Evidence-Based Design in the Hospital Environment: A Staff's Burnout Study in the COVID-19 Era.

OBJECTIVE: This study aimed to evaluate the evidence-based design of the hospital physical space effect on the burnout of nurses and physicians during COVID-19. The research question was to identify the connection between daylight, nature-view windows, and hospital staff burnout during Covid-19. BACKGROUND: The evidence-based design in the hospital environment affects the health of the medical staff. The promotion of the hospital environment has a significant effect on healthcare system improvement. METHODS: This cross-sectional study was performed on 406 nurses and physician's burnout in Guilan province in 2020. Three questionnaires were used: demographic, physical space of the hospital, daylight, nature-view windows, and Maslach Burnout Inventory. Logistic regression (LR) analysis was used to determine the association between burnout and the hospital environment. The significance level was considered with p < .05. RESULTS: The results showed statistically significant correlations between patient units and the environmental characteristics of the hospitals with staff's burnout (p < .001). Of note, 62.9% of physicians and 71.9% of nurses had moderate work-related burnout. The highest burnout score was seen among staffs of emergency departments adjusted multivariate LR model revealed that 27.1% of work-related burnout in nurses and physicians was predictable with age, light, marital status, and hospitals. Our results showed that accessing more daylight could reduce burnout (p = .018, odds ratio [OR] = 0.910). CONCLUSION: Based on the result, the daylight impact on burnout reduction is more significant than other factors. It is suggested that adequate lighting, proper environmental design, and nature-view windows could create appropriate space for enhancing medical staff satisfaction and reducing burnout.

Design of vestibules as transitional spaces in infection control: Necessity of working space changes to cope with communicable infections.

BACKGROUND: After the spread of infectious diseases, people stay at home as a shelter space to be safe and sound. Current homes and work spaces have shown not to be a good environment for health and hygiene. During different crises of infectious diseases, architects and designers analyze the needs for change and evolve of environments to achieve a suitable design that prevents the spread of pathogens. OBJECTIVES: This proper design should help improve people's living standards and mental health in terms of functionality and environmental psychology. METHODS: In the traditional architecture of some countries, such as Canada, Japan, and Iran, the vestibule has provided some possibility of separating the external and internal space. The design of the intermediate space with the appropriate scale of today's buildings at the entrance can create a filter between the indoor and outdoor environments by dividing these spaces. RESULTS: The use of intermediate space by modern technology can prevent the transfer of viral infection into the interior of the building. This can be done by removing the virus from clothes, changing or covering shoes, disinfecting equipment, separating infected items, and creating proper ventilation in the intermediate space so that microorganisms cannot be transferred into the safe environment. CONCLUSIONS: In this paper, we looked at the architectural design in a new light to have a healthier life and more security, by inspiration of the patterns in traditional architecture and the human body.

The Effectiveness of the Anteroom (Vestibule) Area on Hospital Infection Control and Health Staff Safety: A Systematic Review.

The emergence of SARS-CoV2 in 2019 showed again that the world's healthcare system is not fully equipped and well-designed for preventing the transmission of nosocomial respiratory infections. One of the great tools for preventing the spread of infectious organisms in hospitals is the anteroom. Several articles have investigated the role of the anteroom in disease control but the lack of a comprehensive study in this field prompted us to provide more in-depth information to fill this gap. Also, this study aimed to assess the necessity to construct an anteroom area for hospital staff members at the entrance of each ward of the hospital, and specify the equipment and facilities which make the anteroom more efficient. Articles were identified through searches of Scopus, Web of Sciences, PubMed, and Embase for studies published in English until May 2020 reporting data on the effect of the anteroom (vestibule) area in controlling hospital infections. Data from eligible articles were extracted and presented according to PRISMA's evidence-based data evaluation search strategy. Also, details around the review aims and methods were registered with the PROSPERO. From the database, 209 articles were identified, of which 25 studies met the study criteria. Most studies demonstrated that an anteroom significantly enhances practical system efficiency. The results showed that the equipment such as ventilation system, high-efficiency particulate absorption filter, hand dispensers, alcohol-based disinfection, sink, mirror, transparent panel, UVC disinfection, and zone for PPE change, and parameters like temperature, door type, pressure, and size of the anteroom are factors that are effective on the safety of the hospital environment. Studies demonstrated that providing an anteroom for changing clothing and storing equipment may be useful in reducing the transmission of airborne infections in hospitals. Since the transmission route of SARS-CoV2 is common with other respiratory infectious agents, it can be concluded that a well-designed anteroom could potentially decrease the risk of SARS-CoV2 transmission during hospitalization as well.

Ginseng alleviates folliculogenesis disorders via induction of cell proliferation and downregulation of apoptotic markers in nicotine-treated mice.

BACKGROUND: Ginseng is a powerful phytoestrogen with high antioxidant properties. OBJECTIVE: This study aimed to evaluate the effect of Panax Ginseng (PG) on folliculogenesis, proliferation, and apoptosis in the ovary impaired by nicotine. METHODS: Forty adult mice were divided into five groups. Control, sham, and nicotine groups, and co-treated groups of nicotine and ginseng in doses of 0.5 and 1 g/kg. Folliculogenesis was assessed via histopathology and serum evaluation of estradiol, progesterone, follicle-stimulating hormone (FSH), and luteinizing hormone (LH) by ELISA. Lipid peroxidation and antioxidant enzyme activities both in homogenate tissue and serum were assayed by colorimetric analysis. Apoptotic markers of cytochrome c (Cyt c), Bax, and Bcl-2 were evaluated by RT-PCR. Proliferative index was studied by the Ki-67 immunostaining procedure. RESULTS: In comparison to the control or sham groups, nicotine significantly reduced the levels of FSH, LH, and estradiol hormones. An insignificant reduction was observed in the progesterone hormone. Nicotine reduced all healthy follicle numbers, except primordial (P = 0.001). Malondialdehyde (MDA) was increased in tissue and serum in the nicotine group (P = 0.01). Serum catalase (CAT) and enzymatic activity of superoxide dismutase (SOD) both were reduced in tissue and the serum, in the nicotine group. Nicotine induced a reduction in the proliferative indexes of granulosa and theca cells in pre-antral and antral follicles (P = 0.001). However, its effect on the proliferative index of stroma cells was not significant. Apoptotic markers were elevated in the nicotine group (P = 0.001). Co-treatment with ginseng elevated all sex hormones, increased healthy follicles, and reduced tissue or serum lipid peroxidation, compared with the nicotine group (p < 0.05). Co-Treatment with ginseng also reduced the expression of apoptotic markers and increased the proliferative indexes in granulosa and theca cells in pre-antral and antral follicles and also in stroma cells, in comparison to the nicotine group (P = 0.001). All above-mentioned alterations following treatment with ginseng were remarkable, especially in the dose of 1 g/kg. CONCLUSION: This study showed ginseng protects folliculogenesis via alteration of hypothalamic- pituitary-gonadal (HPG) axis, induction of proliferation in ovarian somatic cells, reduction of lipid peroxidation, and downregulation of apoptotic markers in the mouse ovary, treated with nicotine.

The amelioration of nicotine-induced reproductive impairment in male mouse by Sambucus ebulus L. fruit extract.

Nicotine as a toxic agent in cigarette smoke impairs the reproductive system. Sambucus ebulus extract (SEE) is shown to have some beneficial effects such as antioxidant properties. The aim of this study was to evaluate the effects of SEE on the hormones of the pituitary-gonadal axis, lipid peroxidation index, antioxidant enzymes, spermatogenesis, and epididymal sperm parameters in male mice treated with nicotine. Adult male mice were divided into five groups; A: normal saline, B: 1 mg/kg nicotine, C: 1 mg/kg nicotine and 10 mg/kg SEE, D: 1 mg/kg nicotine and 50 mg/kg SEE, D: 1 mg/kg nicotine and 100 mg/kg SEE. Treatments lasted for 35 days. The spermicidal activity of SEE was tested in vitro. Sperm count, motility and morphology were assessed for fertility. Serum testosterone, prolactin and luteinizing hormone (LH) were measured, using ELISA. Serum malondialdehyde (MDA), catalase (CAT), and superoxide dismutase (SOD) activity were measured, using colorimetric assays. Spermatogenesis was evaluated by Johnsen's score and morphometry in histological slides. SEE at different doses did not have any spermicidal activity. Sperm parameters were reduced in the nicotine-treated group, compared with controls (P<0.01). Nicotine reduced testosterone and LH levels (P<0.01) and increased prolactin (P<0.01). A hike in MDA and a reduction in SOD activity without change on CAT, were observed in the nicotine group. Nicotine caused hypospermatogenesis. SEE improved most of the above-mentioned parameters, especially in the doses of 50 and 100 mg/kg. Beneficial effects of SEE in the doses of 50 and 100 mg/kg on male reproduction impairment, induced by nicotine might be partly attributed to the reduction of oxidative stress and changes in the hormones of the pituitary-gonadal axis.

Evaluation of proximal femoral geometry and its relationship with body mass index in Iranian people: a cross sectional study.

INTRODUCTION: There are several studies on the angle of the femoral neck in different countries. It seems that data of diverse races might help the prediction of femoral neck fractures. The present study aimed to evaluate the femoral neck-shaft angle (FNSA) as a predictive factor of neck fracture in Iranian people. METHODS: In this cross-sectional study, the FNSA was measured using radiographs in 635 patients referred to Poursina Hospital in Rasht from September 2018 to October 2019. The body mass index (BMI) was calculated, age and sex of patients were recorded. Data were analyzed by SPSS. The level of statistical significance was adjusted to P<0.05. RESULTS: According to the measured variables, gender, age, BMI and right FNSA are significant in the way that participants with normal BMI have higher FNSA. FNSA decreased with age and height. Obese people had lower FNSA than normal and overweight people. Comparison of left and right angles using the Wilcoxon test showed a statistically significant difference (P<0.001). The right side FNSA was more than the left (59.94%). Only in 39.9%, the left FNSA was more than the right, and in 0.15% both were the same. CONCLUSION: The present cross-sectional study shows a significant relationship between BMI and FNSA. It is suggested that physician evaluates these parameters for prediction of fracture risk in individuals.

Comparative study of the neck shaft angle in femoral neck and intertrochanteric fractures in north part of Iran.

BACKGROUND: A femur fracture is accounted for as one of the most common fractures in the population. The femoral neck has had an angle with the longitudinal axis of the bone shaft, which is defined as neck- shaft angle (NSA). Regional epidemiologic information about NSA might be useful for orthopedic surgeons. In the present study, we aimed conduct a comparative study of NSA in patients with femoral neck or intertrochanteric fractures in Rasht, Iran. METHODS: The study population consisted of all patients with hip fractures. Patients with femoral fractures (neck and intertrochanteric) were examined by an emergency medicine specialist at the time of admission. An Anterior-Posterior X-ray image was taken at the time of admission. Patients NSA was measured by expert orthopedic surgeons and was compared between patients. RESULTS: In the present study, we evaluated the data of 80 patients with femoral fractures and 40 healthy individuals as control group. Patients were divided into two groups of femoral neck fractures (40 patients) and intertrochanteric fractures (40 patients). Analysis of the NSA showed no significant differences between the NSA of patients with neck and intertrochanteric fractures and also control group (P>0.05). Our data showed that the mean NSA in patients with femoral neck fractures were 131.04±3.7° degrees while the NSA of patients with intertrochanteric fractures were 132.07±4.1°. The NSA of controls were also 132.8±6.9°. We also found no significant differences between the NSA of different age groups or between male and female patients. CONCLUSION: The results of this study showed that no significant differences could be indicated between NSA of healthy subjects and patients with femoral fractures. We believe that paradoxical results of former reports could be due to population and regional factors.

Effect of tamsulosin on testis histopathology and serum hormones in adult rats: Experimental study.

BACKGROUND: Tamsulosin is an inhibitory factor of alpha-adrenergic receptors that is used for relieving of the clinical symptoms and management of acute urinary retention. OBJECTIVE: The aim of this study was to evaluate the effects of tamsulosin on the endocrine axis and testicular tissue in adult male rats. MATERIALS AND METHODS: In this experimental study, 30 adult male Wistar rats (weighing 250-300 gr) were divided into three groups: 1) control (received distilled water), 2) experimental 1 (received 0.2 mg/kg/day tamsulosin) and 3) experimental 2 (received 0.4 mg/kg/day tamsulosin) through oral gavage for 28 days. Serum hormones level and testicular histopathology were evaluated at the end of the experiment. RESULTS: In this study, the testicular weight decreased significantly in the experimental groups compared to the control group. A significant decrease was seen in testicular weight (p = 0.004) and the number of Leydig cells in tamsulosin-treated groups (p = 0.012). Tamsulosin improved the hormone profile in experimental groups. Also, higher dose of tamsulosin significantly changed the number of Leydig, spermatogonia cells, the thickness of germinal layer, and the diameter of the seminiferous tubules. CONCLUSION: Results showed that using tamsulosin, possibly reduces the testosterone concentration through adrenergic axis system and in turn has destructive effects on proliferative activity of germ cells.

TNF-alpha G/A308 polymorphism association with nasal polyposis in North part of Iran.

Nasal Polyposis (NP) is a complex multi-factorial disease; associated with several environmental, genetic and inflammatory factors. TNF-alpha is one of the major pro-inflammatory cytokines involved in NP pathogenesis. Some of the polymorphisms of this gene affect its expression. Therefore, the aim of this study was to evaluate the polymorphism of TNF-alpha G/A308 gene and its association with nasal polyposis in north part of Iran. In this case-control study, 60 patients with NP and 75 healthy individuals referred to Guilan University hospital were evaluated. After DNA extraction, RFLP-PCR was used to determine polymorphism. Chi-square test was used to compare the frequency distribution of genotype and alleles of TNF-alpha gene with NP. The frequency of genotype G/G, A/A and G/A in the NP group was 46.7, 10.0 and 43.3%, and in the control group was 65.3, 5.3 and 29.3%, respectively. There was a statistically significant difference between genotype G/G in two groups (P = 0.006, OR 2.58, CI 1.27-5.23). In addition, the frequency of allele A in patients and controls was 31.7 and 20%, respectively; and this difference was statistically significant (p = 0.02). The findings of this study demonstrated that polymorphism in TNF-alpha gene might be a risk factor for NP in north part of Iran and the minor frequency of G308A allele in the current study is slightly more than other major populations. However, more investigations with high number of population are necessary in future.

Oxytocin can decrease germ cells apoptotic index in testis under acute ischemia reperfusion in a rat model.

UNLABELLED: Ischemia reperfusion (IR) is the main pathology of torsion of testis and it is a common urologic emergency. There is some evidence that shows oxytocin (OT) plays role in ischemia reperfusion. OBJECTIVE: To evaluate this hypothesis that OT can decrease germ cell apoptotic index in testis under acute ischemia reperfusion in a rat model. MATERIALS AND METHODS: 20 adult rats were randomly divided into four groups: Control, IR, OT and IR+ OT (OTA). Testicular ischemia was achieved by 720° torsion of the left testis for 2 hr. Then, torsion was removed and reperfusion was performed. Immediately after induction of reperfusion 0.03 µg/kg OT were administered intraperitoneally to the IR+ OT. Three hours after surgery left testis was removed and evaluations were made by Johnson's score, ELISA, immunohistochemistry and histomorphometry for study of maturity of spermatogenesis, endocrine profiles, apoptosis and quantitative studies, respectively. RESULTS: The results showed in addition tissue edema and congestion, a significant reduced in Johnson's score were detected in IR group in comparison with controls (p=0.01), and apoptotic index increased significantly (p=0.001). Administration of OT in OT+IR group, increased Johnson's score but it was not statistically significant. Germinal epithelium thickness was increased significantly (p=0.03), although apoptotic index decreased significantly in comparison with the IR group (p=0.04). However there was not significant difference in serum levels of testosterone, FSH and LH in none of groups (p=0.07). CONCLUSION: These results suggested that OT can decrease apoptotic index and improves complication of acute ischemic reperfusion in testis in a rat model.

The Correlation between Microsatellite Instability and the Features of Sporadic Colorectal Cancer in the North Part of Iran.

Background. The aim of this study was to determine the correlation between MSI and sporadic colorectal cancer in Guilan province, North part of Iran. Materials and Methods. A total of 96 patients who underwent resection for sporadic colorectal cancer in Guilan province were studied. No patients had positive family history of cancers. The frequencies of MSI were analyzed by testing the BAT-26 and BAT-25 markers. Results. MSI analysis revealed that 22.9% of the tumors (22 patients) were microsatellite instability positive and 77.1% (74 patients) were microsatellite instability negative. The highest rate of MSI (40.9%) was found in the rectal region. MSI-H status was seen more frequently in distal tumors (P = 0.04, odds ratio = 3.13, 0.96-10.14). Conclusions. Distal tumor location and MSI may associate with special clinicopathological features. It seems that there may be correlation with underlying genetic and immunologic mechanisms.