A Systematic Review and Meta-analysis of Attitudes of Iranian Nurses and Related Factors Towards End-Of-Life Care.

This meta-analysis aimed to summarize the evidence regarding attitudes of Iranian nurses and related factors towards end-of-life (EOL) care. PubMed, Web of Science, Scopus, Magiran, Iranmedex, Scientific Information Database, and Google Scholar search engine were searched using Persian and English appropriate keywords from the earliest records up to September 11, 2020. A total of 849 nurses were included in six studies. After a meta-analysis of the mean score of nurses' attitudes, the pooled mean was 80.07 out of 120 (Q(5)=4.32, I-squared=0.00%; 95%CI: 73.53-86.60; p < 0.001). Marital status, ward type, education level, a history of participating in EOL care workshops, personal study of EOL care, experience of caring for a dying family member or close people, natural and approach acceptance, fear of death, and professional autonomy had a significant positive relationship with nurses' attitudes towards EOL care. Therefore, further large-scale studies considering potential confounding variables are needed to confirm our findings.

A Middle East systematic review and meta-analysis of prevalence and antibiotic susceptibility pattern in MRSA Staphylococcus aureus isolated from patients with cystic fibrosis.

BACKGROUND: This study aimed to determine the prevalence and antibiotic resistance patterns in Staphylococcus aureus isolated from patients with cystic fibrosis in Middle Eastern countries. METHODS: A systematic search was conducted in the PubMed, Web of Science (ISI), and Scopus databases for studies presenting the prevalence of MRSA strains, antibiotic resistance pattern in S. aureus strains isolated from patients who suffered from cystic fibrosis in Middle Eastern countries from 1999 to 10 June 2020. The following terms were used; prevalence, antibiotic resistance, antimicrobial drug resistance, drug resistance, Staphylococcus aureus, S. aureus, Methicillin-resistant Staphylococcus aureus, MRSA, cystic fibrosis, CF, and the Middle East. The meta-analysis was performed using Comprehensive Meta-analysis software (Version 3.3.070). RESULTS: Patients' age ranged from 1.6 to 18 years. Females were more than males. The prevalence of S. aureus was varied between 5.6 and 77.8%. The prevalence of S. aureus was varied between 5.6 and 77.8% in different countries. The combined prevalence of S. aureus in Middle East countries from 1999 to 2020 was reported by 40.9% (95% CI 29.6-53.1). The pooled prevalence of MRSA was reported at 18.6% (95% CI 1.1-82.6), Z = 0.9, I2 = 98.6, Q = 146.7. The highest combined resistance in S. aureus strains was reported to Penicillin G (94%), followed by Ciprofloxacin (54.9%). CONCLUSION: Regarding a quite prevalence of S. aureus and an intermediate prevalence of MRSA in CF patients, preventive measures and health policies should be implemented in the Middle East area to prevent the spread of infections caused by MRSA strains in CF patients.

Respiratory Support and Clinical Outcomes in Critically Ill Patients with COVID-19 in Intensive Care Unit: A Retrospective Study.

Background: Appropriate respiratory support is crucial for improving the clinical outcomes of critically ill patients infected with the SARS-CoV-2 virus. This study aimed to investigate the different modalities of respiratory support and clinical outcomes in patients with COVID-19 in intensive care units (ICUs). Materials and Methods: In a retrospective study, we enrolled 290 critically ill COVID-19 patients who were admitted to the ICUs of four hospitals in Mazandaran, northern Iran. Data were extracted from the medical records of all included patients, from December 2019 to July 2021. Patients' demographic data, symptoms, laboratory findings, comorbidities, treatment, and clinical outcomes were collected. Results: 46.55% of patients died. Patients with ≥2 comorbidities had significantly increased odds of death (OR=5.88, 95%CI: 1.97-17.52, P=0.001) as compared with patients with no comorbidities. Respiratory support methods such as face mask (survived=37, deceased=18, P=0.022), a non-rebreather mask (survived=39, deceased=12, P<0.001), and synchronized intermittent mandatory ventilation (SIMV) (survived=103, deceased=110, P=0.004) were associated with in-hospital mortality. Duration of respiratory support in nasal cannula (survived=3, deceased=2, P<0.001), face mask (survived=3, deceased=2, P<0.001), a non-rebreather mask (survived=3, deceased=2, P=0.033), mechanical ventilation (survived=5, deceased=6, P<0.019), continuous positive airway pressure (CPAP) (survived=3, deceased=2, P<0.017), and SIMV (survived=4, deceased=5, P=0.001) methods were associated with higher in-hospital mortality. Conclusion: Special attention should be paid to COVID-19 patients with more than two comorbidities. As a specific point of interest, SIMV may increase the in-hospital mortality rate of critically ill patients with COVID-19 connected to mechanical ventilation and be associated with adverse outcomes.

The role of Th22 cells, from tissue repair to cancer progression.

CD4+ T helper (Th) cells play a significant role in modulating host defense. In the presence of lineage specific cytokine cocktail, Naive CD4+ T cells can differentiate into several categories with distinct cytokines profile and effector functions. Th22 cells are a recently identified subset of CD4+ T cell, which differentiate from Naive CD4+ T in the presence of IL-6 and TNF-α. Th22 characterized by the production of interleukin-22 (IL-22) and expression of aryl hydrocarbon receptor (AHR). The main function of Th22 cells is to participate in mucosal defense, tissue repair, and wound healing. However, controversial data have shown that overexpression of IL-22 can lead to pathological changes under inflammatory conditions and tumor progression. This review summarizes our knowledge about the role of Th22 and IL-22 cells in tumor progression through induction of inflammation.