A systematic review and disability-adjusted life years of Scedosporium/Lomentospora infection in patients after near-drowning.

Scedosporium/Lomentospora species exist as saprophytic moulds that can potentially lead to serious infections in patients who have experienced near-drowning incidents. Scedosporium species are distributed across different regions of the world while Lomentospora prolificans has quite a restricted geographic distribution. We aimed to systematically review scedosporiosis cases after near-drowning, their clinical manifestations, underlying diseases, treatments, outcomes and its impact through disability-adjusted life years (DALYs). Five available sources were searched from 1 January 2007, to 20 April 2022. Thirty-eight studies, including 41 patients, were evaluated. Mean age was 33.6 ± 18.6 years (range 1-68), and 28 were male (68.3%). Central nervous system (CNS) dissemination predominated (36/41; 87.8%), presenting mainly as multiple brain abscesses (26/41; 63.4%), followed by lung involvement (22/41; 56.4%). Scedosporium apiospermum species complex was the most causative agent (38/41; 92.7%). Overall mortality was 51.2%. Half of the patients (18/37) were cured after receiving proper treatment, and in most cases, voriconazole alone or in combination with surgery or other antifungals caused survival. The mean survival time was 123 ± 27 days. Mean DALYs in 1980-2022 were 46.110 ± 3.318 (39.607-52.612). Time to diagnosis was estimated to be 120 days, and there was no association between time to diagnosis and outcome. Voriconazole is a potentially effective therapy, and combination of surgery and antifungal treatment may lead to more favourable outcome. Advances in early diagnosis and appropriate antifungal therapy may have contributed to reducing its mortality.

A fatal Candida albicans pericarditis presenting with cardiac tamponade after COVID-19 infection and cardiothoracic surgery.

BACKGROUND: Candida pericardial infection is a rare clinical entity usually related to recent cardiothoracic surgery and chronic debilitating conditions. During the COVID-19 pandemic, invasive fungal infections have been on the rise, likely due to a combination of factors such as immunosuppression, underlying conditions like diabetes, and surgical procedures. CASE PRESENTATION: Herein, we report a 67-year-old diabetic woman with a history of COVID-19 infection who received a high dose of corticosteroids a few months before admission, and previous myocardial infarction for more than 12 years. The patient had a positive cardiac tamponade with signs of dyspnea, chest pain, and low blood pressure. Echocardiographic data were more in favor of constrictive pericarditis. The patient underwent urgent echocardiography-guided pericardiocentesis and then broad-spectrum antibiotic treatment was prescribed. Repeated echocardiography implied a persistent pericardial effusion 10 days later. Subxiphoid aspirates and biopsied tissues showed budding yeast cells and yeast colonies grew on culture media identified as Candida albicans. CONCLUSION: This report should bring to the attention of physicians toward the possibility of Candida pericardial infection presenting with cardiac tamponade after COVID-19 infection and cardiothoracic surgery. Echocardiographic assessment, prompt pericardiotomy, molecular-based identification of causative agent, and early administration of appropriate antifungal treatment should improve the patient's survival.

Do Medical Sciences Students Have the Proper Knowledge, Attitude, and Practice, Regarding the Complementary and Alternative Medicine in Iran?

Background: The increasing use of complementary and alternative medicine (CAM) has changed expectations of healthcare professionals concerning the knowledge, attitude, and practice of CAM. The present study aimed to investigate the knowledge, attitude, and practice of students of Arak University of Medical Sciences (Iran) in 2020 concerning CAM. Methods: The present descriptive cross-sectional study was conducted on 226 medical sciences students using targeted quota sampling. The data collection tool was a researcher-made questionnaire based on valid scientific articles and literature. The questionnaire was comprised of 92 items and assessed students' knowledge, attitude, and practice regarding CAM. Results: The study participants' mean CAM knowledge and attitude scores were 14.12±6.1 and 58.7±29.28, respectively. The primary information sources included mass media, the internet, and friends. Most participants (63.4%) were willing to use CAM methods. The most common CAM was herbal therapy (29.1%), and the most common reason for using, was gastrointestinal problems (39.2%). Conclusion: The participants indicated moderate knowledge and poor attitude regarding CAM. Thus, considering the extensive application of CAM methods among the participants and their insufficient knowledge and inappropriate attitude, that is recommended to include CAM methods be included besides the conventional medicine, in the academic curriculum of students of medical sciences.

Assessment of spiritual needs in cancer patients: A cross-sectional study.

Introduction: Addressing the spiritual needs of patients is an essential component of holistic care in nursing. Acknowledging the spiritual needs of cancer patients enhances the performance of clinical caregivers in providing quality services to such patients. Therefore, caregivers successfully fulfill or decrease the patients' needs and thus increase their adaptation to crises. Methods: The present cross-sectional study was conducted to determine the spiritual needs of cancer patients. In this study, 96 cancer patients were selected from Ayatollah Khansari Hospital in Arak, Iran. The required data were collected through a demographic information form and the Persian version of the Spiritual Needs Questionnaire. Ethical Considerations: Participants' verbal consent to participate in the study was obtained, and they were assured of anonymity and confidentiality. Results: In the present study, the mean age of the participants was 47.82 ± 14.34 years. The frequency distribution of respondents by gender was 36 males (37.5%) and 60 females (62.5%). The mean scores of spiritual needs in the domains of religious needs, need for inner peace, existential needs, and need for giving/generativity were 12.03 ± 3.18, 7.26 ± 3.26, 4.61 ± 2.96, and 4.06 ± 2.32, respectively. The highest and lowest mean values were associated with religious needs and need for giving/generativity, respectively. Religious needs showed a significantly positive relationship with gender, occupation, and the type of treatment (P < 0.05). Moreover, a significant relationship was observed between the need for peace and level of education (P < 0.05). Conclusion: The recognition of the spiritual needs of cancer patients is the first step in prioritizing and planning to provide spiritual care to these patients and supporting them in adapting to and coping with the disease. Therefore, nurses need to acquire the fundamental knowledge and skills required to identify these needs.

Using the Precision Lasso for gene selection in diffuse large B cell lymphoma cancer.

BACKGROUND: Gene selection from gene expression profiles is the appropriate tool for diagnosing and predicting cancers. The aim of this study is to perform a Precision Lasso regression model on gene expression of diffuse large B cell lymphoma patients and to find marker genes related to DLBCL. METHODS: In the present case-control study, the dataset included 180 gene expressions from 14 healthy individuals and 17 DLBCL patients. The marker genes were selected by fitting Ridge, Lasso, Elastic Net, and Precision Lasso regression models. RESULTS: Based on our findings, the Precision Lasso, the Ridge, the Elastic Net, and the Lasso models choose the most marker genes, respectively. In addition, the top 20 genes are based on models compared with the results of clinical studies. The Precision Lasso and the Ridge models selected the most common genes with the clinical results, respectively. CONCLUSIONS: The performance of the Precision Lasso model in selecting related genes could be considered more acceptable rather than other models.

Post-COVID-19 fatal Aspergillus endocarditis: A case report.

BACKGROUND: Aspergillus endocarditis (AE) is a rare fatal infection. The infection is often reported in patients with prosthetic heart valves, immunosuppressed, broad-spectrum antimicrobial use regimens, and drug abusers. METHODS: Herein, we report a rare case of native mitral valve AE in a 63-year-old man, with a probable COVID-19-associated invasive pulmonary aspergillosis nine months ago treated with antifungals. RESULTS: In the last admission, the lethargy, neurological deficit, and septic-embolic brain abscess in brain MRI led to suspicion of infective endocarditis. Transesophageal two-dimensional echocardiography and color Doppler flow velocity mapping showed a large highly mobile mass destroying leaflet and severe mitral regurgitation. The Surgical valve replacement is performed. The surgical valve replacement is performed. Direct microscopic examination and culture of the explanted and vegetative mass revealed Aspergillus section Fumiagati confirmed by molecular method. Despite the administration of voriconazole and transient improvement the patient expired. CONCLUSION: As AE is a late consequence of COVID-19-associated invasive pulmonary aspergillosis, therefore, long-term follow-up of invasive aspergillosis, and prompt diagnosis of surgical and systemic antifungal therapy treatment, are warranted to provide robust management.

The effect of curcumin on NRF2/Keap1 signalling pathway in the epididymis of mouse experimental cryptorchidism.

Nrf2/Keap1 pathway, which prevents cellular damage against reactive oxygen species production, is disrupted in epididymis following cryptorchidism. In this study, we aimed to use curcumin (Cur) as an activator of Nrf2 to decrease the effects of disruption in this pathway caused by cryptorchidism. In this study, animals were randomly divided into following groups: control, sham-surgery, sham-vehicle, sham-Cur50, sham-Cur100 , cryptorchidism, cryptorchidism-vehicle, cryptorchidism-Cur50 and cryptorchidism-Cur100 . For cryptorchidism induction, the left testicle was removed from the scrotum and sutured to the abdominal wall. Two weeks after surgery, Cur was given orally to animals. After 1 month, sperm parameters and testis histopathology were analysed. The expression of Nrf2, NQO1, HO1, and Keap1 genes was evaluated by real-time polymerase chain reaction. Our data showed that Cur, especially at high doses, could improve sperm parameters and testis histopathology, which were damaged following cryptorchidism induction. The expression of HO1, NQO1, and Nrf2 genes, which had decreased in the cryptorchidism group, showed a significant increase after administration of Cur in a dose-dependent manner. Cur, by inducing the expression of genes involved in the Nrf2/Keap1 pathway, could reduce the adverse effects of cryptorchidism and might be used as adjuvant therapy for decreasing cryptorchidism complications before surgery.

Determining the Factors Affecting Long-Term and Short-Term Survival of Breast Cancer Patients in Rafsanjan Using a Mixture Cure Model.

BACKGROUND: Breast cancer is one of the most common causes of death among women worldwide and the second leading cause of death among Iranian women. The incidence of this malignancy in Iran is 22 per 100,000 women. These patients have long-term survival time with advances in medical sciences. The present study aimed to identify the risk factors of breast cancer using Cox proportional hazard and Cox mixture cure models. STUDY DESIGN: It is a retrospective cohort study. METHODS: In this cohort study, we recorded the survival time of 140 breast cancer patients referred to Ali Ibn Abitaleb Hospital in Rafsanjan, Iran, from 2001 to 2015. The Kaplan-Meier curve was plotted; moreover, two Cox proportional hazards and the Cox mixture cure models were fitted for the patients. Data analysis was performed using SAS 9.4 M5 software. RESULTS: The mean age of patients was reported as 47.12 ±12.48 years at the commencement of the study. Moreover, 83.57% of patients were censored. The stage of disease was a significant variable in Cox and the survival portion of Cox mixture cure models (P=0.001). The consumption of herbal tea, tumor size, duration of the last lactation, family history of cancer, and the type of treatment were significant variables in the cured proportion of the Cox mixture cure model (P=0.001). CONCLUSION: The Cox mixture cure model is a flexible model which is able to distinguish between the long-term and short-term survival of breast cancer patients. For breast cancer patients, cure effective factors were the stage of the disease, consumption of herbal tea, tumor size, duration of the last lactation, family history, and the type of treatment.

Self-care and related factors in patients with type II diabetes in Iran.

PURPOSE: To assess Self-care and related factors in patients with type II diabetes in Iran. METHODS: This descriptive cross-sectional study was performed on 100 patients with type II diabetes who were referred to specialized diabetes centers related to Arak University of Medical Sciences in Iran. Data collection was done using a researcher-made questionnaire. The questionnaire consisted of three parts (the first part was demographic information, the second part was self-care behaviors such as diet, exercise, control, treatment, and prevention of complications over the past seven days, and the third part was factors influencing patients' self-care behaviors). The inclusion criteria were; patients 18-80 years of age with a diagnosis of type 2 diabetes, at least one year passed of diabetes diagnosis, no chronic diseases other than those related to diabetes, had awareness of the diagnosis, had no hearing and speech impairments, and no mental illnesses. The exclusion criteria was the patient's failure to answer all questions of the questionnaire. Data analysis was performed using SPSS software version 16, and using descriptive statistics and Pearson test, independent t-test, one-way analysis of variance and Spearman test. RESULTS: The mean score of self-care in patients was 84.41 ± 11.75 and at the intermediate level. Spearman correlation coefficient test results showed a significant relationship between self-care behavior and gender (p = 0.001), and insurance type (p = 0.035). Also, men had higher average self-care compared to women (p = 0.001). The highest average score of self-care was in Adherence to medication and the lowest score was in exercise and physical activity. CONCLUSION: Due to the low self-care score in exercise and physical activity and the lack of periodic renal examinations, planning and educational interventions in all aspects of self-care, especially in terms of sports and physical activity, and periodic renal examinations are essential.

Analysis of Single Nucleotide Polymorphisms in HLA-DRA, IL2RA , and HMGB1 Genes in Multiple Sclerosis.

BACKGROUND: Multiple sclerosis (MS) is a common demyelinating neurodegenerative disorder with significant heritability. Previous studies have associated genetic variants in human leukocyte antigen (HLA) complex, IL2RA , and HMGB1 genes with the pathophysiology of MS. METHODS: In order to investigate the gene association in the Iranian population, we performed a genotyping study of 36 variants in the mentioned genes using Sanger sequencing in 102 MS patients and 113 healthy controls. RESULTS: Our results identified significant associations as well as significant allele frequency differences in some of the studied single-nucleotide polymorphisms including rs4935356, rs3177928, and rs7197 from HLA-DRA gene, and rs12722489 and rs12722490 variants from IL2RA gene (p< 0.05). Moreover, the strong linkage disequilibrium of two common haplotypes was estimated from the HLA-DRA gene. CONCLUSION: This association study may suggest the role of these polymorphisms in the genetic susceptibility of MS in the Iranian population and would facilitate the recognition of causative variants in this disease.

Effectiveness of Sexual Skills Training Program on Promoting Sexual Intimacy and Satisfaction in Women in Tehran (Iran): A randomized clinical Trial Study.

PURPOSE: The purpose of this study was to evaluate the effectiveness of sexual skills training on intimacy and sexual satisfaction in women. MATERIALS AND METHODS: This is a randomized clinical trial study with parallel design. 70 participants (n=35 each) were divided into 2 groups as control and intervention groups. Women were selected in multiple steps. Some requirements for inclusion criteria were: obtaining a standard score of marital satisfaction, women with a record of 6-24 months of marital life, not having a record of abortion, stillborn birth and not being in pregnancy period, not having a child, not suffering from an acute or chronic and serious disease, not having a surgery on pelvic organs, minimum elementary education of the couples and being Iranian. Some factors for exclusion criteria were: women's absence in more than 2 training classes, pregnancy during the study. Data collection was conducted through four questionnaires: demographic characteristics, marital satisfaction, sexual satisfaction and sexual intimacy. Validity and reliability of the questionnaires were measured through content validity and Chronbach Alpha, respectively. The data extracted from the questionnaires were analyzed using SPSS software, version 18.0. For data analysis, descriptive statistics, independent t-test, paired t-test, or non-parametric tests were applied. Significance level of the test was considered p<0.05. RESULTS: The results showed that sexual skills training leads to promotion of sexual satisfaction (p<0.001) and sexual intimacy (p<0.001) among the women in intervention group and the impact of training was stable two months after completion of intervention. CONCLUSION: In total, the training lessons gave positive views to participants towards their sexual issues so that they formed realistic and positive sexual expectations, healthier sexual behaviors and self-expressions and consequently, gained more sexual knowledge that made them able to experience more intimacy and satisfaction in sexual relationships with their spouses.

Translation and Psychometric Properties of the Copenhagen Burnout Inventory in Iranian Nurses.

BACKGROUND: Burnout has its focus on exhaustion and it includes persistent response to long-lasting job-related stressful events. It has a special relevance in health care area in which staff is under constant psychological, emotional, and physical stress. The results of several studies on burnout prevalence among Iranian nurses indicate its high incidence. Therefore, more accurate researches are required for better preventive interventions, and to do so, a reliable validated scale is required. One of the suitable and new tools for the measurement of burnout is Copenhagen Burnout Inventory (CBI). This study aimed to translate and investigate psychometric properties of CBI in Iranian nurses. MATERIALS AND METHODS: In this methodological study, after the translation process, face and content validities via qualitative and quantitative methods was done. Content validation ratio, scale-level content validated index, item-level content validity index were measured. Then, construct validity was determined through factor analysis. Furthermore, internal consistency reliability and stability were assessed. The questionnaire was sent to 450 nurses who were randomly selected via quota sampling. RESULTS: Face and content validity were acceptable. After translation and cultural adaptation process, exploratory factor analysis suggested a new model based on four factors and fit indices validated this model via confirmatory factor analysis. Internal consistency and stability of CBI were affirmed for each subscale separately. CONCLUSIONS: The four-factor Persian version of the CBI proved to enjoy acceptable psychometric properties. It can be applied to evaluate burnout in Iranian nurses or other health care providers.

Bayesian Survival Analysis of High-Dimensional Microarray Data for Mantle Cell Lymphoma Patients.

BACKGROUND: Survival time of lymphoma patients can be estimated with the help of microarray technology. In this study, with the use of iterative Bayesian Model Averaging (BMA) method, survival time of Mantle Cell Lymphoma patients (MCL) was estimated and in reference to the findings, patients were divided into two high- risk and low-risk groups. MATERIALS AND METHODS: In this study, gene expression data of MCL patients were used in order to select a subset of genes for survival analysis with microarray data, using the iterative BMA method. To evaluate the performance of the method, patients were divided into high-risk and low-risk based on their scores. Performance prediction was investigated using the log-rank test. The bioconductor package "iterativeBMAsurv" was applied with R statistical software for classification and survival analysis. RESULTS: In this study, 25 genes associated with survival for MCL patients were identified across 132 selected models. The maximum likelihood estimate coefficients of the selected genes and the posterior probabilities of the selected models were obtained from training data. Using this method, patients could be separated into high-risk and low-risk groups with high significance (p<0.001). CONCLUSIONS: The iterative BMA algorithm has high precision and ability for survival analysis. This method is capable of identifying a few predictive variables associated with survival, among many variables in a set of microarray data. Therefore, it can be used as a low-cost diagnostic tool in clinical research.