Evaluating Preoperative Intravenous Iron and Erythropoietin Treatment and Outcomes in Cardiac Surgery Patients.

Background: Anemia is more common in cardiac surgery patients than in other people. Severe anemia before cardiac surgery strongly predicts blood transfusion. Objectives: This study aimed to evaluate the outcomes of Intravenous (IV) iron and erythropoietin (EPO) injection preoperatively in anemic patients waiting for coronary artery bypass graft (CABG) surgery. Methods: This cross-sectional study was performed between May to December 2020 at Masih Daneshvari hospital in Tehran, Iran. Anemia was described according to the WHO definition (Hb < 130 g/L in men). The study was designed in two groups of men CABG patients. Hematocrit level, platelet count, partial thromboplastin time, international normalized ratio, prothrombin time before surgery, red blood cells (RBCs) transfusion, as well as plasma and platelet units' transfusion during surgery and at the time of hospitalization were obtained from patient's files. The length of stay in the hospital and the consequences, including infection, stroke and heart attack, and mortality, were also obtained from the patient's files and recorded in the checklists. Pearson's chi-squared test, Fisher's exact test, independent samples t-test, univariate logistic regression, and odds ratio (OR) were used. All statistical analyses were performed by the SPSS software version 21. The significance level in this study was considered 0.05. Results: In this study, the data of 64 patients were gathered, among whom 16 (25%) were injected with IV iron and EPO, and the remaining 48 (75%) did not receive any medications for stimulating erythropoiesis. The mean age of patients was 64.05 ± 8.21 years, with an age range of 51 - 91 years. Infection (P = 0.258) and mortality rate (P = 0.440) in the two groups of injection and non-injection did not show a statistically significant difference. The duration of the clamp at the time of surgery (r = 0.699, P = 0.001) and the duration of hospitalization (r = 0.399, P = 0.023) had statistically significant positive relationships with the pump duration. Red blood cell consumption in the injection and non-injection groups was 2.50 ± 2.07 and 2.90 ± 1.80 (P = 0.469), respectively. Conclusions: Infection (P = 0.258), mortality rate (P = 0.440), and RBC utilization (P = 0.469) in the two groups of injection and non-injection were not significantly different.

The Impact of Neutrophil-Lymphocyte Ratio in Febrile Seizures: A Systematic Review and Meta-Analysis.

This meta-analysis was conducted to determine the relationship between neutrophil to lymphocyte ratio (NLR) and febrile seizure (FS). Our study was registered with the PROSPERO (ID: CRD42021259944). Web of Science, Embase, PubMed, Scopus, and ProQuest Central were searched, and finally, 17 studies were included. Standardized mean difference (SMD) was reported with a 95% confidence interval (CI) for the NLR levels. Compared with the febrile control group, the FS patients' NLR levels were significantly higher (SMD = 0.49; 95%CI = 0.26 to 0.72, P < 0.001). Furthermore, we conducted a comparison of NLR levels between febrile controls against simple and complex FS cases separately and found that NLR levels of children with either simple or complex FS were higher compared with those of febrile controls (SMD = 0.42, 95%CI = 0.14 to 0.69, P = 0.003 and SMD = 0.90, 95%CI = 0.71 to 1.09, P < 0.001, respectively). Also, in comparison with the NLR levels of the simple FS group, the complex FS patients' NLR levels were significantly higher (SMD = 0.59, 95%CI = 0.34 to 0.85, P < 0.001). Our study indicated that NLR could be recommended as an inexpensive diagnostic biomarker for FS. In addition, it can be useful when distinguishing between simple FS and complex FS.

Coronavirus Disease 2019 (COVID-19) Infection-Related Stigma, Depression, Anxiety, and Stress in Iranian Healthcare Workers.

Background: Psychological conditions aggravate during outbreaks. Here, we have discussed the existing COVID-19 depression, anxiety, and stress and the resulting stigma and its different aspects in Iranian health care workers and their 1st-degree relatives. Methods: In this cross-sectional study, information of our study groups (237 participants including health care workers and their nuclear family members) was collected via two online stigma and depression, anxiety, and stress scale (DASS) questionnaires. Results: The DASS questionnaire's mean depression, anxiety, and stress scores were 13.59 ± 5.76, 11.07 ± 4.38, and 15.05 ± 5.86, respectively, in our study population. Marriage status was effective on depression and stress scores. Married participants were having less depression (P = 0.008) but more stressful (P = 0.029) than single ones. Education was found to be effective on anxiety and stress scores. Those with an associate, master, Ph.D., and higher college degrees were significantly less anxious and stressed than those with a diploma or bachelor's degrees (P = 0.032 and 0.016, respectively, for anxiety and stress). Participants with a history of psychiatric conditions showed significantly higher depression, anxiety, and stress rates than those without a past psychiatric condition (P = 0.001). Healthcare workers and their nuclear family members suffer from severe stigma (mean stigma scores were 33.57 and 33.17, respectively). Conclusions: Healthcare workers and their nuclear family members in Iran suffer from severe COVID-19 related stigma. We also showed that depression, anxiety, and stress are common among Iranian Healthcare workers and their nuclear family members during this pandemic. This study showed that people with preexisting psychiatric conditions need extra mental care during the pandemic.

Designing the competency-based training model of Iranian medical tourism.

BACKGROUND: Despite the great comparative advantage of Iran in terms of infrastructure, technology, and human resources as well as the significance of medical tourism in the tourist industry, in practice, the quality of human resources has received less attention. Consequently, this study was conducted to design a model of competency-based training for Iranian medical tourism. MATERIALS AND METHODS: This study was an exploratory mix, and the Delphi method and semi-structured interviews were used for the qualitative part of this study. In the second part, the analytical method was utilized for the quantitative part of this study. RESULTS: The results indicated the main components of medical tourism to be public interactions and private interactions and seven subcomponents. Medical Tourism's Competency includes three main components and seven subcomponents. CONCLUSION: Although some training separated and scattered is present in Iran's medical tourism. However, Iran requires a comprehensive training model of which its design was explained in this paper.

Translation and psychometric properties of the MISSCARE survey-Persian version.

BACKGROUND: Providing safe and high-quality nursing care is an essential task of nursing. Nurses may be unable to provide patients with all of the necessary care for numerous reasons, such as an increase in the number of patients and a low number of nursing staff. Moreover, they may have to omit, postpone, or incompletely perform a series of care, referred to as missed nursing care. The purpose of this study was to translate and conduct psychometric testing of the MISSCARE Survey. METHOD: In this study, we accurately translated the MISSCARE Survey. Its acceptability, construct validity, and internal consistency were analyzed. This cross-sectional study was conducted in the summer of 2020 in educational hospitals in Ardabil, Iran. The participants were 300 nurses who worked in educational hospitals and were randomly selected. RESULTS: Participants in this study included 300 nurses from five units, including general medicine (13.3%), COVID-19 (45.0%), surgery (18.7%), critical care unit (6.3%), and intensive care unit (16.7%), who worked various shifts, of whom 84.7% were female. The total content validity in Part A was 0.944, and that in Part B was 0.969. Part A was divided into three domains (necessary care, secondary care, and supportive care), and Part B was divided into five domains (communication, labor resources, material resources, responsibility, and unpredictable situations). In both parts, the chi-square index was < 3, and the RMSEA index was < 0.08. The internal consistency measured by Cronbach's alpha was 0.933 for Part A and 0.910 for Part B for the Persian version of the MISSCARE Survey. CONCLUSION: Based on the outcomes of this research, it can be concluded that the Persian version of the MISSCARE Survey is valid for use in Iranian hospitals and can be used to identify missed care and the reasons behind it. Nursing managers can also use it to improve the situation and provide the highest-quality care.

The effect of platelet apheresis collection on some immunological factors in donors using two different apheresis devices.

INTRODUCTION: The aim of this study was to evaluate and compare two different apheresis and changes in some immunological factors in donors. MATERIAL AND METHODS: The cross-sectional study was performed from January 2017 to September 2018. Fifty six male blood donors were randomly divided into two groups. CD4, CD8, and CD25 markers by flow cytometry, and TGFBeta by real-time polymerase chain reaction (RT-PCR) method were done before and 7 days after the apheresis procedure. Independent Sample t-test, Mann-Whitney U Test, Wilcoxon signed ranked test, and Fisher exact test were used. RESULTS: WBC in MCS+ group after donation is significantly higher than before donation (P < 0.05) but no significant difference was seen between MCS+ and Trima groups in these two indicators. But in CD4, CD25, and TGFBeta, there was no significant difference between the two groups. CONCLUSION: There was no significant difference on CD4, CD25, and TGFBeta gene 7 days after donation.

Predictive Value of Endometrial Length Measurement by Transvaginal Ultrasound and IVF/ICSI Outcomes.

BACKGROUND: The purpose of this study to determine the relationship between endometrial length and positive pregnancy test in patients who underwent assisted reproductive technology (ART). MATERIALS AND METHODS: This cross-sectional study included patients who were referred for in vitro fertilisation/intracytoplasmic sperm injection (IVF/ICSI) therapy from 2013 to 2016. All nulliparous women who met the inclusion criteria were between 20-38 years of age and presented for ultrasound measurements prior to fresh embryo transfer (ET). Endometrial length was measured by transvaginal ultrasound (TVS) with a Medison Accuvix device on the day of human chorionic gonadotropin (hCG) administration. The relationship between endometrial length and treatment success was assessed. The independent sample t test, receiver operating characteristic (ROC) curve and the area under the curve (AUC) index and chi-square test were used for data analysis. P<0.05 were statistically significant. RESULTS: There was a significant relationship between endometrial length (41.5%) and treatment success (P<0.05). The endometrial length of 41.5(mm) with a sensitivity of 66.7%, specificity of 50.6%, positive predictive value of 46.8%, negative predictive value of 69.4%, and efficiency of 56.62% can be used as a proper cut-off point with an AUC of 0.63. CONCLUSION: The value of 41.5(mm) for endometrial length can be used as a proper cut-off point for prediction of a higher ART success rate. We recommend TVS as the first step for assessment of uterine and endometrium receptivity in the ART cycle.

Ultrasound Evaluation of Visceral Fat Thickness for Prediction of Metabolic Syndrome in the First Trimester of Pregnancy in a Sample of Non-obese Iranian Women.

OBJECTIVES: Ultrasonography is a noninvasive and safe modality for assessing body fat and is routinely performed in developed countries. Although pregnant women with obesity are at risk for many unfavorable outcomes, the relationship between abdominal fat distribution and metabolic syndrome (MS) is evident in some studies. Therefore, it is important to evaluate fat thickness in non-obese women and predict MS using fat thickness measurement. METHODS: A total of 132 pregnant women completed anthropometric and demographic questionnaires. All women were scanned for visceral fat thickness (VFT) via ultrasound at 11-14 weeks gestation. Body mass index (BMI) and waist circumference (WC) were calculated at the first prenatal visit. MS components were also measured in the same weeks. RESULTS: MS was detected in seven (5.3%) women. There was a statistically significant difference between women with and without MS for weight, WC, anterior and posterior VFT, insulin, lipid profile (total cholesterol, high-density lipoprotein cholesterol, and triglyceride), and systolic and diastolic blood pressure (p < 0.050). The optimal cut-off points determined for predicting MS disorder were an anterior VFT of 43.83 mm and a posterior VFT of 32.50 mm. CONCLUSIONS: Fat thickness measurement in the first trimester is a good predictor for MS even in women with a normal BMI. Ultrasonography as a safe, simple, and cost-effective modality can be used to assess fat thickness besides the other screening evaluations in the first trimester of pregnancy.

Anti-invasive and antiproliferative effects of Pleurotus ostreatus extract on acute leukemia cell lines.

BACKGROUND: Currently, mushrooms have been used in traditional and folk medicines for their therapeutic activities, such as antibiotic, antitumor, anti-inflammatory, anticancer, antileukemic and immunomodulatory actions. This investigation evaluates the anti-invasive, antiproliferative and cytotoxic effects of Pleurotus ostreatus (Pleurotaceae) on leukemia cell lines. METHODS: The proliferation of KG-1 cells was measured by using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay after treatment with gradient dilutions of P. ostreatus extract. Then, the minimum inhibitory concentration (MIC) of the extract was determined. Moreover, the proliferation of Jurkat cells and bone marrow mesenchymal stem cells (BMSCs), a cancerous cell line and normal body cells, respectively, was considered. The apoptotic morphology of treated KG-1 cells was evaluated with Giemsa staining. The invasion and migration of cells were evaluated using transwell invasion assay. Thereafter, the rates of apoptosis and necrosis were measured by using flow cytometry, and BAX and MMP-9 gene expression were evaluated using quantitative reverse transcription-polymerase chain reaction as apoptotic and metastatic genes, respectively. RESULTS: The MIC of the extract was determined to be 1 mg/mL after 48 h. According to the results, the extract decreased the proliferation of leukemia cell lines (KG-1 and Jurkat cells) but had no antiproliferative effects on BMSCs. Moreover, KG-1 cell migration and MMP-9 gene expression decreased after the treatment, and the rate of apoptosis and BAX gene expression increased significantly. CONCLUSIONS: According to the efficient therapeutic properties of P. ostreatus on leukemia cell lines, this mushroom could be introduced as a natural medicine to cure leukemic patients who suffer from the harmful side effects and enormous costs of chemotherapy.