Prevalence of Delirium and Its Related Factors in Burn Patients; a Systematic Review and Meta-Analysis.

Introduction: Considering the importance of delirium disorder in burn patients and its complications, the present systematic review and meta-analysis aimed to determine the prevalence of delirium and its related factors in burn patients. Methods: A comprehensive, systematic search was performed in different international electronic databases, such as Scopus, PubMed, and Web of Science, as well as Persian electronic databases such as Iranmedex, and Scientific Information Database (SID) using keywords extracted from Medical Subject Headings such as "Prevalence", "Delirium", and "Burns" from the earliest to the 17th of July, 2023. Results: In total, 2,710 burn patients participated in ten original studies. Among the participants, 64.6% were male. In the ten studies, the reported pooled prevalence of delirium among burn patients was 20.5% (95% CI: 10.9% to 35.0%; I2=96.889%; P<0.001). Also, factors such as total body surface area, duration of hospitalization, mortality, days on ventilator, alcoholism, benzodiazepine dose, methadone dose, age, male gender, ICU days, operation days, wound care under anesthesia, and opioid dose had a significant correlation with the prevalence of delirium in burn patients. Conclusion: Health managers and policymakers can reduce the prevalence of delirium in burn patients by eliminating or reducing factors associated with it.

The effect of conjugated linoleic acid supplementation on oxidative stress markers: A systematic review and meta-analysis of randomized controlled trials.

BACKGROUND & AIMS: Recent trial studies have found that conjugated linoleic acid (CLA) supplementation beneficially reduces oxidative stress markers but, there is no definitive consensus on this context. The present systematic review and meta-analysis aimed to investigate the effect of CLA supplementation on oxidative stress parameters. METHODS: We searched PubMed, Web of Science, Scopus, Cochrane Library, and Google Scholar databases until September 2021 to identify randomized controlled trials (RCTs) assessing CLA supplementation effects on oxidative markers including malondialdehyde (MDA), 8-isoprostanesF2α (8-iso-PGF2α), and glutathione peroxidase (GPx). Summary estimates and corresponding 95% confidence intervals (CI) were derived via the DerSimonian and Laird method using a random-effects model. RESULTS: A total of 11 RCTs were included. The obtained results show that CLA supplementation caused a significant decrease in MDA concentrations (Hedges's: -0.35; 95% CI: -0.70 to -0.01, P = 0.04, I2 = 62.1%, n = 7), and also significantly increased 8-iso-PGF2α levels (Hedges's: 1.45; 95% CI: 0.98 to 1.91, P˂0.001, I2 = 42.9%, n = 4). However, the results showed that supplementation with CLA did not significantly change the concentrations of GPx (Hedges's: 0.30; 95% CI: -0.04 to 0.64, P = 0.08, I2 = 0.0%, n = 3). CONCLUSION: It seems this supplement can be used as a dietary supplement to improve oxidative stress parameters. However, further studies are required to demonstrate present results.

How vegetation cover characteristics response to the spread of Prosopis juliflora: a time-series remote sensing analysis in southern Iran.

Plant invasion is recognized as the second most severe threat to biodiversity, following habitat loss. As one of the world's worst invasive alien plant species, Prosopis juliflora (Mesquite) has severely affected the majority of the Earth's dry ecosystems. Hence, this study attempted to identify the distribution, dominance, and changes in the vegetation characteristics of Mesquite-invaded regions along a series of coastal ecosystems in Southern Iran. Mesquite and other tree/shrub types were successfully classified using a temporarily-median-filtered Landsat 8-OLI image with acceptable kappa coefficient and overall accuracy values of 80.66 and 84.75, respectively. The multi-resolution segmentation was used to divide the region into spectrally homogenous parcels, then calculating the percentage cover (dominance) of Mesquite relative to other tree/shrub types. Analysis of MODIS NDVI products in highly invaded parcels showed a steady increase in NDVI values from 0.27 to 0.53 during 2000-2020 with a significant difference (z = -3.12, 0.183, sig ≤ .05, 2-tailed) from that of the low-invaded regions whose NDVI values oscillated constantly in a range between 0.15 and 0.28. Mesquite distribution also showed a local invasion pattern from areas with a steady or saturated status to neighboring parcels. In regions susceptible to Mesquite invasion, constant investigation of uncommon changes in NDVI whose vegetation characteristics differ significantly from that expected in poor dry vegetation covers of southern Iran can be considered as a conservation tool to identify and manage areas with early Mesquite establishment.

The effect of the Alexander Technique on pain intensity in patients with chronic low back pain: A randomized controlled trial.

OBJECTIVE: The present study was performed to determine the effect of the Alexander Technique on the intensity of pain in patients with chronic low back pain (LBP). METHODS: This study is a clinical trial that was performed on 80 patients with chronic LBP in Kashan, Iran. Participants were randomly assigned in control and intervention groups. To assess the participants' LBP, a visual analog scale of pain (VAS-Pain) was completed by both groups. In the intervention group, in addition to routine care for LBP patients, the Alexander Technique was performed in three 60-min sessions per week for 12 weeks. The control group participants received routine care for LBP patients. The two groups completed the VAS-Pain scale immediately after and one month after the intervention. RESULTS: The results showed that there was no statistically significant difference between the two groups in terms of demographic characteristics and mean pain intensity score before the intervention (p > 0.05). Immediately after and then one month after the intervention, there was statistically significant differences between the two groups regarding the mean scores of pain (p < 0.05). The results of repeated measures ANOVA showed that, in the intervention group, the mean score of pain had decreased over time (p < 0.05). CONCLUSION: The results of the present study showed that the Alexander Technique was effective in reducing the intensity of pain among the participants. We recommend the Alexander Technique as a useful and effective intervention for reducing chronic LBP.

The effect of grapes/grape products on glycemic response: A systematic review and meta-analysis of randomized controlled trials.

The aim of this study was to perform a systematic review and meta-analysis of randomized clinical trials (RCTs) to examine the effect of grapes/grape products supplementation on glycemic indices in adults. Our systematic search to find relevant RCTs was performed up to February 2020 using PubMed, Scopus, ISI Web of Science, Cochrane Library, and Google Scholar. Based on the heterogeneity between included studies, a random effects or a fixed model was applied in the meta-analysis, and results were expressed as weighted mean differences (WMD) with 95% confidence intervals (CI). Twenty-nine clinical trials (1,297 participants) fulfilled the eligibility criteria of the present meta-analysis. Overall, the grapes/grape products supplementation significantly reduced homeostatic model assessment of insulin resistance (HOMA-IR) (WMD: -0.54, 95% CI: -0.91, -0.17, p = . 004) but did not affect fasting insulin levels (WMD: -0.90 µIU/ml, 95% CI: -1.04, 2.84, p = .362) and hemoglobin A1C (Hb1Ac) percentage (WMD: 0.00%, 95% CI: -0.10, 0.11, p = . 916) in the main analyses. In addition, changes to fasting blood glucose (FBG) levels were in favor of the control group (WMD: 1.19 mg/dl, 95% CI: 0.05, 2.34, p = .041). We found that giving grapes/grape products to adults might have beneficial effects on the HOMA-IR. Further, large-scale RCTs with longer duration are required to confirm these results.

The effect of cinnamon supplementation on liver enzymes in adults: A systematic review and meta-analysis of randomized controlled trials.

AIMS: The aim of this study was to perform a systematic review and meta-analysis of randomized controlled trials (RCTs) to examine the effect of cinnamon supplementation on liver enzymes. METHODS: A systematic search was performed in electronic databases including PubMed-Medline, Scopus, and ISI Web of Science up to November 2020. We used a random effects model to estimate pooled effect size of alanine aminotransferase (ALT), alkaline phosphatase (ALP), and aspartate aminotransferase (AST) levels. RESULTS: Seven RCTs (9 treatment arms) fulfilled the eligibility criteria of the present meta-analysis. Overall, meta-analysis could not show any beneficial effect of cinnamon supplementation on AST, ALT, and ALP. Subgroup analyses showed that the effect of cinnamon supplementation on ALT was significant at the dosages of <1500 mg/day (Hedges's: -0.61; 95 % CI: -1.11, -0.10; P = 0.002), in trials lasting>12 weeks (Hedges's: -0.83; 95 % CI: -1.36, -0.30; P = 0.01), and in trials conducted of both gender (Hedges's: -0.72; 95 % CI: -1.45, -0.01; P = 0.04). CONCLUSION: In summary, cinnamon supplementation had no significant effect on liver enzymes in adults. However, the effect of cinnamon on ALT levels was significant at the dosages of <1500 mg/day, in trials lasting>12 weeks, and in trials conducted of both gender. Nevertheless, further studies should be performed to confirm our results.

Effect of sour tea supplementation on liver enzymes, lipid profile, blood pressure, and antioxidant status in patients with non-alcoholic fatty liver disease: A double-blind randomized controlled clinical trial.

The aim of this study was to evaluate the efficacy of sour tea supplementation in patients with nonalcoholic fatty liver disease (NAFLD). Seventy NAFLD patients were enrolled in this randomized, double-blind, placebo-controlled clinical trial. Participants received sour tea in the form of a 450 mg capsule or a placebo capsule daily for 8 weeks. Anthropometric indices, liver enzymes, lipid profile, blood pressure, and antioxidant status were evaluated at the baseline and at the end of the study. Sixty-one participants completed the study. After 8 weeks, sour tea administration significantly decreased serum triglyceride (TG) (p = .03), alanine aminotransferase (ALT) (p = .01), and aspartate aminotransferase (AST) (p = .004) levels compared with the placebo. In addition, sour tea supplementation resulted in a significant reduction in systolic blood pressure (SBP) (p = .03) and diastolic blood pressure (DBP) (p = .04), and a significant increase in serum total antioxidant capacity (TAC) levels (p ˂ .001) compared with the placebo. However, no significant changes in anthropometric measures, total cholesterol (TC), low-density lipoprotein cholesterol (LDL-c), and high-density lipoprotein cholesterol (HDL-c) levels were observed after sour tea supplementation compared with the placebo (p > .05). Sour tea supplementation may be effective in improving serum TG, liver enzymes, and blood pressure in patients diagnosed with NAFLD. Further studies are needed to address the exact mechanism of action of these effects.

The Effectiveness of Teaching Nursing Ethics via Scenarios and Group Discussion in Nurses' Adherence to Ethical Codes and Patients' Satisfaction with Nurses' Performance.

BACKGROUND: There are shortcomings in nurses' adherence to ethical principles in practice. The present study aims to investigate the effectiveness of teaching nursing ethics via scenario-based learning and group discussion in nurses' adherence to codes of ethics and patients' satisfaction with nurses' performance. METHODS: Using a quasiexperimental design, the present study employed questionnaires which measure nurses' compliance with nursing codes of ethics and patients' satisfaction with nursing care before, immediately after, and one month after intervention. The collected data were analyzed using the independent t-test, ANOVA, and chi-square test in SPSS v.22. The level of significance was set at p < 0.05. The nurses (n = 80) and patients (n = 160) from various units of two university hospitals in the south-west of Iran participated in the present study. RESULTS: The pretest mean scores of the intervention and control groups in patient rights and patients' satisfaction with nursing care were not significantly different (p=0.07, p=0.21). Yet, there were statistically significant differences between the groups' mean scores as calculated immediately after (p < 0.001, p < 0.001) and one month after intervention (p < 0.001, p < 0.001). CONCLUSION: Employment of new approaches to teach nursing ethical principles improves compliance with nursing ethical codes and patients' satisfaction with nurses' performance.

Urea changes oocyte competence and gene expression in resultant bovine embryo in vitro.

SummaryNutrition influences the microenvironment in the proximity of oocyte and affects early embryonic development. Elevated blood urea nitrogen, even in healthy dairy cows, is associated with reduced fertility and there is high correlation between blood urea levels and follicular fluid urea levels. Using a docking calculation (in silico), urea showed a favorable binding activity towards the ZP-N domain of ZP3, that of ZP2, and towards the predicted full-length sperm receptor ZP3. Supplementation of oocyte maturation medium with nutrition-related levels of urea (20 or 40 mg/dl as seen in healthy dairy cows fed on low or high dietary protein, respectively) dose-dependently increased: (i) the proportion of oocytes that remained uncleaved; and (ii) oocyte degeneration; and reduced cleavage, blastocyst and hatching rates. High levels of urea induced shrinkage in oocytes, visualised using scanning electron microscopy. Urea downregulated NANOG while dose-dependently upregulating OCT4, DNMT1, and BCL2 expression. Urea at 20 mg/dl induced BAX expression. Using mathematical modelling, the rate of oocyte degeneration was sensitive to urea levels; while cleavage, blastocyst and hatching rates exhibited negative sensitivity. The present data imply a novel role for urea in reducing oocyte competence and changing gene expression in the resultant embryos.

Relationship between Body Mass Index, Waist-to-Hip Ratio, and Serum Lipid Concentrations and Thyroid-Stimulating Hormone in the Euthyroid Adult Population.

The aim of this cross-sectional study was to investigate the relationship between body mass index (BMI), waist-to-hip ratio, and lipid parameters and serum thyroid-stimulating hormone (TSH) levels in healthy euthyroid individuals. This cross-sectional study was conducted between June 1st and July 20th, 2013, at Bushehr University of Medical Sciences. One hundred forty euthyroid individuals were divided into 2 groups: a high-TSH group (TSH between 2.0 and 5.5 mIU/L, n=67) and a low-TSH group (TSH between 0.3 and 2.0 mIU/L, n=73). After overnight fast, total cholesterol, triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), TSH, thyroxine (T4), and triiodothyronine (T3) were measured. Height and weight were measured with a stadiometer, and BMI was calculated as weight in kilograms divided by the square of height in meters. Waist-to-hip ratio was determined as waist circumference divided by hip circumference. The simple independent t-test and a general linear model were used for statistical analysis. All statistical analyses were done using the SPSS, version 15, statistical software package. BMI and LDL-C were significantly higher in the high-TSH group than in the low-TSH group after adjustment for age, sex, calorie intake, total fat and carbohydrate intakes, and physical activity. No significant differences were found between the groups in TG, cholesterol, and HDL-C. The association between TSH levels andT4 was significant. Individuals with TSH levels at the upper limit of normality might be at risk of hypercholesterolemia and obesity.

The effects of gabapentin on severity of post spinal anesthesia headache.

Spinal anesthesia is a common anesthesia method and post dural puncture headache (PDPH) is one of its most common adverse effects. Gabapentin is a popular anticonvulsant drug that has been used as an oral nonopioid analgesic in recent years. In this placebo-controlled double-blind study, 120 patients were randomized in two equal groups (Placebo or gabapentin). The patients in the gabapentin group received gabapentin 300 mg orally one hour before the surgery and then every 12 hours for the first 24 hours after the surgery while the placebo group received placebos in the same way. Severity of headache and postoperative pain assessed by verbal rating score for pain (VRSP), morphine consumption, nausea, vomiting, somnolence, pruritus, dizziness in the first 48 hours, hypertension, hypotension, bradycardia and tachycardia in the first 24 hours after the surgery were recorded. In first 48 hour after surgery the mean of severity of headache in the gabapentin group was 0.20±0.05, and in the placebo group it was 0.93±0.01. The mean of postoperative pain in the gabapentin group was2.25±0.793, and in the placebo group it was3.77±0.813. In the first 24 hours post operative the mean of morphine consumptions were 0.20±0.030 and 0.32±0.0 30 mg in gabapentin and placebo groups. No significant differences were found between the two groups regarding incidence rate of the adverse effects. In this study, administration of gabapentin decreased the incidence and severity of post spinal anesthesia headache, postoperative pain and morphine consumption, without any significant differences in serious adverse effects.