Frontline Nurses' Experiences of Patient Care in the COVID-19 Pandemic: A Phenomenological Study.

Introduction: The COVID-19 pandemic is now a major public health crisis in the world. Nurses as key members of professional are exposed the most challenges caused by COVID19. Knowledgeable nurses' experiences can provide appropriate solutions to increase the quality of care and improve the health of the society. This study aimed to explore the lived experiences of nurses' caring for patients with COVID-19. Methods: 12 nurses participated in this phenomenological study. We performed purposeful sampling and in-depth face-to-face and semi-structured individual interviews for collecting data. Qualitative data, was analyzed by the 6-step Van Manen hermeneutic phenomenology. Results: After data analysis, the mean (SD) age of study participants was 32.25 (5.62) years and their mean work experience was 9.75 (5.39) years. From the analysis of data obtained from interviews with nurses working in COVID-19 wards, 1050 primary codes, 17 subthemes and 5 themes were extracted. Main themes include: sincere service, patient oppression, emotional instability, suspension and relaxation. Conclusion: Analysis of data in this study suggested that the nurses who care patients in COVID-19 pandemic, faced many professional and psychological challenges. Healthcare managers should plan for psychological support services for the nurses.

Isfahan Thyroid Cohort Study (ITCS).

BACKGROUND: The Isfahan Thyroid Cohort Study (ITCS) is one of the few population-based epidemiological studies in Iran that investigates the prevalence and incidence of thyroid disorders including hypothyroidism, hyperthyroidism, goiter, nodule, and iodine status. METHODS: This cohort is located in Isfahan, Iran. The first phase was initiated in 2006 with 2523 participants (1275 males, 1248 females). The participants were selected using multi-stage cluster sampling from the general residents of Isfahan, Iran. The study had two phases (2006 and 2011) and its third stage is planned for 2020-2021. RESULTS: The prevalence of thyroid function states was euthyroid (89.3%, 95% CI: 88%-90%), overt hypothyroidism (2.8%, 95% CI: 2%‒3%), subclinical hypothyroidism (5.8%, 95% CI: 4%-6%), overt hyperthyroidism (0.8%, 95% CI: 0.4%‒1%), and subclinical hyperthyroidism (0.99%, 95% CI: 0.6%-1%). Hypothyroidism and hyperthyroidism were significantly associated with goiter. The incidence of thyroid dysfunction was reported as follows: overt hypothyroidism (2.7, 95% CI: 1.6-3.7), subclinical hypothyroidism (20.6, 95% CI: 18-23), overt hyperthyroidism (1.9, 95% CI: 1-2.7) and subclinical hyperthyroidism (2.7, 95% CI: 1.6-3.7) per 1000 (person-year). CONCLUSION: We assessed the prevalence and incidence of thyroid disorders in Isfahan in the first and second phase, respectively. We are conducting the third phase of the ITCS in order to study the associations between thyroid peroxidase antibody (TPOAb) level and environmental factors such as infection.

Comparison of the effect of ginger and aloe vera mouthwashes on xerostomia in patients with type 2 diabetes: A clinical trial, triple-blind / Comparación del efecto de los enjuagues bucales de jengibre y aloe vera sobre xerostomía en pacientes con diabetes tipo 2: un ensayo clínico, triple ciego

Background: Ginger and aloe vera are two medicinal herbs mostly used to produce mouthwash. This study aimedto compare the effects of ginger and aloe vera mouthwashes on the xerostomia in patients referred to Bandar Ab-bas diabetes clinic (Iran).Material and Methods: In this triple-blind clinical trial, three groups (n=35 patients in each group) were studied.One group was given aloe vera mouthwash, the other group used ginger mouthwash, and the control group wasonly given normal saline. All the mouthwashes were used 20 ccs three times daily for 14 consecutive days. Thesymptoms and severity of xerostomia were measured before and after the intervention by the questionnaire pro-posed by Fox et al. as well as VAS scale, respectively. Statistical analysis, including the Shapiro-Wilk test usedto measure the normality of variables, and Chi-square and McNemar used to compare the scores questionnaireproposed by Fox et al., were also applied. Scores of VAS were analyzed using a one-way ANOVA test. P<0.05 wasconsidered as statistically significant in all these tests.Results: The mean age of the participants included in the normal saline group was 58.13±14.75 years old, 54.14±9.35years old in the ginger group, and 53.37±11.57 years old in the aloe vera group. The difference between the scoresof xerostomia before and after performing the intervention (The amount of reduction in xerostomia) in the gin-ger group was 6.12±2.004 cm, in the aloe vera group it was 4.08±2.09 cm, and in the normal saline group it was2.45±2.09 cm. Finally, the ginger and aloe vera mouthwashes significantly reduced all symptoms and severityrelated to xerostomia, respectively(p<0.001). Conclusions: The use of mouthwash is an effective measure to reduce xerostomia under chronic conditions. Aloevera, ginger, and normal saline are known as effective mouthwashes on controlling this complication. According tothe results of this study, ginger and aloe vera mouthwashes could...(AU)

The role of anxiety and depression on acceptance and action, considering emotional schemas in diabetics of Birjand (Iran).

BACKGROUND: Diabetes is one of the most common noncommunicable diseases around the world that accompanies assorted psychiatric disorders including anxiety and depression due to being chronic. OBJECTIVE: The aim of this study was to evaluate the effect of anxiety and depression on acceptance and action, considering emotional schemas of diabetics referring to diabetes clinics of health centers in Birjand, Iran. METHODS: This study was conducted in 2016 and was a correlational study with a structural equation modeling approach. The statistical population of this study were all men and women with type 2 diabetes in Birjand, with an active health record in health centers of this county. To collect data, Depression, Anxiety, and Stress Scale (DASS-21), Acceptance and Action Questionnaire-II (AAQ-II) and Leahy Emotional Schema Scale (LESS) were employed. Using SPSS19 and LISREL, data were analyzed via multiple regression and modeling at p≤0.05. RESULTS: In general, 350 subjects entered the study, most of whom were between 50 and 60 years of age and of whom, (47.7%) were women. Results show that depression has had a negative contribution in predicting quality of life (p=0.0001). In addition, results demonstrated the negative relation of anxiety and depression in predicting no emotional avoidance (flexibility) (p=0.0001). Anxiety and rumination had a positive effect and emotional unawareness had a negative effect on predicting no emotional avoidance (p=0.0001). CONCLUSION: Results of this study showed that by reducing adaptive emotional schemas, emotions reduce psychological flexibility and increase emotional avoidance. In addition, by increasing non-adaptive emotional schemas, it increases no flexibility and emotional avoidance that finally reduces quality of life as well as acceptance and action.

Incidence of thyroid dysfunction in an Iranian adult population: the predictor role of thyroid autoantibodies: results from a prospective population-based cohort study.

BACKGROUND: The prevalence of thyroid dysfunction is high in Isfahan, an area of iodine sufficient in Iran. The aim of this study is to investigate the incidence of thyroid dysfunctions in adults of metropolitan Isfahan and to determine the role of thyroid autoantibodies. METHODS: In a population-based cohort study in 2006-2011, we measured TSH, T4, T3, thyroid peroxidase antibody (TPOAb), and thyroglobulin antibody (TgAb) in 618 out of 2254 people who were euthyroid in 2006. The incidence rates per 1000 person-year (pr) were calculated. The odds ratio (OR), relative risk (RR), and 95% confidence interval (95% CI) were calculated based on logistic regression to quantify the potential predictors of thyroid dysfunction. The receiver-operator characteristic (ROC) analysis along with area under the curve (AUC) was used to determine the optimal cutoff values for baseline TPOAb and TgAb as predictors of thyroid dysfunction. RESULTS: Within a 6-year follow-up, the incidence rate of hypothyroidism was 3.3 in women and 2.1 in men while the incidence rate of hyperthyroidism was 3.8 in women and none in men per 1000 (person-year). A cutoff value of TPOAb at 38 IU/mL was obtained to differentiate the patients with hypothyroidism and hyperthyroidism, with specificity of 0.75 and sensitivity of 0.76, and AUC (CI 95%) of 0.882 (0.743-1.02), P = 0.01 and 0.817 (0.600-1.035) P = 0.033, respectively. There is a statistically significant association of hypothyroidism and hyperthyroidism with positive TPOAb [RR (CI 95%): 1.99 (1.27-3.13) and 2.20 (1.23-3.95), respectively]. CONCLUSIONS: The incidence rate of thyroid dysfunction is high in Isfahan, and higher TPOAb concentration is its strong predictor.

Association of KCNJ11 (E23K) gene polymorphism with susceptibility to type 2 diabetes in Iranian patients.

BACKGROUND: Type 2 diabetes (T2D) is a multifactorial disease with susceptibility of several genes that are related to T2D. Insulin secretion pathway starts with potassium channels in pancreatic beta cells. KCNJ11 gene encodes ATP-sensitive potassium channel subunits. Some studies suggested that KCNJ11 (E23K) mutation increases the risk of T2D. Therefore, present study was designed to investigate the association between E23K polymorphism of KCNJ11 gene and type 2 diabetes mellitus (T2DM) in the Iranian population. MATERIALS AND METHODS: The type of study was case-control and 40 unrelated subjects, including 20 healthy controls and 20 diabetic patients were recruited (diagnosed based on American Diabetes Association criteria). Blood samples were used for isolation of genomic deoxyribonucleic acid (DNA). Having extracted the genomic DNA from human blood leukocytes by means of High Pure PCR Template Preparation Kit, PCR-restriction fragment length polymorphism method was used to detect KCNJ11 E23K gene polymorphism. BanII restriction enzyme was used for digestion. Data were analyzed using Chi-square or Fisher exact test or independent t-test, as appropriate. P < 0.05 was considered. RESULTS: We found that the carrier homozygous for KK genotype are susceptible to T2D (0.049) and in patients the frequency of K allele was higher than control subjects (0.048). CONCLUSION: The present study suggests that KCNJ11 (E23K) gene polymorphism is associated with T2DM.

The effect of salsalate on biochemical factors and endothelial dysfunction of prediabetic patients: A randomized clinical trial.

BACKGROUND: The beneficial effect of using nonacetylated salicylates such as salsalate on decreasing the speed of diabetes progression is a controversial issue. The aim of this study was to evaluate the effect of salsalate on metabolic-syndrome-associated parameters as well as the endothelial function of diabetic and impaired glucose tolerance patients. MATERIALS AND METHODS: Patients were collected from Isfahan endocrinology research center referrals. Patients with impaired glucose tolerance diagnosis or newly diagnosed diabetes were enrolled in the study. Patients were randomized to receive 1.5 g salsalate (2 × 750 mg) BID or placebo twice a day for 3 months. After the mentioned period, all patients were recalled and complete examination was done; blood samples for biochemistry measurements were drawn (for measuring FBS, post prandial glucose, HbA1C, Total cholesterol, HDL, TG, LDL) and forearm flow-mediated dilation (FMD) was performed. RESULTS: Forty patients were enrolled, 32 patients (80%) were female. Mean age of patients was 47.15 ± 6.67 years. FBS (fasting blood sugar) was shown to be significantly different between intervention and control subjects before or after treatment. FMD increased significantly in the intervention group (P = 0.004). CONCLUSION: The study showed that salsalate decreased FBS levels of patients. It may also improve endothelial function as FMD increased significantly in the intervention group.

Papillon-lefèvre syndrome: a series of six cases in the same family.

Papillon-Lefèvre syndrome (PLS) is a rare, autosomal recessive heterogeneous disorder, which is characterized by palmoplantar hyperkeratosis, early loss of primary and permanent teeth, and associated calcification of the dura mater. Herein we described six cases of PLS in the same family. In this series, six cases (two females and four males) with the mean age of 15.6 ± 10.4 years were recruited. Palmoplantar hyperkeratosis was detected in all of the cases, leading to a difficult and painful walking in two cases due to lesions on the soles. Skin lesions were sharply distinct from adjacent normal skin in all cases. Other skin lesions were located in the external malleolus (5/6), knee (4/6), elbow (4/6), toe and dorsal fingers (3/6), and the thighs (2/6). In three cases, all permanent teeth were exfoliated. In three others, no primary teeth remained. Severe gingivitis was observed in three patients. Radiologic study confirmed alveolar bone destruction in five cases. Delayed diagnosis and insufficient treatment of PLS patients can affect patient's life of by causing edentulism at a young age and may impose PLS patients to increased risk of social, psychological, and economical burdens.

Sonographic and functional characteristics of thyroid nodules in a population of adult people in Isfahan.

INTRODUCTION: The aim of this study was to investigate the current status of sonographic characteristics of thyroid nodules in Isfahan, a previously iodine deficient area in central Iran. MATERIAL AND METHODS: In a cross-sectional study conducted in 2006, 2523 adult people (age > 20 years) were selected by a multistage clustering sampling method. Of these people, 263 volunteered persons were underwent sonographic evaluation. Thyroid examination was done by two expert sonographers. Serum T(3), T(3), T3RU, TSH, TPO Ab and Tg Ab, and urinary iodine were measured. RESULTS: Forty-six per cent of the 263 people were women. Their mean age was 35.5 years with a range of 20-64 years. Median urinary iodine was 19.4 microg/dL. The prevalence of thyroid nodules on sonography was 22.4% in the whole group; 30% in women and 16.3% in men (OR = 2.2, P = 0.01). The prevalence of thyroid nodules increased with age (P = 0.006). The prevalence of thyroid nodules was higher in hypothyroid people than in euthyroid people (35.1% v. 20.5%, OR = 2.1, P = 0.04). Neither urinary iodine nor autoantibody concentrations correlated with the prevalence of thyroid nodules in sonography. CONCLUSIONS: The prevalence of thyroid nodule by sonography is still high despite relatively normal urinary iodine in this population.