The effect of artificial saliva on the control of dry mouth: a semi-experimental study on COVID-19 patients under Non-invasive mechanical ventilation.

OBJECTIVES: Since maintaining oral hygiene is essential in nursing care, the present study was conducted to determine the effect of oral care using Mucosamin artificial saliva spray to control dry mouth in ICU patients with COVID-19. MATERIALS AND METHODS: The current semi-experimental research was conducted on eighty patients with COVID-19 selected using the available sampling method. The study tool was a Beck oral assessment scale (BOAS). The case and control groups were selected from two hospitals with relatively similar conditions and treatment procedures. For patients in the intervention group, mucosamin artificial saliva spray was used in addition to the common care, while control group patients received only common care. RESULTS: Eighty patients were randomly assigned to two groups named control and intervention (40 patients in each group). The intervention was very effective in reducing the BOAS score after four days in comparison with the control group (9.23 vs. 12.05, respectively; p-value < 0.001). Based on the adjusted model, the application of artificial saliva reduced the BOAS score, indicating improvement in mouth dryness. While the BOAS score was increased in the control group, it had a declining trend in the intervention one. CONCLUSION: The study's results showed that using artificial saliva spray could effectively reduce the symptoms of dry mouth in patients with COVID-19 treated with non-invasive mechanical ventilation. CLINICAL RELEVANCE: The present study introduced an applicable solution (artificial saliva) to treat mouth dryness in ICU patients under mechanical ventilation.

Prediction of mortality in ICU patients: A comparison between the SOFA score and other indicators.

BACKGROUND: The intensive care unit (ICU) is the most important department for critically ill patients. Different scoring systems are used to assess the severity of the disease and evaluate organ failure during the patient's stay in ICU. AIMS: Our purpose was to evaluate the C-reactive protein/Albumin (CRP/Alb) ratio and SOFA score as indicators of 28-day mortality in ICU patients. MATERIALS AND METHOD: A total of 55 patients were enrolled in this study. CRP and CRP/Alb rates, SOFA scores, and demographic data were used to evaluate 28-day mortality in a referral hospital. RESULTS: Survived and dead patients were significantly different in the CRP, CRP/Alb rates, and SOFA scores. However, in the adjusted model, the SOFA score was the predictor of 28-day mortality in ICU patients. CONCLUSION: SOFA score was also confirmed as a predictor of mortality in ICU patients. Besides, the role of CRP and CRP/Alb in the prediction of disease prognosis or mortality requires further studies.

Comparative Study of the Effect of Lidocaine Spray and Ice Spray on the Pain Intensity During Intramuscular Injection: A Randomized Clinical Trial.

BACKGROUND: Intramuscular injection is one of the most common, invasive, and painful ways to deliver medicine to the body. AIM: Since one of the nurse's duties is to employ different methods to reduce pain caused by treatment procedures, this study was conducted to determine the effect of lidocaine spray and ice spray on pain intensity at the muscle injection site. METHOD: A clinical trial was performed on 90 patients presenting to outpatient clinics of Neyshabur hospitals. The samples were selected using a computerized table of random numbers, and each participant was randomly assigned to one of the control, lidocaine spray, and ice spray groups. Pain severity was measured immediately after intramuscular injection using a numerical pain scale. Descriptive statistics along with statistical tests (chi-square, Fisher, etc.) were used to analyze the data in the R environment version 3.6.2. Ordinal logistic regression was used to compare pain intensity in the three groups by adjusting the effect of age variables and sensory disorders. RESULTS: The mean pain intensity was 3.44 without intervention, 2.63 with lidocaine spray, and 2.27 with ice spray. Statistical tests indicated a significant difference in pain intensity of intramuscular injection between the ice group and the control group (p = .010). Although lidocaine spray reduced the pain intensity, its effect was insignificant compared with the control group. CONCLUSIONS: Both ice and lidocaine spray can be effectively used to reduce the intensity of intramuscular injection pain; however, it seems that ice spray is a more effective, safe, and affordable method.

Relationship between Underlying Diseases with Morbidity and Mortality in Patients with COVID-19.

Background: This study aims to investigate the clinical and demographic features of underlying medical conditions and the potential relationship between underlying diseases and the increased rate of morbidity and mortality due to COVID-19. Materials and Methods: This study was conducted on 350 COVID-19 patients hospitalized at the Masih Daneshvari Hospital from February-July 2021. All participants had confirmed COVID-19 diagnosis based on symptoms and/or positive PCR test or chest X-ray results. Data was collected from medical records on demographics, disease severity, symptoms, underlying conditions like diabetes, hypertension, coronary heart disease, obesity, renal disease/transplantation, and outcomes like hospital stay, ICU admission, and mortality. Relationships between age, underlying diseases, and mortality were analyzed using chi-square and Fisher's exact tests." Results: A total of 350 patients diagnosed with COVID-19 were included in the study, with an average estimated age of (60.8±15.4). The age group of 56 and above had the highest morbidity rate, which accounted for 50% of the total participants. Among the COVID-19 patients, diabetes was the most common underlying medical condition, accounting for 31.4% of the cases. High blood pressure was present in 27.1% of the patients, and 17.1% of the total participants had coronary heart disease (CHD). Additionally, 10.9% of the participants were overweight, and 30 of them had previously experienced kidney failure or transplantation. Moreover, the study found that 40% of patients with diabetes died, while the mortality rate was 38.3% in patients with CHD and 47.4% in overweight participants. High blood pressure patients had a mortality rate of 43.2%, and patients with renal failure or kidney transplantation had a significantly increased risk of mortality at 83.3%. The research also revealed a significant and direct relationship between mortality rate, age group, and underlying disease among the patients (P<0.05). Conclusion: The findings of the present study hold significant implications for preventive interventions and policy adoption, particularly in relation to the use of calendar age as the key criterion for risk evaluation. These results underscore the need for a more precise and focused approach to prioritizing patients with identified risk factors.

Effectiveness of Borage plus syrup on COVID-19 patients in intensive care units.

Introduction: COVID-19 (coronavirus disease-2019) still causes a high rate of death globally with no definite curative treatment described. The traditional plant Borage (Borago officinalis L.) is a good source of gamma-linolenic (GLA). We hypothesized that Borage plus syrup (BPS) would be beneficial in severe COVID-19 patients within an intensive care unit (ICU) setting. Materials and methods: A pilot single center, randomized trial with no placebo was undertaken. A total of 60 PCR-positive severe COVID-19 participants admitted to ICU from June 2020-December 2020 at Masih Daneshvari Hospital Tehran-Iran gave informed consent. The participants were randomly assigned to either Borage Plus Syrup (BPS, 5 ml for 5 days) (n = 30) or standard care (IFN-ß and favipiravir) as a control group (n = 30). Pao2/Fio2, serum ferritin, CRP, bilirubin, IL-6, TNF-α, ALT, AST, PCT and serum IL-8 was measured upon admission and on release. Results: All the measured parameters decreased significantly with BPS treatment. In the control group, most parameters significantly improved apart from AST and PCT. In addition, the suppression of serum TNF levels in the BPS group was greater than that seen in the control group (P ≤ 0.05). Moreover, the length of ICU stay was significantly lower in the BPS group compared with the control group (P ≤ 0.05). Conclusion: Our study shows that addition of BPS to the standard treatment regime of COVID-19 patients in ICU improved outcomes and reduced the length of ICU treatment. Natural products could be considered as new approaches for reducting the harmful consequences of COVID-19.

Cognitive behavioural group therapy for insomnia (CBGT-I) in patients undergoing haemodialysis: a randomized clinical trial.

BACKGROUND: Given the many complications of drug therapy, it seems reasonable to use non-pharmacological therapies that can improve mental and physical disorders in haemodialysis patients. AIMS: This study aims to determine the effectiveness of cognitive behavioural group therapy for insomnia (CBGT-I) in sleep quality, depression, anxiety and general psychological health of haemodialysis patients. METHOD: This randomized clinical trial was conducted on 116 haemodialysis patients who were randomly assigned to experimental (n=58) and control (n=58) groups. In the experimental group, CBGT-I was provided during nine weekly sessions. Data collection tools included Pittsburgh Sleep Quality Index (PSQI), Beck Depression Inventory-II (BDIII), Beck Anxiety Inventory (BAI), General Health Questionnaire (GHQ-28), Clinical Global Improvement Scale (CGI), Client Satisfaction Questionnaire (CSQ) and Working Alliance Inventory-Short Form (WAI-S). Data were analysed by SPSS-25 and p<.05 was considered significant. RESULTS: The findings demonstrated that CBGT-I compared with control group was effective in improving sleep quality (p<.001, η2=.790), depression (p<.001, η2=.616), anxiety (p<.001, η2=.682) and general psychological health (p<.001, η2=.871). Participants of CBGT-I showed notable improvements as a result of the treatment, were satisfied with treatment, and had a good therapeutic relationship. CONCLUSIONS: CBGT-I is effective in reducing depression and anxiety in addition to improving sleep quality and general psychological health in haemodialysis patients. Therefore, it is recommended to be used as a complementary treatment for these patients.

Rapid spread and high mortality due to community-acquired pneumonia caused by Acinetobacter baumannii (CAP-AB) in a Covid-19 intensive care unit.

Acinetobacter baumannii is a rare but dangerous gram-negative bacteria causing nosocomial infections, especially in intensive care units. The increased use of antibiotics in the treatment of bacterial infections leads to drug resistance, delays, or failures in treatment. The patient is a 48-year-old man with coronavirus disease (COVID-19) being treated in the intensive care unit. After contracting Acinetobacter baumannii, the patient's condition deteriorated, and he developed severe pulmonary problems. Due to the unknown presence of Acinetobacter baumannii in the patient, this bacterium transmitted to six other patients in the ward, which resulted in their deaths. In this report, we describe the causes and risk factors of the disease, and the results of laboratory tests and therapeutic processes.