The Effect of Multidimensional Spiritual Psychotherapy on the Quality of Life of Bone Cancer Survivors with a History of Lower Extremity Amputation

INTRODUCTION

This study aimed to investigate the effect of multidimensional spiritual psychotherapy on anxiety, depression, and attitude towards self and god in bone cancer patients after amputation.

METHOD

Forty one cancer patients with a history of Below-The-Knee amputation were recruited in this quasi-experimental study. The design included pre-and post-tests in experimental and control  groups. The experimental group received 15 sessions of multidimensional spiritual psychotherapy. Cattell Anxiety Inventory (CAI), Beck Anxiety Inventory (BAI), Beck's Depression Inventory (BDI), Religious Adherence Questionnaire (RAQ), and Self-concept-God concept questionnaire were administered for data collection.

RESULTS

There was a significant difference between the control and experimental groups in terms of anxiety (P=0.0001), Depression (P=0.0001), God-image (P=0.035, F(1,38)=4.79), God-concept (P=0.006, F(1,38)=8.58), self-image (P=0.0001, F(1,38)=98.62), and self-concept (P=0.0001, F(1,38)=120.56), psychological evolution (P=0.0001, F(1,38)=19.36), and religious adherence (P=0.0001, F(1,38)=84.21).

CONCLUSION

The results of the study indicated that the emphasis on spirituality and the implementation of spiritual care could improve the cancer amputated patients' well-being.

MMP inhibition as a novel strategy for extracellular matrix preservation during whole liver decellularization

As the only reliable treatment option for end-stage liver diseases, conventional liver transplantation confronts major supply limitations. Accordingly, the decellularization of discarded livers to produce bioscaffolds that support recellularization with progenitor/stem cells has emerged as a promising translational medicine approach. The success of this approach will substantially be determined by the extent of extracellular matrix (ECM) preservation during the decellularization process. Here, we assumed that the matrix metalloproteinase (MMP) inhibition could reduce the ECM damage during the whole liver decellularization of an animal model using a perfusion-based system. We demonstrated that the application of doxycycline as an MMP inhibitor led to significantly higher preservation of collagen, glycosaminoglycans, and hepatic growth factor (HGF) contents, as well as mechanical and structural features, including tensile strength, fiber integrity, and porosity. Notably, produced bioscaffolds were biocompatible and efficiently supported cell viability and proliferation in vitro. We also indicated that produced bioscaffolds efficiently supported HepG2 cell function upon seeding onto liver ECM discs using albumin and urea assay. Additionally, MMP inhibitor pretreated decellularized livers were more durable in contact with collagenase digestion compared to control bioscaffolds in vitro. Using zymography, we confirmed the underlying mechanism that results in these promising effects is through the inhibition of MMP2 and MMP9. Overall, we demonstrated a novel method based on MMP inhibition to ameliorate the ECM structure and composition preservation during liver decellularization as a critical step in fabricating transplantable bioengineered livers.

How Do Iranian Researchers Measure Spirituality in Health Studies? A Scoping Review

Background

Despite the existing literature on the effect of spirituality on health, lack of consensus on definition and evaluation methods are major barriers to applying the results of these studies. In this scoping review, we intend to identify the instruments used for evaluating spirituality in health in Iran and evaluate their domains.

Methods

We searched PubMed, Scopus and Web of Science, Islamic World Science Citation Center, Scientific Information Database, and Magiran between 1994 and 2020. We then identified the questionnaires and searched for the original article reporting the development or translation, as well as the psychometric evaluation process. We extracted data on their type (developed/translated), and other psychometric properties. Finally, we categorized the questionnaires accordingly.

Results

After selecting the studies and evaluating the questionnaires, we identified 33 questionnaires evaluating religiosity (10 questionnaires), spiritual health (8 questionnaires), spirituality (5 questionnaires), religious attitude (4 questionnaires), spiritual need (3 questionnaires) and spiritual coping (3 questionnaires). Other existing questionnaires had issues in the development or translation process or lacked reported psychometric evaluations.

Conclusion

Many questionnaires have been used in spiritual health studies in the Iranian population. These questionnaires cover different subscales according to their theoretical base and the developers' perspectives. Researchers should be informed about these aspects of the questionnaires and select the instruments meticulously based on the aim of their study and the characteristics of the questionnaires.

COVID-19 Pandemic and Spiritual Challenges in Iran

ndividuals encounter unprecedented critical conditions globally. The Coro navirus Disease 2019 (COVID-19) has spread worldwide [1]. In addition to biopsychological health, this crisis has affected other areas of human life, like the spiritual health of individuals [2]. This issue can be of great importance because spiritual issues are closely related to general health, and especially mental health among individuals [3]. In Iran, >99% of the population is Muslim; thus, spiritual and religious is sues overlap and greatly interact [4]. Spirituality is the search to find the greatest meaning in life and closeness to the source of existence [5]. Religion structures such a search by drawing the place of religious authorities, shaping social networks, certain customs, valuing works, encouraging collective participation, and so on [6]. Due to this overlap, damaging these structures during the CO VID-19 pandemic may create a kind of spiritual crisis. How did the coronavirus create a spiritual crisis? Some aspects of this crisis include the following: 1. We can consider religious spirituality in the Iranian society as hierarchical; with important holy places and houses of religious leaders at the top; and religious pub lic meetings at the bottom, as well as mosques and Hus seiniyahs1 in the middle. All of them were closed and physical access to them had become impossible during 1. A mosque-like place used for religious meetings and religious rituals public quarantine. These include the places where some Muslims used to visit to strengthen their inner spiritual resources and release daily psychological stress. 2. In Iranian culture, individuals have a very close rela tionship with religious authorities (clerics). Accordingly, in religious affairs and some social issues, and even some daily affairs, the intellectual policy of the society is deter mined by religious leaders. Numerous religious leaders are elderly and among the high-risk group of COVID-19; therefore, this relationship was challenged by the COV ID-19 pandemic and reduced biosocial relationships. 3. The potential of religious communities and psycho social support to each other in reducing psychological stress and preventing mental disorders has been empha sized in various studies [7]. Islamic teachings also place great emphasis on community and participation among religious brothers, while these communities were also banned under quarantine due to illness

Development of a pre-hospital emergencies protocol for the management of suicidal patients in Iran

Background

Suicide is a painful consequence of many psychiatric disorders and one of the most frequent psychiatric emergencies. Generally, pre-hospital technician is the first person in the treatment chain who attends the situation; hence, his/her sound clinical judgment and professional behavior can play an important role in preventing or stopping the suicide process. We tried to develop a concise, evidence-based, and step-by-step guide for dealing with a suicidal patient, which could be quickly reviewed by technicians before confronting a suicide situation.

Method

We reviewed the literature for suicide management plans and protocols, to extract the evidence-based interventions and instructions for dealing with a suicide situation. Then, we discussed the extracted material in an expert panel, and developed the initial version of the protocol considering the local socio-cultural issues and available facilities. Subsequently, we reviewed the protocol in a meeting with pre-hospital technicians and emergency physicians, to receive their feedback and address any possible executive problems. Finally, we revised the protocol to its final version considering the feedbacks.

Results

The basic principles of dealing with a suicidal patient are similar to other psychiatric emergencies and include: Patient Safety; Patient evaluation and diagnosis; and Patient (behavioral and pharmacological) management. However, specific considerations should be taken into account and special arrangements are necessary for suicidal patients. Whether the patient has attempted suicide or not, would guide the management to one of the two major paths. In addition, the needs of the family should be considered.

Conclusion

A locally adapted protocol considering existing facilities in the emergency system and cultural issues in Iranian society is provided for pre-hospital emergency technicians.

Cinnamon effects on blood pressure and metabolic profile: A double-blind, randomized, placebo-controlled trial in patients with stage 1 hypertension

OBJECTIVE

Cinnamon effect on blood pressure remains controversial. The present pilot study assessed cinnamon effect on blood pressure, and metabolic profile of stage 1 hypertension patients (S1HTN).

MATERIALS AND METHODS

This double-blind placebo-controlled randomized trial was conducted between June and October 2019, in Mashhad, Iran. Study inclusion criteria comprised S1HTN diagnosis, based on 24-hour ambulatory blood pressure monitoring (ABPM). Subjects were randomly assigned to two groups: cinnamon group (capsule, 1500 mg/day, 90 days) and placebo group. On days 0 and 90, ABPM derived systolic and diastolic blood pressure (SBP and DBP, respectively), blood lipid profile, and fasting blood sugar (FBS) were recorded.

RESULTS

The two groups did not differ significantly regarding vascular risk factors, educational status, lipid profile and blood pressure at baseline, except for lower HDL-c in cinnamon group (p=0.03). On day 90, there was no significant difference between two study groups for lipid profile and blood pressure. A statistically significant decrease in mean 24-hr SBP and mean day SBP was observed in the cinnamon group, while mean night SBP and mean night DBP were decreased significantly in the placebo group after 90 days. A statistically significant decrease in mean change of day value of SBP was found in the cinnamon group, compared to the placebo. On day 90, FBS remained practically unchanged but a significant increase in HDL-c (5.8 unit; p=0.01) and a significant decrease in LDL-c levels (17.7 unit; p=0.009) were observed in the cinnamon group compared to placebo group.

CONCLUSION

Cinnamon caused a statistically significant decrease in mean ambulatory SBP but in a clinically moderate way, and lipid profile was significantly improved. Therefore, cinnamon might be considered a complementary treatment in subjects with S1HTN.

First line in psychiatric emergency: pre-hospital emergency protocol for mental disorders in Iran

INTRODUCTION

This article is a report of designing a rapid and effective guide for paramedics who take care of patients in a pre-hospital setting to answer developing demands.

METHODS

The relevant literature was reviewed, and the topics were extracted. Then, the extracted items were discussed in an expert panel. Finally, items were discussed in a meeting including emergency technicians and emergency technical assistants to identify implementation problems.

RESULTS

Important topics for managing psychiatric patients were categorized at three levels: 1) Patient safety and security issues, 2) Patient status assessment and diagnosis, and 3) Patient management (medical, behavioral management, and referral to a treatment center).

DISCUSSION

This protocol can be a solution to improve emergency technician training. Such summarized protocols can be used for rapid review immediately before exposing a patient with an acute psychiatric condition. Due to specific cultural and different access to medicines in Iran, some issues are different.

Simvastatin as an Adjunctive Therapy to Risperidone in Treatment of Autism: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial

OBJECTIVES

Providing novel treatments for autism has been a subject of long-standing research. Based on etiopathological findings, we aim at assessing potential therapeutic effects of statins, here simvastatin, on autism symptoms for the first time.

METHODS

In this randomized, double-blind, placebo-controlled, parallel-group 10-week clinical trial, 70 drug-free children aged 4 to 12 years old with diagnosis of autistic disorder based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, who had an Aberrant Behavior Checklist-Community (ABC-C) scale irritability subscale score of ≥12, were equally randomized to receive either simvastatin (20-40 mg/day) or placebo as an adjunct to risperidone (1-2 mg/day) whereas administration of both drugs was started simultaneously from baseline. Patients with comorbid psychiatric disorders, active medical conditions, severe intellectual disability, seizure disorders, history of any treatments for autism in the past 6 months, or history of current anti-inflammatory drug consumption were excluded. Primary outcome was defined as the difference in mean change of the ABC-C scale irritability subscale score from baseline to the endpoint ( www.irct.ir ; IRCT201602041556N86).

RESULTS

Significant differences in change of the ABC-C scale irritability (mean difference [95% confidence interval (CI)] = -3.45 [-5.37 to -1.54], p = 0.001; Cohen's d = 0.89) and hyperactivity/noncompliance (mean difference [95% CI] = -4.27 [-6.69 to -1.86], p = 0.001; Cohen's d = 0.87) subscales scores were detected between the two arms. No significant difference was detected in case of the other three subscales.

CONCLUSIONS

This study provides preliminary evidence for potential therapeutic effects of simvastatin in the treatment of autism that warrants further investigations.

The effectiveness of diclofenac gel and eutectic mixture of local anesthetic cream on vein puncture pain severity with vein catheter in patient undergoing cesarean section: A randomized, double-blind, placebo-controlled trial

AIM

This study was aimed to explore the effect of applying diclofenac gel and a eutectic mixture of local anesthetic (EMLA) cream on vein puncture pain severity with vein catheter in the patients undergoing cesarean section.

MATERIALS AND METHODS

The sample comprised 90 women undergoing elective cesarean section that referred to Imam Ali Hospital's maternity section in Amol city (Northern Iran). Data collection tools included visual analog scale for pain severity and a checklist for short term possible side-effects of diclofenac gel, EMLA cream and Vaseline ointment as placebo.

RESULTS

The pain of vein puncture with diclofenac gel and EMLA cream was significantly lower than that with the Vaseline ointment (P = 0.001). Similarly, there was a significant difference between using diclofenac gel and EMLA cream in catheter insertion pain severity (P = 0.006). In addition, there was no short term possible side-effect with using diclofenac gel and Vaseline ointment, but a short term side-effect (blanching) was detected in 20% of subjects with EMLA cream.

CONCLUSION

Compared to Vaseline cream, EMLA cream and diclofenac gel application significantly reduces the pain severity associated with vein catheter insertion. Use of diclofenac gel is preferred compared with EMLA cream, because of economics, more efficiency purpose, and no side-effects.