Outcomes of organ donation in brain-dead patient's families: Ethical perspective.

BACKGROUND:: The families of brain-dead patients have a significant role in the process of decision making for organ donation. Organ donation is a traumatic experience. The ethical responsibility of healthcare systems respecting organ donation is far beyond the phase of decision making for donation. The principles of donation-related ethics require healthcare providers and organ procurement organizations to respect donor families and protect them against any probable harm. Given the difficult and traumatic nature of donation-related experience, understanding the outcomes of donation appears crucial. OBJECTIVE:: The aim of this study was to explore the outcomes of organ donation for the families of brain-dead patients. METHODS:: This was a qualitative descriptive study to which a purposeful sample of 19 donor family members were recruited. Data were collected through holding in-depth semi-structured interviews with the participants. Data analysis was performed by following the qualitative content analysis approach developed by Elo and Kyngäs. FINDINGS:: The main category of the data was "Decision to organ donation: a challenge from conflict to transcendence." This main category consisted of 10 subcategories and 3 general categories. The general categories were "challenging outcomes," "reassuring outcomes," and "transcending outcomes." ETHICAL CONSIDERATIONS:: The study was approved by the regional ethical review board. The ethical principles of informed consent, confidentiality, and non-identification were used. CONCLUSION:: Donor families experience different challenges which range from conflict and doubtfulness to confidence, satisfaction, and transcendence. Healthcare providers and organ procurers should not discontinue care and support provision to donor families after obtaining their consent to donate because the post-decision phase is also associated with different complexities and difficulties with which donor families may not be able to cope effectively. In order to help donor families achieve positive outcomes from the tragedy of significant loss, healthcare professionals need to facilitate the process of achieving confidence and transcendence by them.

Cytosolic Calcium Measurement Utilizing a Single-Cell Biochip to Study the Effect of Curcumin and Resveratrol on a Single Glioma Cell.

A microfluidic method has been developed for real-time measurement of the effects of curcumin on the intracellular calcium concentration in a single glioma cell (U87-MG). This method is based on quantitative fluorescence measurement of intracellular calcium in a cell selected in a single-cell biochip. This biochip consists of three reservoirs, three channels, and a V-shaped cell retention structure. Because of the adherent nature of glioma cells, a single cell can adhere within the aforementioned V-shaped structure. The single-cell calcium measurement will minimize cell damage caused by conventional cell calcium assay methods. Previous studies have shown that curcumin increased cytosolic calcium in glioma cells using the fluorescent dye: Fluo-4. So in this study, the effects of 5 µM and 10 µM solutions of curcumin on the increases of cytosolic calcium in a single glioma cell have been measured. Moreover, the effects of 100 µM and 200 µM of resveratrol are measured. At the final stage of the experiments, ionomycin was used to increase the intracellular calcium to the highest possible level due to dye saturation. It has been demonstrated that microfluidic cell calcium measurement is a real-time cytosolic assay that requires small quantities of reagent, which will have potential uses for drug discovery.

An exploration into the challenges of managing the COVID-19 pandemic in mass education centers in Iran: A qualitative content analysis.

Background: During the COVID-19 pandemic, Iran's mass education centers, which house a large number of trainees, encountered numerous difficulties in managing the disease. Understanding these challenges can help manage future pandemics. This study was conducted to explore the challenges of managing the COVID-19 pandemic in mass education centers in Iran. Methods: In this qualitative study, we used a qualitative content analysis of data collected from June to October 2022 in eight mass education centers in Iran. Semi-structured interviews (n=19) were used for data collection. Results: Four main themes and eleven subthemes were identified: The essence of dormitory life (Subthemes included: "The high population density in the dormitory", "Public toilets" and, Interprovincial travel), the inflexibility of the profession (Subthemes included: "Inapplicable health protocols" and, "Inflexible rules and regulations"), Negligence (Subthemes included: "Not adhering to health protocols", "Non acceptance of illness", and "High-risk taking"), and Weakness of health-care platform (Subthemes included: "shortage of healthcare facilities", "Lack of specialized personnel", and "The uni-dimensional aspect of healthcare services"). Conclusion: We identified several challenges that made the handling of COVID-19 difficult in Iran's centers for mass education. These findings can help future research in addressing the challenges and designing adaptable plans for pandemic management in mass education centers.

The effects of a team-based planned care program on the quality of sleep in cardiac surgery patients hospitalized in the intensive care unit: A two-group controlled clinical trial.

BACKGROUND: Sleep disturbances as a major health problem are common in patients hospitalized in critical care units. This study examined the effects of a team-based care plan on the quality of sleep in patients hospitalized in a cardiac surgery intensive care unit (CSICU) of a multidisciplinary hospital. MATERIALS AND METHODS: In this clinical trial, 100 patients with cardiac surgery were selKMected through convenience sampling and then nonrandomly allocated to the intervention and or the control group. A plan of care with the recommendation of all intensive care unit care teams was designed and then applied. In this study, the Richards-Campbell Sleep Questionnaire was used to evaluate sleep quality. Patients in the intervention group received the care plan for two consecutive nights. The study's national approval code is IRCT2017091915512N2. Collected data were analyzed using SPSS software (v. 21), and by paired, independent t, Chi-square, and Fisher's exact tests. RESULTS: Quality of sleep in patients admitted to the CSICU is significantly improved by noise reduction both in the first and second nights. Moreover, the team-based care plan requires good coordination between all team members taking care of cardiac surgery patients admitted to the CSICU (P < 0.001). CONCLUSIONS: The team-based care plan significantly improves the quality of sleep. It may be due to the close coordination between all team members to avoid sleep disturbances.

Distinguishing Characteristics of COVID-19-Associated Mucormycosis; a Case Series.

Introduction: Since the emergence of COVID-19 pandemic, several articles have reported the co-existence of mucormycosis and COVID-19. This study aimed to distinguish the characteristics of COVID-19-associated rhinocerebral mucormycosis. Methods: In this case series, 18 patients with COVID-19-associated rhinocerebral mucormycosis and unique clinical manifestations and outcomes, who were referred to Amiralam Hospital, a tertiary otorhinolaryngology center, Tehran, Iran, during the COVID-19 era, were reported. Results: Eighteen patients with the mean age of 62.0 ± 11.6 (range: 42 - 83) years were studied (50% males). The mean time interval between diagnosis of COVID-19 and first manifestation of mucormycosis was 15.5 ± 9.7 days. The most common presenting symptom was facial paresthesia (72.2%). Fifty percent of patients developed frozen eye. Palatal necrosis was seen in 7 cases (38.8%). Remarkably, facial paralysis was observed in 5 (27.7%) patients. Another notable clinical picture was cavernous sinus thrombosis, seen in 7 patients. We also had two cases of carotid artery occlusion. Three patients, unfortunately, passed away. Conclusion: Rhinocerebral mucormycosis is one of the most important complications of COVID-19 patients, especially those with underlying diseases. It seems that the key to proper management of mucormycosis is early diagnosis and timely intervention, which could give a patient a chance to live more.

The effects of Continuous Care Model on depression, anxiety, and stress in patients on hemodialysis.

This quasi-experimental study was carried out to determine the effects of the Continuous Care Model on stress, anxiety, and depression in patients on hemodialysis in Hamedan, Iran in 2005. Thirty-eight patients were selected randomly and the Depression Anxiety Stress Scale (DASS-21) was used for data collection. Data analysis showed a significant relationship between applying the Continuous Care Model and DASS-21 scores. According to the findings, applying this care model can improve the lives of patients on hemodialysis.

The Effect of Social Support Skill-training Group Intervention on Perceived Social Support in Veterans with Posttraumatic Stress Disorder.

BACKGROUND: Traumatic events related to war have long effects on psychiatric psychopathologies. From these disturbing conditions, posttraumatic stress disorder (PTSD) is considered to be the most characteristic feature of psychiatric traumatic experience. The current study was designed to assess the effect of two social support skill-training group interventions on perceived social support in veterans with PTSD. MATERIALS AND METHODS: The study was conducted with the clinical trial method. According to the inclusion criteria, 60 of 367 veterans with PTSD were selected and randomly allocated into two intervention groups and a control group. The two training programs on social support skills consisting of three sessions, each being 1.5-2 h, were held weekly for 3 weeks. The Multidimensional Scale of Perceived Social Support was filled by samples before and 6 weeks after intervention. The data were analyzed by descriptive and analytical statistics using PASW Statistics 18. RESULTS: The ANOVA results showed that after intervention, there were significant differences in perceived social support between intervention groups and control group (F = 1.06, p = 0.001), but there was no significant difference between intervention groups by t-test (t = 28.05, p < 0.10). The paired t-test showed a significant difference in all subscale scores of perceived social support between two intervention groups before and after intervention (p < 0.05). CONCLUSIONS: The results of the current study agreed with the positive effects of social support skill training on perceived social support in veterans with PTSD. It is suggested that these training courses should be included in the community re-entry programs of veterans with PTSD.

Management of Chronic Daily Headache and Psychiatric Co-Morbidities by Lifestyle Modification: Participatory Action Research Combining New Communication Media.

BACKGROUND: Lifestyle modification has a significant role in chronic daily headache (CDH) management. Participatory action research (PAR) can play an important role in managing chronic medical conditions. However, it has been scarcely used in CDH management. OBJECTIVES: This study aimed to empower patients with CDH to modify their lifestyle in order to reduce both their headache and related psychiatric co-morbidities in a multidisciplinary headache clinic at Baqiyatallah hospital, Tehran, IR Iran. METHODS: In the PAR plan, 37 patients (27 females) diagnosed with CDH were selected using purposeful sampling. Along with face-to-face group sessions, all available communication means such as phone calls, emails, short message system (SMS), and social media (Telegram) were used to facilitate the process. Questionnaires of health promotion lifestyle profile (HPLPІІ), visual analog scale (VAS), and depression-anxiety-stress scale (DASS21) were used to collect data. The data were analyzed using SPSS software. RESULTS: Mean age of the patients was 38.33 (± 9.7) years. Both "general pain" and "the worst imaginable pain" reduced (mean of reduction: 2.56 ± 2.7 and 2.3 ± 2.9, respectively, P < 0.001). > 50% of pain reduction occurred in "the worst imaginable pain" category (-1.45 ± 2.02, P < 0.001) and mean VAS score reduced to 5.20 (± 2.3) compared to the start of the study (7.50 ± 1.9, P < 0.001). Mean DASS-21 score also reduced significantly for depression (P < 0.016), anxiety (P < 0.026), and stress (P < 0.008). HPLPІІ score significantly improved (118.17 ± 14.8 vs. 160.83 ± 16.4, P < 0.001) and the highest increase was seen in the subscale of "stress management" (17.73 ± 2.8 vs. 25.53 ± 3.9, P < 0.001). CONCLUSIONS: The empowering PAR plan combined with new communication tools helped the CDH patients better handle their lifestyle, reduce their headache, and lower their symptoms. Further studies with better use of currently available communication tools and social media are recommended for action research to be more applicable.

The Effect of Wood Aerosols and Bioaerosols on the Respiratory Systems of Wood Manufacturing Industry Workers in Golestan Province.

BACKGROUND: Occupational exposure to dust leads to acute and chronic respiratory diseases, occupational asthma, and depressed lung function. In the light of a lack of comprehensive studies on the exposure of Iranian workers to wood dusts, the objective of this study was to monitor the occupational exposure to wood dust and bioaerosol, and their correlation with the lung function parameters in chipboard manufacturing industry workers. MATERIALS AND METHODS: A cross-sectional study was conducted on chipboard workers in Golestan Province; a total of 150 men (100 exposed cases and 50 controls) were assessed. Workers were monitored for inhalable wood dust and lung function parameters, i.e., FVC, FEV1, FEV1/FVC, and FEF25-75%. The workers' exposure to bioaerosols was measured using a bacterial sampler; a total of 68 area samples were collected. The analysis was performed using the Mann-Whitney, Kruskal-Wallis, and regression statistical tests. RESULTS: The geometric mean value and geometric standard deviation of inhalable wood dust for the exposed and control groups were 19 ± 2.00 mg/m3 and 0.008 ± 0.001 mg/m3, respectively. A statistically significant correlation was observed between the lung parameters and cumulative exposure to inhalable wood dust, whereas a statistically significant correlation was not observed between the lung parameters and bioaerosol exposure. However, the exposure of Iranian workers to bioaerosols was higher, compared to their foreign coworkers. CONCLUSION: Considering the high level of exposure among workers in this study along with their lung function results, long-term exposure to wood dust may be detrimental to the workers' health and steps to limit their exposure should be considered seriously.

Experiences of Iranian Nursing Faculty Members on Working in Conflict Climate.

BACKGROUND: Few studies have been conducted on role conflict in nursing faculty in the world. This research reports the first study about this subject in Iran. OBJECTIVES: The purpose of this research was to explore the experiences of role conflict in Iranian nursing faculty members. MATERIALS AND METHODS: We conducted a qualitative study using a conventional content analysis approach. We used semi-structured and in-depth interviews by purposive sampling of 19 (15 instructors, three group managers and one educational assistant) participants to identify the influential factors of role conflict among nurse faculty members, working in seven nursing colleges in Iran. RESULTS: The three following categories emerged from data analysis: "roles Interference"; "role ambiguity", and "conflicting expectations". The main theme was "working in conflict climate". CONCLUSIONS: This study highlighted the influential factors that could produce role conflict for nursing faculty members. The results can help university leaders to improve nursing faculty working conditions.

Effect of Vitamin B12 supplementation on serum homocysteine in patients undergoing hemodialysis: A randomized controlled trial.

Clinical studies have shown that hyper-homocysteinemia is a potent independent risk factor for cardiovascular diseases, and many different methods have been investigated for lowering it in hemodialysis (HD) patients. Our study investigated the effect of Vitamin B 12 supplementation on serum homocysteine levels in these patients. This randomized trial was conducted on 140 HD patients. They were randomly distributed by lottery method into two groups: intervention and control. In the intervention group, 100 µg/mL of Vitamin B 12 was intravenously injected two times a week, for eight weeks. No intervention was performed in the control group. Serum levels of homocysteine, hemoglobin (Hb), and hematocrit (Hct) were measured at the beginning and again after eight weeks (2 months) of treatment. About 91% of the patients had hyperhomocysteinemia (serum homocysteine >15 µmol/L). The median baseline levels of serum homocysteine in the intervention and control groups were 31.9 and 26.9 µmol/L, respectively (P = 0.1). After eight weeks, the median homocysteine level reduced significantly in the Vitamin B 12 group to 22.2 versus 28.4 µmol/L in control group (P = 0.006). The mean Hb and Hct also changed significantly during our study (12.3 vs. 11.4 g/dL; P = 0.003 and 37.9 vs. 35.3%; P = 0.02, respectively). Our results demonstrated the existence of a statistical negative relationship between Vitamin B 12 and serum levels of homocysteine. Detailed investigations with larger sample sizes and longer-term use of Vitamin B 12 are recommended.

Relationship Between Low Back Pain With Quality of Life, Depression, Anxiety and Stress Among Emergency Medical Technicians.

BACKGROUND: Musculoskeletal disorders have become increasingly common among healthcare providers. They have become the most common cause of work-related disabilities among nurses. OBJECTIVES: The current cross-sectional study aimed to measure the prevalence of back pains among emergency medical technicians (EMTs), and association of back pain with quality of life, depression, anxiety and stress. MATERIALS AND METHODS: One hundred and eighty registered nurses working as EMTs at the Hamadan Emergency Medical Center were selected by consensus. Data collection tools were Demographic, Perceived Quality-of-Life, Short Form Health Survey (SF-36), and Depression Anxiety Stress Scales (DAS21) and pain scale measurements. RESULTS: Data showed that while 50.7% of the participants had an average awareness of the basic principles of back care, the majority (71.8%) had at least one type of back pain. There were associations between the prevalence of pain and depression (P = 0.049), pain and awareness (P = 0.035), and stress and job satisfaction (P = 0.024). CONCLUSIONS: A large number (about two-thirds) of EMTs had some sort of back pain; it is highly recommended to promote the attitude and motivation of the individuals to take care to prevent back injury and inform them of the principles of back care. Implications for primary prevention and care practice include encouraging EMTs to apply accurate principles of back care.

Occupational Exposure and Health Impairments of Formaldehyde on Employees of a Wood Industry.

BACKGROUND: Occupational exposure to formaldehyde may decrease white blood cell counts and change blood concentration. In this study, the influences of occupational exposure to formaldehyde on the number of white blood cells and blood concentrations were studied. METHODS: This case-control study was conducted in June of 2012 at North Wood Factory, Golestan Province, Iran. The US-NIOSH method No. 2541 was used to determine the occupational exposure of 30 workers of the production line (case group) and 30 administrative staffs (control group) to formalde-hyde. The number of white blood cells and blood concentration were determined using the normal blood count method and related indices. Demographic features as well as the symptoms of being exposed to formaldehyde were collected using a standard questionnaire. RESULTS: The occupational exposure of case group ranged from 0.50 ppm to 1.52 ppm. The prevalence of all studied symptoms from formaldehyde exposure in workers (2

Exploring spirituality in Iranian healthy elderly people: A qualitative content analysis.

BACKGROUND: Spirituality is recognized as a personally important matter to the elderly, and there are evidences of its impact on their health. The aim of this study was to explore the concept of spirituality from the perspectives of Iranian healthy elderly individuals. MATERIALS AND METHODS: A conventional qualitative content analysis of carried out with 21 healthy elderly people from both male and female genders were chosen using a purposive sampling method in Tehran in 2010-2011. Data collection was done through semi structured interviews. A qualitative content analysis was used to analyze the participants' experiences and perceptions on spirituality, using a central question 'what characterizes the spirituality in the Iranian healthy elderly people?' RESULTS: THE FOLLOWING CATEGORIES EMERGED FROM THE DATA ANALYSIS: (1) Spiritual health, with four sub categories including saying prayer as a calming factor; beneficence as a way to God; loss of psychological and spiritual support; faith as a way to happiness; (2) spiritual beliefs, with three sub categories including seeking help from God in difficulties; God's power over life and death; doing good deeds is the God's will; and (3) religious practice with three sub categories including saying prayer; reading Quran; and going to mosque, religious ceremonies and pilgrimage. CONCLUSIONS: In this study was found that spirituality was a fundamental element in elderly individuals' lives that help them to adapt with daily living conditions.

Pain and health-related quality of life in war veterans with bilateral lower limb amputations.

BACKGROUND: Amputation and pain may have considerable impact on health-related quality of life. OBJECTIVES: The purpose of this study was to assess the impact of pain on health-related quality of life in a population of war related bilateral lower limb amputees. MATERIALS AND METHODS: The Veterans and Martyrs Affairs Foundation (VMAF) database documented 578 patients with bilateral lower limb amputation; 335 consented to the study (response rate = 58%). The majority of participants in the sample were males (96.7%). Types of pain were investigated using a questionnaire. Health-related quality of life (HRQOL) was investigated using the sf-36 questionnaire. RESULTS: About two third of amputees reported phantom pain 66.7% (n = 223) and vertebral column pain 60.9% (n = 204). The most common type of pain was lumbosacral pain 52.8 % (n = 177) followed by neck 18.2 % (n = 61) and thoracic pain 9.6% (n = 32). Back pain affected on vitality, social function, mental health and mental component scale in our cases (P < 0.05). Neck pain affected all components of health-related quality of life (P < 0.05). Thoracic pain affected quality of life significantly (P < 0.05). The results obtained from logistic regression analysis indicated that none of the three spinal column pains including neck, thoracic and lumbosacral pain resulted in poor physical or mental component scales. CONCLUSIONS: This study revealed that bilateral lower limb amputees suffer from different types of pain and poor health-related quality of life. Therefore, the assessment and management of all types of pain are necessary to improve quality of life in veterans.

An innovative educational model in intraocular pressure measurement.

Tactile palpation is a simple technique that can prove useful for estimating intraocular pressure (IOP) in primary healthcare settings, mainly in the absence of equipment, for very young children, patients who are intellectually challenged, those with eyes with extremely irregular corneas, and patients with corneal prostheses. Accordingly, this technique can also aid in the diagnosis of high IOP in primary and emergency care settings. To the best of our knowledge, there is no instrument that can quantify the estimation of IOP and teach tactile examiners. This group has developed a digital instrument called the MEHDI-IOP Measurement Model to train primary healthcare workers as well as blind individuals in the estimation of IOP. In this simple instrument, elastic spheres with a specific inner pressure can be touched and the responses of candidates with regard to the estimated pressure can be graded accordingly.

Reflex anuria affecting both kidneys following hysterectomy.

In situations when there is unilateral ureteral obstruction, the contralateral kidney retains its normal function. In rare instances however, it has been reported that unilateral ureteral obstruction can lead to reflex anuria (RA) and acute renal failure (ARF). Even more unusually, RA with ARF can occur without organic obstruction due to ureteric manipulation during pelvic surgery. We report a 78- year-old woman, who underwent hysterectomy because of endometrial carcinoma. She developed ARF evidenced by anuria of 120-hours duration, and gradual rise of serum creatinine levels to 11.8 mg/dL on the fifth day after hysterectomy. Ultrasound study of the urinary tract revealed bilateral moderate hydronephrosis. Detailed evaluation did not reveal any organic obstruction. She was managed with hemodialysis, control of hypertension and correction of fluid and electrolyte imbalances. By the sixth day, diuresis was established, and the blood urea and serum creatinine levels decreased to normal by the sixteenth day. The patient was finally discharged on the eighteenth day. Our case suggests that urologists and nephrologists should consider RA as one of the causes of anuria and ARF.