Amiodarone-Induced Myxedema Coma in Elderly Patients: A Systematic Review of Case Reports.

This systematic review aimed to explore whether elderly patients administered amiodarone were susceptible to developing myxedema coma. Utilizing the Cochrane guidelines, a comprehensive review of databases such as Medline (PubMed), Science Direct, CINAHL Cochrane, and Google Scholar was undertaken to examine case reports on amiodarone-induced myxedema coma. Following stringent criteria for inclusion, 12 pertinent case reports were identified. These findings suggested a high probability of myxedema coma development in patients who had been administered amiodarone. Specifically, patients who received an oral dosage of 100-200 mg of amiodarone were reported to have developed bradycardia and hypothermia alongside elevated thyroid-stimulating hormone (TSH) levels. Upon diagnosis, the majority of patients were treated with a regimen of levothyroxine and hydrocortisone medication. Despite the myriad potential causes of myxedema coma complicating the diagnosis, it was found that through a combination of clinical symptoms and serum TSH measurements, a confirmed diagnosis could be reached. Furthermore, it was observed that amiodarone-induced myxedema coma responded favorably to treatment with levothyroxine and glucocorticoids.

Fatigue among post-hematopoietic stem cell transplant patients in Jordan: prevalence and associated factors.

BACKGROUND: During hematopoietic stem cell transplant (HSCT), patients underwent various serious prolonged treatments, including conditioning and immunosuppressive drugs, resulting in several symptoms and alterations in the patient's functioning. One of the most commonly reported symptoms is fatigue. AIM: To assess fatigue levels and associated factors during the first 100 days post-HSCT among Jordanian patients. METHODS: A descriptive cross-sectional design assessed fatigue and associated factors during the first 100 days post-HSCT among Jordanian patients. A convenient sample was used to recruit post-HSCT patients. Data were collected using the demographic survey and the Brief Fatigue Inventory (BFI) scale. RESULTS: The findings of this study demonstrated that 40.5% of the participants had severe total fatigue scores, while the mean BFI intensity average score was 5.01 and the mean interference of fatigue with patients' daily life was 5.06. In terms of fatigue interference with daily activities, the highest interference was with the patient's mood and normal work, while the lowest interference was with the walking ability. The analysis revealed a strong positive correlation between the fatigue intensity and its interference with the daily activities (r = .98, p ˂.001). Besides, a significantly strong negative correlation was found between the number of days post-HSCT and fatigue scores (r = - .92, p ˂.001). CONCLUSION: Post-transplant, patients experienced increased fatigue intensity, reduced physical activity, interference with the patient's mood, and diminished functional capacity. Patients who have HSCT require a significant nursing care immediately post-transplant.

Nurses' Self-Efficacy, Confidence and Interaction With Patients With COVID-19: A Cross-Sectional Study.

OBJECTIVE: The aim was to evaluate nurses' self-efficacy, confidence, and nurse-patient interaction during caring of patients with coronavirus disease 2019 (COVID-19). METHODS: A cross-sectional design with online survey was used with a Self-efficacy scale, Self-confidence scale, and Caring nurse-patient interaction scale: 23-item Version-Nurse (CNPI-23 N). RESULTS: A sample of 120 nurses participated in the current study. The results showed that the participants had a moderate level of self-efficacy, self-confidence and interaction (M = 28.84 (SD = 7.7), M = 47.41 (SD = 9.0), and M = 93.59 (SD = 16.3), respectively). Positive relationships were found between nurse' self-efficacy, self-confidence, and nurse-patient interaction (r = 0.81; P < 0.0001 and 0.79; P < 0.0001, respectively). Significant differences were found in self-efficacy according to years of experience, academic qualifications and position (F = 2.10; P = 0.003; F = 3.60; P = 0.002, and F = 2.60; P =0.007, respectively). Furthermore, the results indicated that there was a significant difference in self-confidence and nurse-patient interaction also. CONCLUSION: Nurse educators and administrators should develop and implement further strategies, such as continuing education and training, compensatory payment, organizational support, and availability of protective measures to increase their self-efficacy, self-confidence, and interaction with COVID-19 patients.

Effectiveness of booster BCG vaccination in preventing Covid-19 infection

IntroductionThe evidence that BCG (bacille Calmette-Guerin) vaccine may increase the ability of the immune system to fight off pathogens other than tuberculosis has been studied in the past. This nonspecific immunity gained our interest, especially after initial reports of less cases in countries with universal BCG vaccination. In hopes of possible protective immunity, all staff of the Emirates International Hospital (United Arab Emirates) were offered a booster BCG vaccine in early March 2020. All the hospital staff were then tested for Covid-19 infection by the end of June 2020. MethodologyWe divided the subjects into two groups: booster vaccinated, versus unvaccinated. The rate of Covid-19 infection was compared between the groups. Criteria included all staff who were offered the vaccine. Results71 subjects received the booster vaccination. This group had zero cases of positive COVID 19 infection. 209 subjects did not receive the vaccination, with 18 positive PCR confirmed COVID 19 cases The infection rate in the unvaccinated group was 8.6% versus zero in the booster vaccinated group. (Fishers exact test p-value=0.004). ConclusionOur findings demonstrated the potential effectiveness of the booster BCG vaccine, specifically the booster in preventing Covid-19 infections in an elevated-risk healthcare population.

Prognostic Performance of NUTRIC Score in Quantifying Malnutrition Risk in the Critically Ill in Congruence With the Bioelectrical Impedance Analysis.

BACKGROUND: There is still no concrete guidance for assessing malnutrition risk in the critically ill. Nutrition Risk in the Critically Ill (NUTRIC) score is undertaken cautiously compared with other validated tools such as bioelectrical impedance analysis (BIA). This study aimed to assess the malnutrition risk in the critically ill using NUTRIC score and assess its congruency with the BIA. METHODS: In this cross-section observational study, intensive care unit (ICU) patients from various etiologies were assessed using the earlier tools in addition to other prognostic markers (Acute Physiologic Assessment and Chronic Health Evaluation II [APACHE II] and Sequential Organ Failure Assessment [SOFA] scores), caloric attainment, and feeding complications. RESULTS: Of a total 411 assessed patients, 313 (76.2%) were enterally fed, and 318 (77.4%) were mechanically ventilated. Mean age was 60.7 years, and the median of the assessment since admission was the 12th day. Of those enterally fed patients, 57.9% attained the caloric requirements. Both APACHE II and SOFA scores were compatible in ascertaining ICU mortality at a moderate level (17.88 and 7.17, respectively). The NUTRIC score and phase angle (PA) measured by BIA revealed no differences in the malnutrition risk between patients with and without enteral nutrition. However, regression indicated that the NUTRIC score has explained only 1.1% of the variance of PA after controlling other covariates (ß = -0.222, P = .009, confidence interval = -0.31 to -0.05). CONCLUSIONS: NUTRIC score has a limited prediction to the urgency of aggressive nutrition therapy within the early period of ICU admission.

Validation study of the Arabic version of the Brief Fatigue Inventory (BFI-A).

BACKGROUND: Fatigue is the most reported and most distressing symptom among patients with cancer. However, no questionnaire that measures fatigue and fatigue interference with life has been translated into Arabic. AIMS: This study aimed to translate and validate the Arabic version of the Brief Fatigue Inventory (BFI-A). METHODS: The BFI was translated into Arabic using the forward-backward translation technique. This cross-sectional study collected data from cancer patients through a self-administered questionnaire that included the BFI-A, Insomnia Severity Index (ISI), Zung Depression Scale (ZDS), MD Anderson Symptom Inventory total score (MDASI), and Medical Outcome Study Short Form 36 (SF-36) Vitality Subscale. Descriptive and inferential statistics were used including mean, standard deviation, internal consistency, and correlation coefficient using Pearson's correlation. RESULTS: A total of 79 patients were recruited in Amman, Jordan, in 2015. Mean of the total BFI-A was 4.01 (2.4), showing that 83.5% had nonsevere fatigue. Cronbach's α coefficient of the BFI-A was 0.93. The correlations between total BFI-A scores and BFI-A items were significant (P < 0.05) and ranged from 0.75 to 0.86. BFI-A showed a significant correlation (P< 0.05) with the following tools: ISI = 0.70, ZDS = 0.69, MDASI = 0.75, and SF-36 Vitality Subscale = -0.57. CONCLUSIONS: This study suggests that the BFI-A is a reliable and valid tool to assess fatigue among Arab cancer patients.

Quality of nursing work life and related factors among emergency nurses in Jordan.

OBJECTIVES: The objective of this study is to assess quality of nursing work life (QNWL) and related factors among nurses working in emergency room (ER). METHODS: A cross-sectional descriptive design was employed. Data were collected from a convenient sample of nurses working in ER Eligible participants were required to complete a demographic and work related variables sheet, the Brooks Quality of Nursing Work Survey (BQNWLS). RESULTS: A total of (186) nurses participated in the study. Study participants reported a BQNWL mean score of (M = 140.15, SD = 28.34) indicating a moderate BQNWL. Additionally, the participants scored moderate levels on all BQNWL subscales. The mean score of BQNWL was statistically better for nurses who had training courses on emergency department (t = -2.663, P = 0.008). However, no other statistically significant differences were found in BQNWL scores in regarding to demographic and work related variables. CONCLUSION: The results of this study reported a noticeable alteration in QNWL among nurses working in ER. The nurses had a moderate QNWL levels. Also, the results emphasized on the importance of conducting further interventional research studies in the future to establish effective measures to enhance nurse QNWL. Consequently, this may improve the provided nursing care for the patients and their families.

The impact of introducing the Modified Early Warning Score 'MEWS' on emergency nurses' perceived role and self-efficacy: A quasi-experimental study.

BACKGROUND: Early warning Score is a bedside track and trigger system used to facilitate early detection and management of deteriorating patients. Although emergency department nurses are the key to implement this task, their interaction and contribution to provide an estimate of patients' severities is still suboptimal and neglected. AIM: This study aimed to introduce an educational programme using the Modified Early Warning Score (MEWS) to nurses working in the emergency departments and to assess the programme impact on nurses' self-efficacy and perceived role. METHODS: This non-equivalent, multi-centre, quasi-experimental study, assigned two groups of emergency nurses into intervention and control. The intervention group received three interactive educational sessions totalling 12 h relevant to the application of MEWS in emergency situations using a validated programme called 'COMPASs'. The other group received no intervention. Both groups were assessed for self-efficacy and perceived role in the pre-test, immediate post-test, and three months later follow-up phase. RESULTS: A total of 232 participants were divided into intervention and control groups (118 and 114, respectively), having no variations in age, gender, or experience as registered nurses. The intervention group showed a significant improvement in the self-efficacy scores for the nurses (F: 152.21, df: 2, p < 0.001). Similarly, the intervention nurses exhibited a significant improvement in the perceived role scores after the intervention (F: 121.20, df: 2, p < 0.001). The control group showed no changes in either variable across the three phases. While older nurses with longer experience showed higher self-efficacy after the programme, the perceived role explained an additional 57.0% of the variance in self-efficacy after controlling these two demographics (Beta: 0.743, p < 0.001, CI: 1.18-1.66). CONCLUSION: The existence of an early warning system in the emergency department is able to enhance nurses' self-efficacy and perceived role coinciding with nursing interactions with the multidisciplinary team.

Teaching module for improving oncology nurses' knowledge and self-confidence about central line catheters caring, complications, and application: A pretest-posttest quasi-experimental design.

The aim of the present study was to assess the effectiveness of implementing an educational module based on the Centers for Disease Control and Prevention guidelines on the nurses' knowledge and self-confidence regarding central line catheters (CVCs) caring, complications, and application. A pretest-posttest quasi-experimental design was used. A sample of 100 oncology nurses from oncology units participated in two groups, experimental group (N = 50) and control group (N = 50). The participants completed knowledge test and self-confidence scale before and after the educational program. The results showed that there was a significant difference between the experimental and control groups regarding knowledge related to CVC guidelines and management after the interventional sessions (t = -7.85, P = .001). The mean and standard deviation for experimental group were 15.95 (5.45) and 7.35 (2.73) for the control group. Furthermore, the results showed significant difference (t = -22.20, P = .001) between the experimental group (M = 61.50, SD = 14.20) and the control group (M = 35.50, SD = 7.20) regarding self-confidence in managing CVCs. It is concluded that using educational program strengthens nurses' skills, improves safety, and increases opportunity to learn, and thus, it will increase the self-confidence.

Cardiovascular Involvement in Behçet Disease: Clinical Implications.

Behçet disease (BD) is a multisystem disorder, with vasculitis as its underlying pathological process, in contrast to the classic triad of recurrent oral and genital ulcerations, with uveitis. Vascular involvement in BD includes venous thrombosis, arterial occlusion, and pulmonary artery and aortic aneurysm formation. Cardiac involvement is rare and often obscure. It includes intracardiac thrombi formation, and is associated with a poor prognosis. Our objectives are to describe two cases with BD, complicated with vascular and cardiac involvement, and to raise awareness of these rare complications, the needed routine surveillance, and thus to prevent inappropriate interventions, serious outcomes, and mortality. We present two male patients from the Mediterranean Basin with BD. The first was diagnosed early as a BD patient. The second was diagnosed at the time of cardiovascular (CV) involvement. We recommend that patients who are diagnosed, or even suspected of suffering from BD, especially in endemic areas along the Silk Route pathway, should be followed up routinely for CV involvement, even if rare, obscure, or with a bizarre presentation.

Clinical Significance of Conditions Presenting with ECG Changes Mimicking Acute Myocardial Infarction.

The electrocardiogram (ECG) is the primary tool in the diagnosis of acute myocardial infarction (AMI). However, other clinical conditions, both cardiac and noncardiac originated pathologies, may result in ECG tracing of AMI. This may lead to an incorrect diagnosis, exposing the patients to unnecessary tests and potentially harmful therapeutic procedures. The aim of this report is to increase the still insufficient awareness of clinicians from multiple disciplines, regarding the different clinical syndromes, both cardiac and noncardiac, associated with ECG abnormalities mimicking AMI, to avoid unjustified thrombolytic therapy or intervention procedures. During a 9-year period, the data from six patients (five females, one male; mean age, 50 years [range, 18 to 78 years]) who were admitted to cardiac care unit (CCU) with transient ECG changes resembling AMI were recorded retrospectively. During this 9-year period, 5,400 patients were hospitalized in CCU: 1,350 patients were diagnosed as ST-elevation myocardial infarction (STEMI) and 4,050 patients were diagnosed as non-ST-elevation myocardial infarction (NSTEMI). Only two out of six patients had chest pain with ECG changes criteria suspicious of AMI. STEMI was suspected in four out of six patients. All patients, but one, had normal left ventricular (LV) function. One patient had transient LV dysfunction. All patients, but one, with perimyocarditis, had normal serum cardiac markers. In four out of six patients, who underwent coronary arteries imaging during hospitalization (by angiography or by CT scan), normal coronary arteries were documented. Two patients who underwent ambulatory cardiac CT scan imaging after being discharged from hospital documented patent coronary arteries (case no. 3), or some insignificant irregularities (case no. 4). The discharge diagnoses from CCU were as follows: postictal syndrome, pericarditis, hypothermia, stress-induced ("tako-tsubo") cardiomyopathy, anaphylactic reaction, and status of postchemotherapy. All patients experienced full recovery with normal ECG tracing. During the 5-year follow-up, all patients were alive, and cardiac morbidity was not reported. We conclude that both cardiac and noncardiac clinical syndromes may mimic AMI. Comprehensive clinical examination and profound medical history are crucial for making the correct diagnosis in conditions with ECG changes mimicking AMI.

Association of heart block with uncommon disease States.

A variety of diseases, other than the common Lev-Lenègre disease, are associated with cardiac conduction system abnormalities. These include acute processes, such as acute rheumatic fever, and other disorders, such as sarcoidosis, connective tissue disorders, neoplasms, and bacterial endocarditis with cardiac abscess formation. The purpose of the study is to raise awareness of these rare conditions. We present 10 adult patients (4 males and 6 females) with a mean age of 47 years (range: 19-69), with various rare diseases associated with heart block, who needed temporary or permanent pacemaker therapy in the past two decades. These conditions included acute rheumatic carditis, Wegener granulomatosis, cardiac involvement of metastatic breast cancer, bacterial endocarditis, sarcoidosis, S/P chest radiotherapy, and quadriplegia with syringomyelia postspinal cord injury, and adult congenital heart block. We conclude that patients with these disorders should be followed periodically, to allow for early detection and treatment of cardiac conduction disturbances, with pacemaker therapy.

Mild rheumatic mitral regurgitation in the presence of dominant stenotic pliable valve: an echocardiographic structural valve analysis in patients undergoing balloon valvuloplasty.

BACKGROUND: Understanding the mechanism and the main components involved in rheumatic mitral regurgitation (MR) associated with dominant pliable mitral stenosis (MS) may improve our ability to repair some mixed rheumatic mitral valve pathologies. OBJECTIVES: To assess mitral valve structural components in pure mitral stenosis versus mitral stenosis associated with mild regurgitation METHODS: Using two-dimensional echocardiography, we performed mitral valve structural analysis in two groups of patients prior to balloon mitral valvuloplasty (BMV). The first group, consisting of 13 females and 2 males (mean age 39 +/- 5 years), suffered from pure pliable mitral stenosis (PPMS), while the second group, with 22 females and 2 males (mean age 44 +/- 5 years), had mixed mitral valve disease (MMVD) characterized by mild MR in the presence of dominant pliable MS. All echocardiographic measurements relating to the mechanism of MR were undertaken during the systolic phase. RESULTS: The mean Wilkins scores of the PPMS and MMVD groups were 7 +/- 1 and 8 +/- 1 respectively (P = 0.004). No significant differences were found between the MMVD group and the PPMS group regarding annular circumference (15.5 +/- 1.4 cm vs. 15.4 +/- 1.6cm, P = 0.84), annular diameter (36 +/- 4 mm vs. 38 +/- 5 mm, P = 0.18), and chordae tendinae length directed to the anterior mitral leaflet (AML) (10 +/- 2 mm vs. 11 +/- 2 mm, P = 0.137). However, anterior vs. posterior mitral leaflet length during systole was significantly lower in the MMVD than in the PPMS group (2.2 +/- 0.5 vs. 2.8 +/- 0.4, P = 0.02), whereas the AML thickness at the co-aptation point was greater in the MMVD than in the PPMS group (7 +/- 1 vs. 5 +/- 1 mm, P = 0.0004). CONCLUSIONS: In rheumatic valves, thickening and shortening of the AML are the main factors determining the appearance of mild MR in the presence of dominant pliable MS.

Translating the insomnia severity index into Arabic.

PURPOSE: The purpose of this study was to translate the Insomnia Severity Index (ISI) into Arabic (Fusha dialect), and obtain preliminary reliability and validity estimates for the translated version. BACKGROUND: Arabic populations experience sleep problems that interfere with their vitality and quality of life. The ISI was established to screen for insomnia in both clinical and research situations. DESIGN: This study used a descriptive correlational design. The ISI was translated into Arabic using the back-translation method and compared with three other sleep measures: the Pittsburgh Sleep Quality Index, the Epworth Sleepiness Scale, and the Vitality Subscale from the Medical Outcomes Study Short Form-36. These measures were administered to 35 healthy Arabic bilingual participants from three community locations. FINDINGS: The mean ISI score was 9.2 (SD = 5.8; range 0-20). Internal consistency reliability was 0.84. The correlations between the total ISI score and the single items ranged from 0.49 to 0.92 (p < .01). In terms of convergent validity, the total ISI score showed a strong positive correlation with the Pittsburgh Sleep Quality Index global score (r = 0.76, p < .001) and a moderate, negative correlation with vitality (r = -0.38, p =.026). CONCLUSIONS: The translated ISI demonstrated adequate reliability and validity. The translated ISI needs further testing in a larger sample of both clinical and healthy Arabic populations in their own countries. CLINICAL RELEVANCE: Preliminary psychometric estimates show that the translated ISI is reliable and valid in this community-dwelling Arabic sample. The translated ISI allows for Arabic researchers to screen for insomnia and plan for future intervention studies.

Translating the Pittsburgh Sleep Quality Index into Arabic.

This descriptive correlational study describes the translation process and the psychometric testing of the Pittsburgh Sleep Quality Index (PSQI). The PSQI has been successfully translated into Arabic and back-translated into English by 10 Arabic bilingual translators. Then the PSQI is tested in a sample of 35 healthy Arabic bilinguals.The internal consistency reliability for the Global PSQI demonstrates borderline acceptability (Cronbach's alpha = .65). The reliability is further supported by moderate to high correlations between five PSQI components and the global PSQI score (r = .53 to .82, p < .01). Convergent validity is supported by the global PSQI correlating strongly with the Insomnia Severity Index (r = .76) and moderately with the related construct of the Medical Outcome Study Short Form-36 vitality subscale (r = -.33). Further testing of the PSQI is needed in a larger Arabic population, both clinical and healthy populations, living in their native countries.

Multivessel acute coronary thrombosis and occlusion--an unusual cause of cardiogenic shock.

A 44-year-old male was admitted with ST-elevation myocardial infarction and cardiogenic shock. Angiography revealed a left anterior descending artery (LAD) as well as right a coronary artery acute thrombotic occlusion and large mobile thrombi in the circumflex artery. He was treated mainly with multivessel thrombus aspiration and intra-aortic balloon insertion. Subsequent intravascular ultrasound a week later revealed mild disease of the LAD only. We suggest that in selected patients with cardiogenic shock, plaque rupture with resultant acute thrombosis in a single coronary artery may lead to low coronary perfusion pressure and consequent multivessel thrombus formation. Thrombus aspiration should be the main therapeutic modality in such unusual cases.

CCL21 is an effective surgical neoadjuvant for treatment of mammary tumors.

In previous studies, the chemokine CCL21 has shown biological activities that include T cell, natural killer (NK) cell, and dendritic cell (DC) chemoattraction. The goal of this study was to determine the effects of administering CCL21 to orthotopic mammary tumors in terms of impact on tumor growth rate, immune cell infiltration of the primary tumor and survival. We found that a single intratumoral administration of CCL21 slowed the growth of orthotopic mammary tumors and increased intratumoral infiltration by T cells, NK cells and DCs. CCL21 intratumoral administration also prolonged the survival of tumor-earing mice. Furthermore, mice that received intratumoral neoadjuvant CCL21 ior to surgical resection of tumors survived significantly longer than control mice. The urviving neoadjuvant CCL21-reated mice, when challenged again with cl-6, had significantly slower rate of tumor growth than challenged control mice. Thus, our ata indicate that CCL21 treatment prior to mammary tumor resection can significantly rolong survival and increase resistance to subsequent tumor challenge. Overall, our indings suggest that intratumoral administration of CCL21 has potential as a neoadjuvant mmunotherapy for breast cancer.

'Frozen' posterior mitral leaflet in rheumatic mitral stenosis: incidence and impact on outcome of balloon mitral commissurotomy.

BACKGROUND AND AIM OF THE STUDY: The incidence and clinical significance of immobile and 'frozen' posterior mitral leaflet (FPML) were evaluated in the pathophysiology and immediate outcome of patients with severe pliable mitral stenosis (MS) undergoing percutaneous balloon mitral commissurotomy (PBMC). METHODS: During the past four years, 30 'ideal' patients (mean age 46 +/- 8 years) with Wilkins' score <8, bilateral commissural fusion and absence of commissural calcification underwent peri-procedural echocardiographic analysis. Anterior mitral leaflet (AML) mobility index (MI), chordae tendineae (CT) length, and mitral valve area (MVA) were evaluated. RESULTS: Pre-procedure FPML was noted in 28 patients (93%). All patients achieved MVA > or = 1.5 cm2. Post-procedure MVA in patients with bilateral commissural splitting was 1.9 +/- 0.2 cm2 versus 1.6 +/- 0.1 cm2 in patients with unilateral commissural splitting (p < 0.05). CT lengths directed to the AML and PML were 15 +/- 2 mm and 8 +/- 2 mm, respectively (p < 0.05). MI of the AML before and immediately after PBMC was 0.4 and 0.6, respectively (p < 0.05). None of the patients with FPML showed improved mobility following successful PBMC. CONCLUSION: FPML may be found in most patients with pliable MS. It is mainly a result of short, rigid and fused CT directed to the PML. A 'single-wing door' or a unicuspid valve may be used as a model for rheumatic pliable MS. It is suggested that pre-procedure leaflet morphology and functional assessment should focus on the AML.