Identifying and ranking of the main organizational resilience indicators in the hospital during the COVID-19 pandemic: A study using fuzzy Delphi technique (FDT) and fuzzy analytical hierarchy process (FAHP)

Resilience in a hospital is referred to as the capability to withstand and respond to disasters while maintaining critical functions. The current study aims to identify and prioritize the defining indicators of organizational resilience in dealing with the critical conditions of the COVID-19 pandemic. First, a literature review and semi-structured interviews with experts were performed for the identification of the primary indicators affecting the hospital's organizational resilience in critical conditions caused by the COVID-19 disease. Next, the fuzzy Delphi technique (FDT) was used to determine the effective and final indicators with a 70% agreement level. Finally, the indicators were weighted and prioritized using the FAHP method. The results shows that three indicators of leadership and management (NW = 0.092), preparedness (NW = 0.080), and learning from previous experiences (NW = 0.078) had the greatest impact on the organizational resilience of the hospital, respectively. Three indicators of logistics support, fallibility culture, creativity, and innovation with the final weights of 0.56, 0.054, and 0.053 gained the least importance, respectively. It can be concluded that a higher level of leadership and management, preparedness, and learning from previous experiences in the conditions of the COVID-19 pandemic can help control this crisis.

Determining the effect of selected mental factors on turnover intention through two modulators - stress and resilience over COVID-19 period

INTRODUCTION

Turnover intention among nurses has risen in an alarming rate since the onset of the pandemic. There are various underlying factors to turnover intention. The present study aims to determine the effect of a number of mental factors on nurses' professional-turnover intention through two modulators of stress and resilience over COVID-19 period.

METHODS

The current cross-sectional study was conducted at three hospitals in Khuzestan Province, southern Iran, during the winter of 2021. To collect the data, given the restrictions in place during COVID-19 period, the web link of electronic self-reported questionnaires (including general health, mental workload, work-family conflict, resilience, job stress, corona fear, and turnover intention) were sent to 350 nurses through e-mail and other social media (WhatsApp and Telegram). Accordingly, they were asked to complete the questionnaire during rest periods within two weeks. Totally, 300 people (85% participation) filled out the questionnaires. Finally, a model was constructed in the Amos software.

RESULTS

The results showed that the four independent parameters of decreasing general health, increasing mental workload, increasing WFCs and fear of COVID-19 can indirectly increase nurses' turnover intention by increasing job stress. Among these variables, the highest indirect effect coefficient on turnover intention was related to the general health parameter (-0.141). The results also demonstrated a negative correlation between job stress and resilience, with lower resilience raising job stress and, consequently, increasing intention to quit the job.

CONCLUSION

Mental factors affecting turnover intension were identified in this study through path analysis. Therefore, it is recommended that the required resilience-enhancing measures to be taken by hospitals and nursing administrations to reduce psychological pressures caused by mentioned variables with the aim of minimizing job-related stress and fostering nurse retention.

Possible Benefits of Paclitaxel Therapy for COVID-19

The Article Abstract is not available.

Greener synthesis of Rod Shaped Zinc Oxide Nanoparticles using Lilium ledebourii tuber and evaluation of their Leishmanicidal activity

Background

Nanoparticles (NPs) with unique chemical and physical properties can be used for therapeutic purposes because of their strong antimicrobial activates. Nanoparticles have been used as an antimicrobial agents to inhibit microbial growth.

Objectives

In view of the strong antimicrobial activity of nanoparticles, the biogenic synthesis and leishmanicidal activity of rod-shaped zinc oxide (R-ZnO) nanoparticles was explored using Lilium ledebourii tuber extract.

Materials and Methods

The ensuing nanoparticles are characterized by UV-visible spectroscopy, X-ray diffraction and transmission electron microscopy and their leishmanicidal activity evaluated against the Leishmania major (L. major) by MTT assay.

Results

The R-ZnO nanoparticles displayed excellent leishmanicidal activity against the L. major as they significantly inhibited the amastigotes. The IC₅₀ values of R-ZnO nanoparticles being ~ 0.001 mg.mL^-1. R-ZnO nanoparticles can inhibit L. major growth in a dose-dependent manner under in vitro conditions.

Conclusion

A simple, low-cost feasible and eco-friendly procedure was developed for biosynthesis of R-ZnO nanoparticles using natural bioresource that can inhibit human parasite cells growth in a dose-dependent manner under in vitro conditions.

Effects of concomitant exposure to styrene and intense noise on rats' whole lung tissues. Biochemical and histopathological studies

Concurrent exposure to styrene (ST) and noise is common especially in industrial environments. The present study aims to determine the related oxidant-induced changes as the result of combined exposure to ST and noise. For this purpose, 24 male Wistar rats were used in four experimental groups (n = 6/groups): (1) control group, (2) the group exposed to an octave band of noise centered at 8 kHz (100 dB SPL) (6 h/day), (3) the group inhalationally exposed to ST (750 ppm) (6 h/day), (4) the group exposed to noise and ST simultaneously. The DNA damage was measured by assessing the concentration of 8-hydroxyl-2-deoxyguanosine (8-OHdG) using ELISA kit. Levels of lipid peroxidation (MDA), GSH and antioxidative activity of SOD and CAT were also determined in whole lung tissues. The results relatively indicated that sub-acute exposure to both noise and ST can lead to pathological damage in rat lung tissues. Furthermore, enhanced levels of 8-OHdG and MDA production were observed in lung tissues. In contrast, GSH, CAT and SOD were markedly reduced in co-exposed group. The results of the study verified additive interaction between noise and ST on accumulation of DNA oxidation products, progressive morphological damages as well as undermining the antioxidative defense system in the rat lung tissues.

Croup as Unusual Presentation of Post-transplantation Lymphoproliferative Disorder after Liver Transplantation in an 18-month-old Child

Post-transplantation lymphoproliferative disorder (PTLD) is a serious complication of solid organ transplantation that occurs due to immunosuppression and other risk factors. PTLD may present with involvement of other organs and with unusual presentation. The presentation is often extranodal (e.g., in the gastrointestinal tract, lung, or the central nervous system). Herein, we report on a 1.5-year-old girl who underwent liver transplantation almost 5 months prior to admission. She was on medications such as tacrolimus and prednisolone. Her presentation was started with symptoms of the upper respiratory infection followed by croupy cough and respiratory distress with no response to usual treatments. She had respiratory arrest during broncoscopy. Therefore, emergency tracheostomy was done. Biopsy from the paratracheal mass revealed large B cell non-Hodgkin lymphoma (PTLD, monomorphic and high grade). This case presentation shows that persistent upper airway symptoms, particularly stridor and croupy cough, in children who underwent liver transplant should be further evaluated; the physician needs to have a high degree of clinical suspicion for the diagnosis of PTLD in this situation.

Mercury in the Oriental sole (Brachirus orientalis) near a chlor-alkali plant in the Persian Gulf, Iran

Total mercury in muscle and liver of Oriental sole from the largest inlet in the Persian Gulf was evaluated. Fish were collected from three channels of Moses Inlet near a chlor-alkali plant. Ahamdi and Jafari channels were closest to this plant and Ghanam was farther away. We sampled in August 2007 and February 2008. The overall estimated marginal mean for total mercury in sole tissue was 2.4 ± 0.1 mg/kg wet weight. Mercury in fish was similar in August and February; but muscle from Ahmadi contained higher mercury in August (1 ± 0.2) than in February (0.5 ± 0.01). This trend was reversed in the liver (1.3 ± 0.2 and 3.7 ± 0.3).

Prevalence of zinc deficiency in 3-18 years old children in shiraz-iran

BACKGROUND

Zinc is an essential trace element with a prominent role in human nutrition. Zinc deficiency has been linked to growth retardation, hypogonadism in males, and lack of sexual development in females. It ranges from 50% in sub-Saharan Africa to 5% in high income countries. The aim of this study is to evaluate the prevalence of zinc deficiency in healthy children in Shiraz, southern Iran.

METHODS

In this study, 902 children aged 3-18 years old were randomly sampled for serum zinc level. Age, sex, weight, height, BMI, stunting and wasting indices were also recorded. With atomic absorption spectrophotometry method, the serum level of zinc less than 70 µg/dL was considered as deficient.

RESULTS

Mean serum level of zinc was 122.3±55 µg/dL. The prevalence of zinc deficiency was 7.9%. There was no relationship among serum zinc level and age, sex, height, weight or BMI, but mild wasting (weight for age) and mild stunting (height for age) were significantly more prevalent among zinc deficient children compared to children with normal or high level of zinc.

CONCLUSION

Zinc deficiency in Shiraz is not as prevalent as other areas of Iran. It was significantly more frequent among stunted and wasted (malnourished) children. Difference in soil zinc level, recent wide prescription of zinc supplements by pediatricians and especial pattern of nutrition, considered as possible factors responsible for lower prevalence of zinc deficiency in Shiraz, deserve more investigations.

Evaluation of Candida infection after six months of transplantation in pediatric liver recipients in iran

BACKGROUND

Liver transplantation (LT) is the standard treatment of end-stage liver diseases (ESLD). Invasive fungal infection is one of the important causes of morbidity and mortality after transplantation.

OBJECTIVE

To determine the incidence of late-onset (after 6 months of LT) Candida infection in recipients.

METHODS

A retrospective study was conducted to evaluate 50 pediatric patients after LT for 8 years at the LT Unit of Nemazee Hospital affiliated to Shiraz University of Medical Sciences, Shiraz, Iran. We followed the patients until 6 months post-LT for episodes of Candida infection proven by culture.

RESULTS

One recipient (2%) developed late-onset esophageal candidiasis with improvement after intravenous amphotricin therapy but finally expired with a diagnosis of post-transplant lymphoproliferative disorder (PTLD).

CONCLUSIONS

The incidence of late-onset Candida infection is not significant in pediatric liver recipient, but it still remains a significant problem. Control of Candida colonization would reduce the risk of invasive fungal infections and possibly more fatal complications.

Evaluation of cytomegalovirus infection after six months of liver transplantation in children in shiraz, southern iran

BACKGROUND

Liver transplantation (LT) is a life-saving treatment for end-stage liver diseases (ESLD). Cytomegalovirus (CMV) infection is one of the important causes of morbidity after LT.

OBJECTIVE

To evaluate the incidence of late-onset (after 6 months of LT) CMV infection in pediatric recipients.

METHODS

A retrospective analysis was conducted to evaluate 50 pediatric patients who underwent LT for 8 years at the LT Unit of Nemazee Hospital affiliated to Shiraz University of Medical Sciences, Shiraz, Iran. We retrospectively investigated episodes of CMV infection after 6 months of LT proven by CMV antigenemia test.

RESULTS

Three recipients (6%) developed late-onset CMV infection. These patients finally responded to ganciclovir.

CONCLUSION

CMV infection is one of the most common post-LT viral infections that usually occurs in the first six months of LT. Our study shows that the incidence of late-onset CMV infection is relatively low, but it still remains a significant problem. Therefore, monitoring and management is crucial for improving the survival of children.

Morbidity and mortality of children with chronic liver diseases who were listed for liver transplantation in Iran

Liver transplantation is the treatment of choice for end-stage liver disease in children, but donor shortage is still a main problem in this age group. The aim of the present study is to evaluate the complications and mortality of liver disease in children waiting for transplantation. We analyzed medical records of 83 children aged <18 yr, who were listed for liver transplantation but the organ was not available for them between 1999 and 2006. The outcome was assessed from their records or follow-up data. Among the children (mean age, 8 +/- 5 yr; 50.5% boys) listed for liver transplantation, but the organ was not available for them, the common causes of cirrhosis were biliary atresia (27.7%) and cryptogenic (24.1%). The mean follow-up duration was 14 +/- 13.4 months (range 0.5-54 months). Sixty-seven (80.7%) patients developed one or more complications while awaiting transplantation. The most common complications were gastrointestinal bleeding (44.6%), spontaneous bacterial peritonitis (36.1%), infectious complications (28.9%), encephalopathy (24.1%), renal (18.1%), and pulmonary problems (10.8%). Fifty-one (61.4%) patients needed hospital admission because of complications and 26 (31.3%) patients died while awaiting transplantation. About two-thirds of children listed for liver transplantation needed hospital admission because of complications and one-third of them died without any liver transplantation. It seems that more split liver transplantation as well as the introduction of a live-related program in our center will provide many benefits to our children.

Chest pain in children and adolescents: epigastric tenderness as a guide to reduce unnecessary work-up

Our objective was to evaluate and highlight the significance of epigastric tenderness in children and adolescents with chest pain. In a 26-months period, patients who were referred for pediatri cardiology evaluation at Shiraz University of Medical Sciences with chief complaint of chest pain were studied. Patients with epigastric tenderness were evaluated endoscopically by gastroenterologist. Patients who had positive findings on endoscopy were appropriately treated. Since there were no serious findings on cardiac evaluation, no other treatment was necessary. The patients were re-evaluated 4 weeks later. Response to therapy was defined as relief of the initial symptoms as well as epigastric tenderness. One hundred thirty-two patients were referred for evaluation of chest pain during this period. Epigastric tenderness was found in 44 (33.3%) of these patients and endoscopy was performed. Endoscopy showed positive findings in 41 (93.2%). Thirty (75%) of these patients had varying degrees of gastritis. Duodenitis was found in six (13.6%) and gasteroduodenitis in five (11.4%). Esophagitis, which was always associated with gastritis, was seen in five (11.4%). Only three (6.8%) had normal endoscopy. Urease test was positive in three (7.3%) of the specimens. Two of the patients did not return for follow up. From the remaining 39 patients who received gastroenterology treatment, resolution of symptoms was seen in 38 (97.4%). Careful history and physical examination must guide the assessment of children and adolescents referred for evaluation of chest pain. Epigastric tenderness must be used as a reliable sign to initiate a gastrointestinal evaluation.

Carpal tunnel syndrome: reappraisal of five clinical tests

A combination of 5 clinical tests: Tinel (9, 10), Phalen (wrist flexion) (1, 2, 17), reverse Phalen (wrist extension) (4), carpal compression (11, 18), vibration (13, 14) was used in 74 hands with symptoms of carpal tunnel syndrome and proved by median sensory conduction velocity and distal latency across wrist and compared with 58 normal hands. Tinel test was the most specific and the least sensitive, vibration test was the most sensitive and the least specific. Carpal compression test was less sensitive and specific compared to Durkan's study. There was no correlation between Phalen time, reverse Phalen time, carpal compression time, and nerve conduction measurements. Cases with positive Tinel and vibration tests has slower sensory nerve conduction velocity (SNCV) compared to cases with negative results. Also patients with positive vibration tests had longer duration of symptoms in comparison to patients with negative test results. Up to now electrodiagnostic studies are the standard in diagnosing carpal tunnel syndrome and determining severity of median nerve involvement at wrist.

Isoprenaline induces biosynthesis of proline-rich proteins in the salivary glands of rat but not in sheep

Long-term treatment of rats with isoprenaline resulted in induction of proline-rich proteins (PRPs) in the salivary glands, which were subsequently purified by TCA solubility and column chromatography. When rats were removed from beta-agonist regimen, then these proteins were no longer observed. Treatment of sheep with isoprenaline did not reveal the induction of PRPs.