

Sampling was done from October 2019-November 2019. Content and construct validity of the questionnaire were evaluated. Reliability was estimated using Cronbach's alpha and McDonald's omega coefficients and composite reliability. The construct validity of nursing student's perceived incivility was investigated by exploratory and confirmatory factor analyses.

RESULTS

Content validity index 0.88 for the whole instrument. The three factors of violent behaviours, irresponsible behaviours and unsound behaviours explained more than 51.485% of the variance. Factor structure extracted using model fit indices (PCFI = 0.763, PNFI = 0.732, CMIN/DF = 2.501, RMSEA = 0.056, GFI = 0.941, AGFI = 0.918, CFI = 0.935) and convergent validity were also confirmed. Internal consistency and composite reliability were estimated to be more than 0.7. The results showed that Iranian perceived nursing student's incivility questionnaire is a three-dimensional construct with good validity and reliability.

COVID-19 and the Brain: A Psychological and Resting-state fMRI Study of the Whole-brain Functional Connectivity

Background: Coronavirus 2019 (COVID-19) spreads rapidly worldwide and causes severe acute respiratory syndrome. The current study aimed at evaluating the relationship between the whole-brain functional connections in resting state and cognitive impairments in patients with COVID-19 compared with that of a healthy control group. Methods: Resting-state fMRI and Montreal cognitive assessment (MoCA) data were obtained from 29 patients of the acute stage of COVID-19 on the third day of admission and 20 healthy controls. Cross-correlation of the mean resting-state signals was determined in the voxels of 23 IC (Independent Components) of brain neural circuits. To assess cognitive function and neuropsychological status, MoCA was performed on all participants. The relationship between rs-fMRI information, neuropsychological status, and paraclinical data were analyzed. Results: The COVID-19 group got a lower mean MoCA score and showed a significant reduction in the functional connectivity of the IC14 (P <0.001) and IC38 (P <0.001) regions compared with controls. The increase of functional connectivity was observed in the COVID-19 group compared with controls at baseline in the default mode network (DMN) IC00 (P <0.001) and dorsal attention network (DAN) IC08 (P <0.001) regions. Furthermore, alternation of functional connectivity in the mentioned ICs was significantly correlated with the mean Montreal Cognitive Assessment (MoCA) scores and inflammatory parameters-ie, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP). Conclusions: Functional connectivity abnormalities in four brain neural circuits associated with cognitive impairment and increased inflammatory markers in patients with COVID-19.

Factor Analysis of Iranian Version of Nursing Students' Incivility Questionnaire

Background:

Uncivil student behavior is one of the challenging issues in the nursing schools that disrupts the learning process and teacher-student interactions. Planning to control student's incivility requires knowing the condition using valid tools. The purpose of this study was to investigate the validity and reliability of the incivility occurrence's questionnaire among Iranian students.

Materials and Methods:

This methodological study was conducted on 358 nursing students and 122 nursing faculty members. The samples were selected from the nursing students of second to fourth year from September to October 2019. McDonald's omega, Cronbach's alpha coefficients and composite reliability were calculated. Exploratory and confirmatory factor analysis were used to investigate the construct validity of tool.

Results:

Content validity index was 0.94 for the whole instrument. In factor analysis, three factors of irresponsible, violent, and unsound behaviors were identified. These factors explained more than 50.52% of the variance. Model fit indices Parsimonious Normed Fit Index) = 0.74, Root Mean Square Error of Approximation = 0.05, Parsimonious Comparative Fit Index = 0.78, Goodness-of-Fit Index = 0.92, Comparative Fit Index ( CFI) = 0.92, Adjusted Goodness-of-Fit Index) = 0.89, CIMN=2.58) indicated the proportion of factors. Internal consistency was 0.77 to 0.89.

Conclusions:

This questionnaire is a three-dimensional tool with appropriate validity and reliability that can be used to evaluate occurrence rate of nursing student incivility in Iran.

The psychometric properties of the Persian version of the MUSIC Model of Academic Motivation Inventory among nursing students

Aim

To determine the psychometric properties of the Persian version of the MUSIC Inventory in nursing students.

Design

Cross‐sectional psychometric study.

Methods

Transcultural adaptation of the MUSIC Model of Academic Motivation Inventory was carried out using translation to Persian and back‐translation. Then, the qualitative and quantitative face and content validity of the inventory were evaluated. Construct validity was assessed by exploratory factor analysis. To perform construct validity and reliability, a convenience sample of 360 undergraduate nursing students was recruited. Cronbach's alpha was used to assess internal consistency reliability.

Results

Cronbach's alpha for all items of the MUSIC inventory was .94, and each factor was between .72–.93. Exploratory factor analysis supported the 5‐factor structure of the MUSIC inventory. These 5 factors explain 66.59% of the overall extracted variance. Three items of the MUSIC inventory, which were related to the empowerment component, were deleted.

Conclusion

Based on the findings of this study, the Persian version of the MUSIC Model of Academic Motivation Inventory is a valid and reliable tool for Persian language nursing students.

The effects of teaching methods on academic motivation in nursing students: A systematic review

Motivation is one of the key factors in educational achievement. Like any other field of study, motivation in nursing is highly critical. The instructor's knowledge about the teaching methods that are effective in academic motivation of students enables them to adopt proper measures to improve the teaching efficiency. The present paper is a systemic review of the efficiency of instructional interventions in improvement of academic motivation in nursing students. The published papers related to the study from 2000 to February 2020 were searched at different databases such as PubMed, Scopus, Web of Science, PsycInfo, and ERIC. To examine the quality of the articles, critical appraisal instrument for reports of educational interventions was used. Totally, 18 articles entered the study for structured review. The majority of the articles reported that educational interventions improved academic motivation in nursing students. The effective teaching methods described in the reviewed articles that led to an improvement in academic motivation were simulation, case-based learning, cooperative learning, learning contract, peer assessment, and self-assessment using video typing. As the findings showed, implementation of applied and participatory methods in teaching process improved the academic motivation of nursing students. Therefore, using such methods, nursing instructors can improve the academic motivation of their students.

The effect of the Verbascum Thapsus on episiotomy wound healing in nulliparous women: a randomized controlled trial

Background

The pain and discomfort caused by episiotomy affect the quality of life of the mothers, so rapid and complete repair of the episiotomy is very important. Due to the effective ingredients of Verbascum Thapsus, it has been used since ancient times to treat wounds. Therefore, this study aimed to evaluate the effect of Verbascum Thapsus on episiotomy wound healing.

Methods

The study was designed as a randomized, double-blind, controlled clinical trial. Ninety-three primiparous women who were referred to Fatemeh Zahra Hospital in Saveh in 2015 were randomly divided into two groups of intervention (Verbascum Thapsus) and control (placebo). Both groups covered the episiotomy wound twice a day for 10 days with 2 cm of prescribed creams. Wound healing was assessed using the REEDA scale before the intervention and on days 1,3 and 10 after the intervention.

Results

Before the intervention, there was no statistically significant difference in terms of demographic characteristics, obstetrics, and REEDA scores between the two groups (p < 0.05). The mean scores of REEDA on days 1 and 3 in the intervention group were better than the control group but were not statistically significant. However, on the tenth day after the intervention, the mean scores of REEDA were significantly better in the Verbascum group than the placebo (p = 0.01).

Conclusions

According to the results of this study, it seems that Verbascum Thapsus is effective in repairing episiotomy wounds. The researchers hope that the results of this study can provide clinical evidence for the use of this herbal medicine in the wound healing process.

Trial registration

This study was registered in the Iranian Registry of Clinical Trials (IRCT) with the code “IRCT201404073106N15” on 02/12/2015.

Major depressive disorder diagnosis based on effective connectivity in EEG signals: a convolutional neural network and long short-term memory approach

Deep learning techniques have recently made considerable advances in the field of artificial intelligence. These methodologies can assist psychologists in early diagnosis of mental disorders and preventing severe trauma. Major Depression Disorder (MDD) is a common and serious medical condition whose exact manifestations are not fully understood. So, early discovery of MDD patients helps to cure or limit the adverse effects. Electroencephalogram (EEG) is prominently used to study brain diseases such as MDD due to having high temporal resolution information, and being a noninvasive, inexpensive and portable method. This paper has proposed an EEG-based deep learning framework that automatically discriminates MDD patients from healthy controls. First, the relationships among EEG channels in the form of effective brain connectivity analysis are extracted by Generalized Partial Directed Coherence (GPDC) and Direct directed transfer function (dDTF) methods. A novel combination of sixteen connectivity methods (GPDC and dDTF in eight frequency bands) was used to construct an image for each individual. Finally, the constructed images of EEG signals are applied to the five different deep learning architectures. The first and second algorithms were based on one and two-dimensional convolutional neural network (1DCNN-2DCNN). The third method is based on long short-term memory (LSTM) model, while the fourth and fifth algorithms utilized a combination of CNN with LSTM model namely, 1DCNN-LSTM and 2DCNN-LSTM. The proposed deep learning architectures automatically learn patterns in the constructed image of the EEG signals. The efficiency of the proposed algorithms is evaluated on resting state EEG data obtained from 30 healthy subjects and 34 MDD patients. The experiments show that the 1DCNN-LSTM applied on constructed image of effective connectivity achieves best results with accuracy of 99.24% due to specific architecture which captures the presence of spatial and temporal relations in the brain connectivity. The proposed method as a diagnostic tool is able to help clinicians for diagnosing the MDD patients for early diagnosis and treatment.

Ear and Face Mucormycosis; A Case Report

Mucormycosis is an invasive fungal infection belonging to order of Mucorales which causes a high rate of mortality. This infection is mostly common in the immunosuppression conditions such as diabetes mellitus, chemotherapy, organ transplantation and hematologic malignancies.

Outcomes of Cochlear Implantation in Post-lingually Deaf Patients

INTRODUCTION

Cochlear implantation has been mentioned as the most effective therapeutic intervention in deaf patients and especially those with post-lingual deafness. We aimed to assess hearing improvement of post-lingually deaf patients after cochlear implantation.

MATERIALS AND METHODS

in this cross-sectional study all the post-lingually deaf patients who had undergone cochlear implantation (CI) surgery between December 2010 and February 2016 were assessed. Patients were recalled and after explaining the study process and signing an informed consent form, an audiometry was done by a single audiologist. In addition, demographic information, cause of hearing loss, age of onset, history of hearing aid use and surgical complications were recorded in a pre-designed checklist.

RESULTS

Twenty-nine male and 21 female with a mean age of 22.52±19.45 years underwent analysis. Most of patients (80%) had progressed condition since childhood. Sudden sensorineural hearing loss (SSNHL) was the most prevalent (10%) known etiology of deafness followed by meningitis (6%), Trauma (2%) and ototoxic drugs (2%) in the remaining 20% of the patients. Patients had the highest mean (37.1±12.61 dB) in 4000 Hz frequency and the lowest mean of hearing threshold level (32.6±8.37 dB) was for 1000 Hz frequency. Mean hearing threshold level was significantly lower in patients with lower ages of cochlear implantation (p=0.435). Patients with higher ages of deafness onset showed lower degree of hearing improvement (p=0.462).

CONCLUSION

The results of our study suggest that cochlear implantation significantly improves hearing function of post-lingual patients and can be considered as a certain cure for these patients in Iran.

Increasing prevalence of gestational diabetes mellitus when implementing the IADPSG criteria: A systematic review and meta-analysis

AIMS

Quantify the proportional increase in gestational diabetes (GDM) prevalence when implementing the new International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria compared to prior GDM criteria, and to assess risk factors that might affect the change in prevalence.

METHODS

A systematic review and meta-analysis was performed of cohort and cross-sectional studies between January 1, 2010 to December 31, 2018 among pregnant women with GDM using IADPSG criteria compared to, and stratified by, old GDM criteria. Web of science, PubMed, EMBASE, Cochrane, Open Grey and Grey literature reports were included. The relative risk for each study was calculated. Subgroup analyses were performed by maternal age, body mass index, study design, country of publication, screening method, sampling method and data stratified according to diagnostic criteria.

RESULTS

Thirty-one cohort and cross-sectional studies with 136 705 women were included. Implementing the IADPSG criteria was associated with a 75% (RR 1.75, 95% CI 1.53-2.01) increase in number of women with GDM with evidence of heterogeneity.

CONCLUSIONS

The IADPSG criteria increase the prevalence of GDM, but allow movement towards more homogeneity. More studies are needed of the benefits, harms, psychological effects and health costs of implementing the IADPSG criteria.

A comparative study on the performance of NSFWQIm and IRWQIsc in water quality assessment of Sefidroud River in northern Iran

Local water quality indices (WQIs) are usually developed by modifying internationally recognized indices, which are considered reference index. In previous works on WQIs, the performance of local and reference indices has not been compared with each other. Therefore, the question crosses the mind whether using local or international indicators individually can show all qualitative aspects of a water resource. In this study, it was aimed to make this comparison between NSFWQI_m (National Sanitation Foundation Water Quality Index) as the reference index and IRWQI_sc (Iranian Water Quality Index for Surface Water Resource-Conventional Parameters) as the local one through a case study (Sefidroud River in northern Iran). Based on the results, the indices' performance in representing the seasonal and spatial fluctuations of the river water quality was almost similar. However, the water quality scores obtained by the two indices were somewhat different. Based on NSFWQI_m, the average water quality score of the river was about 49.0, by which the water was categorized in "bad" class, while IRWQI_sc represented an average score of 56.1, which corresponds to "fairly good" class. Therefore, NSFWQI_m identified the water quality with stricter criteria than IRWQI_sc, regarding the public health. On the other hand, according to relative standard deviations (0.17 for NSFWQI_m, 0.21 for IRWQI_sc) of the obtained water qualities, IRWQI_sc better distinguished between high and low water qualities of the river. Accordingly, in order to better interpret the quality conditions of surface water resources in Iran, it is necessary to use both indices since NSFWQI_m (reference index) attracts attention to stricter international standards and requirements, while IRWQI_sc (local index) causes more focus on seasons or locations with the worst water quality.

Effect of allopurinol on diabetic nephropathy; a double-blind clinical trial study

Introduction: Diabetic nephropathy (diabetic kidney disease) is the most common cause of renal failure. Objectives: Regarding the role of allopurinol in the improvement of diabetic kidney disease, this study aimed to investigate the ameliorative effect of allopurinol in diabetic nephropathy patients. Patients and Methods: This double-blind clinical trial study was performed on 60 patients with diabetic kidney disease referenced to nephrology clinic during 2019-2020. Patients were divided into case (treated with allopurinol 100 mg/d) and control (received placebo pill) groups. Three and six months of intervention, complete blood count (CBC), fasting blood sugar levels (FBS), serum blood urea nitrogen (BUN) levels, creatinine (Cr) and uric acid (UA) levels, 24 hours urinary protein, glomerular filtration rate (GFR), neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) were measured and compared between the two groups. Results: After six months, reduction of UA and 24 hours urinary protein were not significant in the control group (P > 0.05) but it was significant in the allopurinol group (P < 0.05). In the allopurinol group, NLR and PLR levels decreased significantly during the six months (P < 0.01) however there was no significant change in the control group (P > 0.05). Conclusion: Low dosage of allopurinol (100 mg/d) reduces UA, proteinuria, NLR and PLR in patients after six months. Therefore it can be used for diabetic nephropathy patients as a supplementary, inexpensive and safe treatment.

Major depressive disorder assessment via enhanced k-nearest neighbor method and EEG signals

The aim of this paper is to introduce a novel method using short-term EEG signals to separate depressed patients from healthy controls. Five common frequency bands (delta, theta, alpha, beta and gamma) were extracted from the signals as linear features, as well as, wavelet packet decomposition to break down signals into certain frequency bands. Afterwards, two entropy measures, namely sample entropy and approximate entropy were applied on the wavelet packet coefficients as nonlinear features, and significant features were selected via genetic algorithm (GA). Three machine-learning algorithms were used for classification; including support vector machine (SVM), multilayer perceptron (MLP) a novel enhanced K-nearest neighbors (E-KNN), which uses GA to optimize the feature-space distances and provides a feature importance index. The highest accuracy obtained by using frequency-based features was from gamma oscillations which resulted in 91.38%. Performance of nonlinear features were better compared to the frequency-based features and the results showed 94.28% accuracy. The combination of the features showed 98.44% accuracy with the new proposed E-KNN classifier.

Spiritual healing from Iranian cancer patients' viewpoints: A hybrid concept analysis

BACKGROUND

Spiritual healing is a complementary and alternative treatment with different meanings in different cultures and religions. However, the concept has not been defined from the cancer patients' points of view. The present study was done with the aim of concept analyses of spiritual healing from Iranian cancer patients' viewpoints.

METHODOLOGY

The study was done using a hybrid method at three phases including of theoretical study, field study, and final analysis. In the theoretical study phase and using the keyword "spiritual healing," pertinent articles were searched in main databases. In the field study phase, ten cancer patients were interviewed, and in the final phase, the two other phases were analyzed. After determining features, antecedents, and consequences, a conclusive definition of spiritual healing from Iranian cancer patients' viewpoints was proposed.

FINDINGS

Spiritual healing from Iranian cancer patients' viewpoints was featured with four themes, including connection with paranormal forces; effective, noninvasive, inexpensive, and efficient therapeutic method; a way to achieve piece, adaptation, and health and influenced by cultural and religious beliefs. Spiritual healing is a complementary and alternative treatment that helps careseekers to achieve health through paranormal forces and energies. As the findings showed and according to the participants' viewpoints, the source of such forces and energies was divine force and the healers were mediums to transfer the energy.

CONCLUSION

The findings supported that religion and faith were the key elements of spiritual healing in the Iranian Islamic context.

Changing diagnostic criteria for gestational diabetes in Sweden - a stepped wedge national cluster randomised controlled trial - the CDC4G study protocol

Background

The optimal criteria to diagnose gestational diabetes mellitus (GDM) remain contested. The Swedish National Board of Health introduced the 2013 WHO criteria in 2015 as a recommendation for initiation of treatment for hyperglycaemia during pregnancy. With variation in GDM screening and diagnostic practice across the country, it was agreed that the shift to new guidelines should be in a scientific and structured way. The aim of the Changing Diagnostic Criteria for Gestational Diabetes (CDC4G) in Sweden (www.cdc4g.se/en) is to evaluate the clinical and health economic impacts of changing diagnostic criteria for GDM in Sweden and to create a prospective cohort to compare the many long-term outcomes in mother and baby under the old and new diagnostic approaches.

Methods

This is a stepped wedge cluster randomised controlled trial, comparing pregnancy outcomes before and after the switch in GDM criteria across 11 centres in a randomised manner. The trial includes all pregnant women screened for GDM across the participating centres during January–December 2018, approximately two thirds of all pregnancies in Sweden in a year. Women with pre-existing diabetes will be excluded. Data will be collected through the national Swedish Pregnancy register and for follow up studies other health registers will be included.

Discussion

The stepped wedge RCT was chosen to be the best study design for evaluating the shift from old to new diagnostic criteria of GDM in Sweden. The national quality registers provide data on the whole pregnant population and gives a possibility for follow up studies of both mother and child. The health economic analysis from the study will give a solid evidence base for future changes in order to improve immediate pregnancy, as well as long term, outcomes for mother and child.

Trial registration

CDC4G is listed on the ISRCTN registry with study ID ISRCTN41918550 (15/12/2017)

Strategies to promote academic motivation in nursing students: A qualitative study

BACKGROUND

Academic motivation is highly important in nursing education. Providing high-quality nursing care requires students who have motivation to acquire information and skills. However, nursing students lose their motivation gradually during their program. Thus, the present study is aimed at elaborating on the strategies to improve academic motivation in nursing students.

MATERIALS AND METHODS

A qualitative study was conducted in Saveh University of Medical Sciences. The data were collected through focus groups and individual semi-structured interviews with forty nursing students, professors, and lecturers of nursing and midwifery school. The participants were selected through purposeful sampling method. This method is used for the selection of people who have had experience with or are part of the culture or phenomenon of interest. Data analysis was done as a continuous process through conventional qualitative content analysis.

RESULTS

The strategies to promote academic motivation of nursing students were categorized into four main categories including strategies pertinent to professors (empowering and motivating to improve the quality of teaching), strategies pertinent to students (creating positive attitude toward nursing, empowering, and encouraging academic achievement), strategies pertinent to clinical education (improvement of the quality of clinical training and optimization of the academic and clinical relationships), and strategies pertinent to faculty (providing extracurricular activities, proper curriculum programming, and educational and welfare facilities).

CONCLUSIONS

The strategies to improve academic motivation are available in different areas including professors, students, faculty, and clinical education. In general, improving the quality of education and creating positive attitude in nursing students increase their academic motivation.

Academic Motivation in Nursing Students: A Hybrid Concept Analysis

Background:

Taking into account the breadth of the concept of motivation and its importance for nursing students, it is imperative to clarify the concept of academic motivation. This study is an attempt to analyze the concept of academic motivation in nursing students.

Materials and Methods:

The study was carried out in 2018 as a combined literature review and qualitative research. Hybrid concept analysis model was employed to clarify the concept at three phases. At theoretical phase, articles indexed in credential databases were searched using keywords “academic motivation” and “nursing.” Totally, 30 articles were analyzed. At fieldwork phase, 12 nursing students were interviewed. At conclusive phase, the findings of the two earlier phases were analyzed. After determining the attributes, antecedents, and consequences, a final definition of academic motivation in nursing student was introduced.

Results:

Academic motivation has six main attributes including “being an internal process,” “purpose oriented,” “variable,” “unique,” “driving force of educational performance,” and “facilitator of learning and educational achievement.” In addition, antecedents and consequences of academic motivation in the nursing students were revealed and a general definition of the concept was codified.

Conclusions:

Academic motivation of nursing students is a broad and multi-dimensional concept that is affected by various personal, family, social, educational, and professional factors. Moreover, it is a factor in achieving academic success, better quality of learning, creativity, academic satisfaction, reduction of anxiety, continuing education, and training competent nurses.

Evaluation of the efficacy of amplitude-integrated electroencephalography in the screening of newborns with metabolic disorder admitted to the NICU

Background

Neonate patients with metabolic disorder show encephalopathy and seizures that may lead to morbidity and mortality. Thus rapid detection and treatment of these patients is necessary. Although Amplitude-integrated electroencephalography (aEEG) has been used for more than a decade in the evaluation of infants with encephalopathy but has not been used in the assessment of neonates suffering from metabolic disorders. In this study, we tried to determine the efficacy of aEEG as an easily available diagnostic tool in the diagnosis of neonates with metabolic diseases.

Methods

All cases which admitted to the Neonatal Intensive Care Unit (NICU) of the Children’s Medical Center during a one-year period were enrolled. aEEG recordings were obtained by installing 4 electrodes on the infant’s head by a trained nurse and aEEG was recorded for at least 24 h with a description of the whole tracing. Clinical information, final outcome and questionnaires, including patient information: symptoms of the disease, gender, age, duration of hospitalization and the type of the metabolic disease were recorded in details. The obtained data was analyzed with the Spss24 software.

Results

Only 3 (two girl and one boy) out of 29 aEEGs recordings were abnormal; other patients showed normal aEEGs. The most common clinical and neurological manifestations were seizure (34.5%), hypotonia (31%), and mortality rate was 10.3%. There was no significant correlation between aEEG findings and gender, age, type of disease, laboratory tests findings and positive family history.

Conclusions

Although it has been shown that EEG has a diagnostic value in metabolic diseases, there has been no study on the efficacy of aEEG to evaluate neonates with metabolic diseases. But good accessibility and easy of working with aEEG, promote a tendency to use this procedure as screening tool for metabolic diseases.

The current study about aEEG monitoring in these patients, while limited, can be used as a pilot study for further research on this topic.

Therefore, a correct judgment in this field requires administration of aEEG on a larger population of neonates with metabolic diseases.

Development and Optimisation of Spironolactone Nanoparticles for Enhanced Dissolution Rates and Stability

Stable solid lipid nanoparticles (SLNs) and nanostructured lipid carriers (NLCs) formulations to enhance the dissolution rates of poorly soluble drug spironolactone (SP) were being developed. Probe ultra-sonication method was used to prepare SLNs and NLCs. All NLCs contained stearic acid (solid lipid carrier) and oleic acid (liquid lipid content), whereas, SLNs were prepared and optimised by using the solid lipid only. The particles were characterised in terms of particle size analysis, thermal behaviour, morphology, stability and in vitro release. The zeta sizer data revealed that the increase in the concentration of oleic acid in the formulations reduced the mean particle size and the zeta potential. The increase in concentration of oleic acid from 0 to 30% (w/w) resulted in a higher entrapment efficiency. All nanoparticles were almost spherically shaped with an average particle size of about ∼170 nm. The DSC traces revealed that the presence of oleic acid in the NLC formulations resulted in a shift in the melting endotherms to a higher temperature. This could be attributed to a good long-term stability of the nanoparticles. The stability results showed that the particle size remained smaller in NLC compared to that of SLN formulations after 6 months at various temperatures. The dissolution study showed about a 5.1- to 7.2-fold increase in the release of the drug in 2 h compared to the raw drug. Comparing all nanoparticle formulations indicated that the NLC composition with a ratio of 70:30 (solid:liquid lipid) is the most suitable formulation with desired drug dissolution rates, entrapment efficiency and physical stability.

Oral Tadalafil in Children with Pulmonary Arterial Hypertension

OBJECTIVE

Tadalafil is a selective Phosphodiesterase-5 inhibitor that has been reported to have vasodilatory and antiproliferative effects on the pulmonary artery. In this study we evaluated the safety and efficacy of oral tadalafil in children with pulmonary arterial hypertension (PAH).

METHODS

This open label study, prospective and interventional was carried out in 25 known patients aged 2 month-5 years in 3 medical centers in Iran, between March 2013-Jun 2014. Tadalafil suspension was administrated at 1 mg/kg daily for all patients. Hemodynamic and safety parameters were assessed at baseline and then monthly for a total of 4 visits.

RESULTS

19 patients received tadalafil as initial therapy, in all visits significant improvements in mean pulmonary arterial pressure were observed (p<0.01). Of the 25 patients, 6 (24%) had been on sildenafil for longer than 6 months. After transition from sildenafil to tadalafil clinical improvement was noted (p<0.05). Administration of tadalafil suspension was generally safe and well tolerated. Nausea was the most frequently reported adverse events which occurred in 3 patients during treatment.

CONCLUSIONS

Oral tadalafil was administered easily and tolerated well and improved mean pulmonary artery pressure (MPAP) in children with PAH, which suggests that oral tadalafil may be more effective and safer than sildenafil in the treatment of PAH.

Sleep hygiene training program for patients on hemodialysis

INTRODUCTION

The high prevalence of sleep disorders highlights the importance of its treatment in hemodialysis patients. Due to complications of hypnotic medications, considering effective nonpharmacological methods to improve sleep quality is important. This study has conducted to determine the effect of a sleep hygiene training program on sleep quality of hemodialysis patients.

MATERIALS AND METHODS

In a randomized controlled clinical trial, 82 hemodialysis patients were randomly selected and allocated to the intervention (n = 41) and control (n = 41) groups. A 1-month sleep hygiene program was provided to the intervention group within 6 sessions, and the sleep quality was assessed by the Pittsburgh Sleep Quality Index before and after the intervention. The global and components scores were compared between the two groups.

RESULTS

The mean global scores and component scores of sleep quality were not significantly different between the two groups before the intervention. The mean global score of sleep quality of the intervention group significantly reduced after sleep hygiene education, as compared to the baseline values. The mean global score of the intervention group was significantly lower than that of the control group after the intervention (intervention, 9.92 +/- 3.80 versus control, 13.05 +/- 4.28). Also, the mean scores subjective sleep quality, sleep latency, sleep disturbances, and daytime dysfunction were significantly lower in the intervention group.

CONCLUSIONS

The findings of this study suggest that nursing and physicians team should consider reducing sleep problems of hemodialysis patients by training sleep hygiene.

Two-year follow-up study on neurodevelopmental outcomes after term intrapartum asphyxia using age and stages questionnaire

Birth asphyxia is one of the multiple causes of neonatal encephalopathy. The objective of this study was to evaluate neurodevelopmental outcomes of newborn term infants with definitive asphyxia. Thirty infants met study criteria for asphyxia. The 5-year incidence of asphyxia was estimated to be 5.5 in 1000. According to the Age and Stage Questionnaire, 10.5% of 6-month-old infants, 14.3% of 12- and 18-month-old infants, and 5.3% of 24-month-old infants had neurodevelopmental delay in gross motor function in the absence of cerebral palsy. In 7.3% of 18-month-old infants, neurodevelopmental delay in problem-solving ability was observed. Higher values of Apgar score and bicarbonate levels were associated with higher Age and Stage Questionnaire total score. Delivery type, maternal age, gravidity of mother, and existence of mother disease during pregnancy were also associated with lower Age and Stage Questionnaire total score in different stages of life.

Comparing Electrolytes in Prestorage Leukocyte-Reduced Packed Cell versus Unfiltered Packed Cell

BACKGROUND

Blood transfusion is associated with side effects caused by residual leukocytes in blood and blood components. Using leukodepleted blood components can decrease some of these adverse effects. Among the various methods to remove leukocytes in blood components, prestorage leukoreduction has been most efficient, but the evidence of clinical side effects awaits further studies. We evaluated changes of electrolytes in prestorage leukocyte-reduced red blood cells.

MATERIALS AND METHODS

In this case-control study, one hundred twenty eight packed cells were studied: 64 unfiltered packed cells and 64 prestorage filtered packed cell. Two groups were matched as sex and age. Electrolytes such as Calcium, Sodium, and Potassium of two groups were measured, and compared during preparation.

RESULTS

In this study, mean of Calcium in unfiltered and filtered group were 6.16±1.09 mg/dl and 5.57±2.21 mg/dl, respectively (P-value<0.055). Mean of Sodium in unfiltered group also was 155.91+/-9.51meq/l and in filtered group, 153.05+/-13.21meq/l (P-value<0.163), and mean of Potassium in unfiltered group was 5.01+/-1.72 meq/l and in filtered group, 7.42+/-2.45meq/l (P-value<0.001).

CONCLUSION

Releasing of Potassium during preparation of prestorage leukoreduction can cause increased Potassium level and hemoglobin concentration changes in prestorage filtered packed cell.

Bis(2-amino-4-methyl-pyrimidin-1-ium) hexa-aqua-cobalt(II) disulfate dihydrate

In the title hydrated mixed-cation salt, (C(5)H(8)N(3))(2)[Co(H(2)O)(6)](SO(4))(2)·2H(2)O, the complete octa-hedral hexa-aqua complex cation is generated by crystallographic inversion symmetry. In the crystal, the components are linked by O-H⋯O and N-H⋯O hydrogen bonds, the latter, involving pyrimidinium cations and sulfate anions, generating R(2) (2)(8) loops. These, together with π-π inter-actions between centrosymmetrically related pyrimidinium cations [centroid-centroid separation = 3.5460 (8) Å], lead to the formation of a three-dimensional network.

Sorbed metals fractionation and risk assessment of release in river sediment and particulate matter

Fractionation of metals in natural sediment and suspended particulate matter (SPM) of Tadjan River is investigated. Competitive sorption, sorption capacities of sediment and SPM as well as fractionation of metal-loaded sediment and SPM are also examined. A risk assessment code (RAC) is applied to estimate the risk of heavy metals release into the environment during the sorption process. Results revealed that sediments and SPM containing more than 25 % of clay minerals and higher amounts of calcite have great capacity of metal sorption, particularly for Cu, Ni, and Mn. Assessing the risk of metals release prior to and following sorption tests indicates that RAC of metals would significantly increase from the level of no or low risk in natural sediment and SPM to high or very high risk after sorption. The Langmuir model reveals that the highest affinity for Cu, Mn, and Ni in sediment is the organic fraction. The classic isotherm models of Freundlich and Langmuir can fit the data from chemical extraction studies of adsorbed metals, indicating that although sorption was apparently a physical and chemical process in the river, isotherm models can be used to simulate the sorption and accumulation in different geochemical phases within the particulate matter.

Macrophage migration inhibitory factor gene polymorphism is not associated with pemphigus vulgaris in Iranian patients

BACKGROUND

Promoter polymorphisms of the macrophage migration inhibitory factor gene are associated with increased production of macrophage migration inhibitory factor. Elevated levels of macrophage migration inhibitory factor have been observed in the sera of patients with pemphigus vulgaris. More than this, macrophage migration inhibitory factor promoter gene polymorphism has been found to confer increased risk of susceptibility to chronic inflammatory diseases.

OBJECTIVE

We investigated whether there is an association between promoter polymorphism of the macrophage migration inhibitory factor gene and pemphigus vulgaris.

METHODS

One hundred and six patients with pemphigus vulgaris, and a control panel of one hundred healthy volunteers were genotyped for a single nucleotide polymorphism identified in the 5'-flanking region at the position -173 of the gene, using polymerase chain reaction-restriction fragment length analysis.

RESULTS

We found a notably high prevalence of C/C genotype in our nation but no significant difference was observed between patients and controls.

CONCLUSION

The result of this study using a large and well documented trial of patients showed that macrophage migration inhibitory factor -173G-C polymorphism is not associated with pemphigus vulgaris; but as the role of macrophage migration inhibitory factor in the inflammatory process has not been delineated in detail and the prevalence of C/C genotype is notably higher in our nation, this finding merits more consideration.

Hair regrowth with topical triiodothyronine ointment in patients with alopecia areata: a double-blind, randomized pilot clinical trial of efficacy

BACKGROUND

Thyroid hormone receptors are expressed in hair follicles and it is known that thyroid hormones can have a positive effect on hair growth, i.e. process which is disrupted in alopecia areata.

OBJECTIVES

The aim of this study was to determine the efficacy of topical triiodothyronine in patients with patchy alopecia areata.

METHODS

Ten patients with patchy alopecia areata were treated with triiodothyronine and placebo applied twice daily to either of two bilaterally symmetrical patches for 12 weeks. The two sides were randomly assigned following simple randomization procedure to one of the two treatment groups. The patients and the investigator were blinded to the content of the tubes. Hair regrowth was evaluated every 4 weeks. Blood samples for measurements of complete blood count along with thyroid function (T3, T4 and TSH) and liver function tests were taken at the baseline and at the end of study.

RESULTS

After 12 weeks of treatment, there was no statistically significant difference between the outcome in terms of reduction of the patch size and hair regrowth. No adverse effects were noted.

CONCLUSION

Triiodothyronine in the studied dosage and formulation was safe but not more effective than placebo. However, newer thyroid hormone analogues might be more effective and evaluating their effects probably warrants further consideration.

Interferon-Beta-1b Induced Autoimmune Hemolytic Anemia in a Patient with MS: A Case Report

A 26-year-old lady with the diagnosis of multiple sclerosis who had received interferon beta1-b for eleven months was visited in MS clinic of our hospital because of icter and fatigue. Laboratory tests showed anemia, indirect hyperbillirubinemia, increased LDH, positive direct and indirect coomb's tests, and increased reticulocyte count and percentage. Other causes of autoimmune hemolytic anemia (AHA) and pre-existing AHA in the patient were ruled out. After INF discontinuation, symptoms disappeared, hemoglobin increased, and indirect coomb's test became negative. We concluded that autoimmune hemolytic anemia should be considered in all MS patients who receive interferon beta1-b and present with symptoms and signs of anemia.