Centers In Tehran Research Articles

Home Healthcare Medication Safety risks among older adults with chronic diseases: a qualitative study

BackgroundOlder adults receiving home care often face significant safety risks related to medication management due to their chronic diseases and complex health needs. Despite the increasing reliance on home healthcare services, the specific factors contributing to medication safety risks in this demographic remain inadequately explored.Objective/AimThis study aims to explore the key factors involved in medication safety risks among older adults with chronic diseases receiving home healthcare in Iran.MethodsQualitative research employing conventional content analysis was conducted using Graneheim and Lundman’s approach. was conducted in three home care centers in Tehran (Iran) from August 2020 to July 2022. Data were collected through semi-structured interviews with 7 nurses, 2 supervisors, 2 nursing assistants (experts in non-nursing careers), 1 home care inspector (expert of the Deputy of Treatment), and 3 family caregivers in home settings, along with four participatory observations and visual methods (narrative photography) focusing on medication safety challenges. The trustworthiness of the research was evaluated using Lincoln and Guba’s four criteria for qualitative studies.FindingsFactors associated with medication safety risks were found to rely on its major components Patients’ attribution, Families’ characteristics, Home care centers’ condition, Health caregivers’ characteristics, and the Homes’ situations, where these factors all account for various medication safety risks. Indeed, a medication safety risk can be attributed to more than one of the factors associated with medication safety risk by participants at home.ConclusionAs a result, the analysis of factors associated with medication safety risks highlights a complex interplay among various elements, including patients, families, home care centers, health caregivers, and the home environment. These interconnected factors are crucial for identifying the diverse medication safety challenges faced by participants in home settings. A comprehensive understanding of these dynamics is essential for improving medication safety protocols and enhancing health outcomes for this vulnerable population.

From experts' perspective, factors affecting the effectiveness of online educational programs in promoting the health literacy of MS patients: A grounded theory approach.

Online educational programs have emerged as a promising tool for promoting health literacy (HL) among multiple sclerosis (MS) patients. However, identifying influencing factors is crucial for maximizing their effectiveness. This study aimed to explain the factors affecting the effectiveness of online educational programs in promoting HL among MS patients in Iran. A qualitative methodology based on Grounded Theory (GT) was employed and participants were recruited using snowball sampling. A total of 17 experts, including patient educators and HL experts, were interviewed until theoretical saturation was achieved. Participants were selected from patient rehabilitation centers in Tehran and members of the Iran MS Society. Analysis of the interview data revealed six contextual factors. These factors included socioeconomic status, healthcare infrastructure, technological accessibility and literacy, cultural and linguistic diversity, support networks and caregiver involvement, and health policy and regulatory environment. Addressing socioeconomic disparities, improving technological access and literacy and fostering cultural sensitivity are essential steps to enhance the effectiveness and accessibility of these programs. Moreover, collaboration with caregivers and policymakers is crucial for creating an enabling environment that supports the successful integration of online health education initiatives into MS care. Findings from this study can enhance the efficacy and productivity of online programs aimed at boosting HL among patients with specific conditions like MS.

Parents’ views and experiences of raising babies born with cleft lip and palate: a qualitative study

BackgroundParents of children born with cleft lip/palate encounter numerous challenges. This study aims to provide a deeper understanding for authorities to better support these parents by exploring the views and experiences of Iranian parents raising babies with cleft lip/palate through qualitative research.MethodsThis qualitative study collected data through face-to-face, in-depth, semi-structured interviews. Using purposive sampling, parents of children with cleft lip/palate who visited the Department of Oral and Maxillofacial Surgery at the Children’s Medical Center in Tehran, Iran, were selected. Thematic content analysis was employed to interpret the data and identify themes and subthemes.ResultsFrom 20 interviews, six themes were identified. The diagnosis theme was associated with timing. Key concerns within the psychosocial experiences theme included initial reactions, pressure from society, the child’s future in the community, hiding from family, feeling guilty about the anomaly, and couples’ relationships. The challenges in childcare theme included feeding difficulties, financial challenges, and cleft treatments. The information acquisition theme included primary awareness and the importance of knowing how to care for the child. The coping theme included gaining awareness, accepting the problem as God’s will and destiny, minimizing the significance of the child’s cleft, and support. Parents had concerns about informing the child of his/her condition.ConclusionsParents of infants with cleft lip/palate feel unsupported by medical staff in feeding practices and seek improved training for staff. They propose a program to empower staff and advocate for psychological support for parents. Access to specialized baby bottles and financial support is crucial, along with establishing a parent-led community for sharing experiences.

How Hospitalizations Can Be Effective in Subsequent Care of Children with Asthma?

Asthma is a prevalent chronic inflammatory disorder in children, and poor therapeutic response in asthmatic children could result from various factors related to the physician, patient, disease, and treatment. This study aimed to evaluate the most important causes of failure in asthma control. One hundred three children referred to the Children’s Medical Center in Tehran, Iran, participated in this study in 2017. A specific questionnaire was organized and completed by telephone interviews with parents. The mean age of participants was 10.30 years, and 68.9% were male. More action plans (45/53) were received from hospitalized patients in the asthma and allergy ward than from hospitalized patients in the emergency department (13/46). Moreover, 85% of admitted patients in the asthma and allergy ward were visited by a specialist compared with 50% in the emergency department (23/46). Hospitalization in the asthma and allergy ward resulted in receiving more action plans, spirometry tests, and visits by an allergist after discharge compared with admission to the emergency department.

Comparison of the Effects of Acceptance and Commitment Therapy and Emotion-Focused Therapy on Mental Vitality in Caregivers of Elderly Parents

Introduction: Caregiving burden for older adults can impose significant physical and emotional demands, leading to a reduction in mental vitality among caregiver children. Effective psychological interventions are crucial to enhance their well-being. Methods: This quasi-experimental study included two psychological interventions: Acceptance and Commitment Therapy (ACT) and Emotion-Focused Therapy (EFT), with baseline, post-test, and follow-up phases, along with a control group for comparison. The research population comprised female caregivers who accompanied their older adults to health centers in Tehran. From a total of 169 individuals, 45 participants were selected through convenience sampling and were randomly assigned to three groups of 15 participants each, forming two experimental groups and one control group. Data were collected using the Ryan and Frederick Mental Vitality Questionnaire, and multivariate covariance analysis was applied for data analysis to assess the effectiveness of the interventions. Results: The analysis showed that both ACT and EFT interventions significantly improved the mental vitality of caregiver children in the post-test and follow-up stages compared to the control group (p = 0.001). Additionally, EFT demonstrated a greater impact on enhancing mental vitality compared to ACT. Conclusion: Emotion-focused interventions, such as EFT, can be considered a more effective approach for improving the mental vitality of caregiver children of older adults. This highlights the importance of incorporating tailored emotional support strategies in caregiver assistance programs.

The Prevalence of Typical and Atypical Enteropathogenic <i>Escherichia coli</i> Strains Isolated from Non-diarrheal Stool Samples of Children of Tehran

Background: Diarrheagenic Escherichia coli (DEC) strains cause a self-limited gastrointestinal disease in developing countries and often infect children. Enteropathogenic E. coli (EPEC) is the most common DEC strain, which is usually carried by diarrheal children. However, some non-diarrheal EPEC carriers, particularly atypical enteropathogenic E. coli (aEPEC), have been increasing in some countries, including Iran. Objectives: Our aim was to evaluate the prevalence of typical EPEC and atypical EPEC strains and their antimicrobial resistance rate among non-diarrheal children under 10 years of age, isolated from schools and welfare centers in Tehran. Methods: We collected 350 fecal specimens from non-diarrheal children. The strains were analyzed for the presence of virulence genes such as eae, bfpA, stx-1, and stx-2 genes. Antibiotic resistance rates of the strains were examined using the disk diffusion method. Results: Among 350 fecal specimens, 160 specimens were taken from boys and 190 specimens from girls. The results of the genotypical-based assay for eae, bfpA, stx-1, and stx-2 genes showed 32% of isolates were eae positive. Overall, of 142 isolates, 1.4% were only bfpA positive and 7.04% and 1.7% contained stx-1 and stx-2, respectively. Resistance rate to tigecycline among EPEC strains was more reported than other antibiotics. On the other hand, 13.43% of isolates were considered Fosfomycin-susceptible EPEC strains. Conclusions: The results showed the prevalence of atypical enteropathogenic E. coli strains is increasing in schools, and so there is a dangerous alarm as these carriers spread the antimicrobial-resistant strains in the community and can shift the microbial flora pattern.

Spatial analysis and integrated multi-criteria decision making methods; a model to evaluate justice in the distribution of urban services in Tehran

ABSTRACT With the increase in the population of cities, the amount of demand grows faster than the amount of supply, and on the other hand, the access level of all urban activists who are on the demand side is not the same, which causes injustice in cities. In this study, Tehran, a metropolis in Iran, has been selected as the study area to measure the realization of spatial justice. For this purpose, 14 indicators have been selected, and then these indicators have been weighted using the MEREC model, and then Tehran regions have been ranked with three MCDM models, including MARCOS, CODAS, and MAIRCA. Additionally, spatial distribution patterns of facilities were examined using the ANN in ArcGIS Pro. The results showed that in terms of achieving spatial justice, the areas located in the center of Tehran have a much better situation than other areas of the city.

Obstacles to the Development of the Use of Artificial Intelligence from the Point of View of Physicians Working in Selected AJA Medical Centers: A Qualitative Content Analysis Study

Background: Considering the increasing use of decision support systems, specifically artificial intelligence (AI), in the field of medicine, our goal in this study was to identify, from the perspective of physicians working in AJA medical centers, the obstacles hindering the adoption and use of AI in the treatment and diagnosis of patients. Objectives: This study investigated the obstacles faced by specialist physicians working in AJA medical centers regarding the implementation of AI in their professional practice. Methods: A qualitative approach using contractual content analysis was employed. Data were collected through semi-structured, in-depth interviews and analyzed using the qualitative analysis method of Granheim and Lundman (2004) from May to July 2022. The study included 20 physicians working in selected AJA medical centers in Tehran. Sampling was conducted based on entry criteria and targeted to ensure maximum diversity. Results: The study involved 20 specialist physicians (15 men and 5 women) from selected AJA medical centers in Tehran, with an average age of 42 years and an average work experience of 14 years. The identified obstacles to the development of AI in these medical centers were categorized into three main groups: Extra-organizational and organizational factors, individual factors, and educational factors. These categories included 10 subcategories: Sanctions and economic issues, organizational attitudes, rules and regulations, available facilities, quality of facilities, knowledge and attitude, individual resistance to change, education quality, educational curriculum, and clinical professors. Conclusions: Iran's unique conditions pose challenges to the development and implementation of AI in its medical centers. This study highlights the need to address these obstacles by revising organizational rules and regulations and educating stakeholders on the benefits of AI. These measures could promote the use of AI in military medical centers and improve the quality of care.

The Relationship Between Neutrophil-to-Lymphocyte Ratio and Clinical Outcomes in Pediatric Patients After Cardiopulmonary Bypass Surgery: A Retrospective Study

Objectives: This study aimed to evaluate the prognostic utility of the neutrophil-to-lymphocyte ratio (NLR) and the perioperative change in NLR [Neutrophil Change Index (NCI)] in pediatric patients undergoing surgery with cardiopulmonary bypass (CPB) and to assess their correlations with clinical outcomes. Methods: A retrospective observational study was conducted with 416 patients from Children’s Medical Center in Tehran, Iran, spanning November 2021 to November 2022. Perioperative neutrophil and lymphocyte counts were collected, along with data on the presence or absence of complications. The prognostic value of NLR and NCI was evaluated concerning the length of ICU stay and mechanical ventilation among three groups: A no-complications survival group, a complications survival group, and a mortality group. Results: All patients showed an average rise in NLR postoperatively. The postoperative NLR magnitude did not significantly differ among the groups (P = 0.237) and was only correlated with mechanical ventilation duration (P = 0.0497), not with ICU stay length. However, the NCI was significantly lower in the mortality group compared to both the no-complication and surviving-complication groups (P < 0.001 and P = 0.032). Neutrophil Change Index also showed a statistically significant correlation with ICU stay and mechanical ventilation duration (P = 0.004 and P = 0.002). ROC analysis indicated that NCI had some ability to discriminate mortality cases, with an AUC of 0.734. Conclusions: While NLR showed perioperative changes, its magnitude alone was not correlated with clinical outcomes. In contrast, the NCI demonstrated a significant relationship with outcomes, with surviving-complication patients having a higher perioperative NCI than those in the mortality group. A higher NCI was associated with shorter ICU stays, reduced mechanical ventilation time, and lower mortality risk in pediatric patients undergoing CPB surgery. Overall, NCI proved to be a more effective tool than NLR in predicting adverse outcomes in this patient population.

The Effectiveness of Cognitive-Behavioral Group Therapy on Depression and Self-Efficacy of Patients with Hypertension

Introduction: Hypertension is one of the most common chronic diseases, which if not properly managed, can lead to not only physical health issues but also reduced psychological well-being and efficiency. Therefore, the aim of the present study was to determine the effectiveness of cognitive-behavioral group therapy on depression and self-efficacy in patients with hypertension. Methods: The present study was a quasi-experimental intervention, conducted as a pre-test, post-test design with experimental and control groups, and with a 90-day follow-up. The study population consisted of all hypertension patients who referred to healthcare centers in Tehran in 2023, from which 38 subjects were selected through purposive sampling and randomly assigned to experimental and control groups. The data collection tools included a demographic form, the Beck’s Depression Inventory (BDI-II), and the General Self-Efficacy Scale (GSE-17). Data were analyzed using repeated measures ANOVA with a significance level of 0.05, using SPSS-21 software. Results: Cognitive-behavioral group therapy was effective in reducing depression (F=78/6, P<0/001) and increasing self-efficacy (F=12/7, P< 0/001) among patients with hypertension. Additionally, the effect size of cognitive-behavioral therapy was 70% for depression and 27% for self-efficacy, with the effects persisting up to three months post-treatment. Conclusion: The finding indicated that cognitive-behavioral therapy can lead to improvements in depression and an increase in psychological self-efficacy in patients with hypertension. Therefore, this cost-effective and affordable treatment method can be utilized alongside routine treatment (medication) to enhance the psychological well-being of these patients.

Predicting Depression in Middle-Aged Individuals in Tehran Based on Socioeconomic Status, Loneliness, Spiritual Well-Being, and Marital Satisfaction in 2023

Introduction: Information related to the amount of the most significant risk factors identified in relation to depression in middle-aged Iranian individuals is insufficient. Accordingly, the aim of this study was to predict depression in middle-aged residents of Tehran based on their socioeconomic status, feelings of loneliness, spiritual well-being, and marital satisfaction. Methods: This cross-sectional study employed a quantitative descriptive-correlational approach and regression analysis. A total of 216 middle-aged individuals visiting health centers in Tehran in 2023 were selected through convenience sampling. Participants completed questionnaires assessing marital satisfaction (Hudson), social-emotional loneliness in adults, spiritual well-being (Dehshiri et al.), socioeconomic status (SES), and the Beck Depression Inventory (BDI-II). Multiple linear regression analysis was conducted using SPSS version 24 to examine the relationship between predictor variables and depression. Rusults: Among the 216 middle-aged participants in Tehran, aged between 40 and 60 years, 47/68% were male (103 individuals) and 52/31% were female (113 individuals). The prevalence of depression among middle-aged individuals in Tehran was found to be 46/3% (100 individuals). Notably, only spiritual well-being significantly predicted the variability in depression among middle-aged individuals in Tehran (B=0/19, p< 0/01). Conclusion: Contrary to previous studies, socioeconomic status, loneliness, and marital satisfaction did not statistically predict the variability in depression among middle-aged individuals in Tehran. It is recommended that further research be conducted to identify the most significant risk factors associated with depression in this demographic.

Effectiveness of Brain Training Exercises on Visual and Auditory Memory in Students with Dyslexia

Background: Dyslexia, a learning disorder characterized by reading difficulties, can also impair memory function in students. Objectives: This study aimed to address the gap in knowledge regarding the effectiveness of brain training exercises in enhancing memory function in this population. We investigated whether such interventions could improve academic success for students with dyslexia. Methods: A quasi-experimental design was utilized, incorporating pre-test, post-test, and 45-day follow-up measurements, with a control group for comparison. The target population comprised elementary school students diagnosed with dyslexia at learning disability centers in Tehran, Iran, during the 2022 - 2023 academic year. Using convenience sampling, 30 participants were selected and then randomly assigned to either the experimental (brain training) or control group through simple random assignment. Visual memory and digit-letter sequencing abilities were assessed using validated tools: The Visual Memory Questionnaire and the Wechsler Adult Intelligence Scale-Third Edition (WAIS-III) Digit-Letter Sequencing subtest, respectively. The experimental group participated in eight brain training sessions, each lasting 60 minutes, while the control group received no intervention during the study period. Data analysis was performed using SPSS version 27.0. Repeated measures ANOVA with Bonferroni post-hoc tests were employed for data analysis. Results: Post-test visual memory scores were significantly higher in the brain training exercises group (M = 8.73, SD = 1.60) compared to the control group (M = 5.30, SD = 1.25). Auditory memory scores demonstrated a similar trend, with the brain training group outperforming the control group (M = 10.80, SD=1.78 vs. M = 6.86, SD = 1.99). The brain training program produced significant improvements in visual and auditory memory among students with dyslexia, as evidenced by post-test results (P < 0.001). Conclusions: This finding suggests a robust positive effect of the intervention on memory function. These results suggest that brain training exercises can be a promising intervention for enhancing memory function in students with dyslexia.

A Comparison of Clinical and Laboratory Features in Neonatal Proven Sepsis and COVID-19

Background: The clinical manifestations of COVID-19 in neonates are generally mild and commonly require only supportive treatment. However, it is important to note that they can sometimes present with symptoms like bacterial sepsis, which can lead to confusion in diagnosis. In this study, our objective was to compare laboratory data and clinical manifestations between 2 groups to identify opportunities for reducing the unnecessary use of antibiotics. Methods: The study was conducted as a cross-sectional study between January 2020 and 2023 on neonates who were admitted to the neonatal intensive care unit or the neonatal ward of Children’s Medical Center in Tehran, Iran. We specifically compared the laboratory data and clinical characteristics of neonates who tested positive for either a blood culture or a reverse transcription polymerase chain reaction for COVID-19. Results: Sixty-seven neonates in COVID-19 group and 68 neonates in the bacterial sepsis group entered. Prominent symptoms in the bacterial sepsis group include vomiting, seizure, apnea, mottling, increased need for ventilation and laboratory findings showing elevated levels of C-reactive protein and thrombocytopenia. In the COVID-19 group, patient exhibit symptoms such as cough, diarrhea, fever and laboratory findings that indicate neutropenia and leukopenia. Symptoms of nervous involvement were rare in this group. Conclusion: It is crucial to carefully assess the symptoms, laboratory results and overall condition of the patient before deciding on antibiotic initiation. By combining rapid COVID-19 testing and clinical variables, it is possible to identify low-risk infants who are unlikely to have bacterial infections.

A randomized controlled trial on the impact of a specialized training program on anxiety and perceived pain in infertile women undergoing hysterosalpingography

Hysterosalpingography (HSG) is a minimally invasive procedure that can be painful. This study aimed to examine the impact of a tailored training program on anxiety and perceived pain intensity in infertile women undergoing HSG. This research was a clinical trial involving 86 infertile women who were candidates for HSG and conducted at the radiology department of the Royan Infertility Center in Tehran, Iran, between November 22, 2021, to March 11, 2023.The participants were divided into two groups:43 women in the intervention group and 43 women in the control group. The randomization of the samples was carried out using a random number table. The women in the intervention group received two face-to-face group training sessions. Data were collected using valid questionnaires. Additionally, the heart rate and blood pressure of the participants were recorded. Data analysis showed the training intervention was significantly associated with reducing anxiety levels, perceived pain, systolic blood pressure, diastolic blood pressure, and heart rate in women undergoing HSG (p < 0.05). These findings support the use of structured training interventions to improve the overall experience and outcomes for patients undergoing HSG.Trial Registration Number: IRCT20150905023897N4.

Comparison of Sexual Function, Satisfaction, and Assertiveness in Genital Cosmetic Surgery Groups: A Randomized-Sampling Cross-Sectional Study.

Sexual dissatisfaction is one of the main motivations for seeking female genital cosmetic surgery (FGCS), though the outcomes of such surgeries are controversial. Evaluation of the sexual function, satisfaction, and assertiveness in FGCS groups. From five clinical centers in Tehran, Iran, 200 women in the study group (women seeking or had undergone labiaplasty (LP), women seeking or had undergone multi-procedure (MP) of FGCS simultaneously) and the control group were randomly selected. Participants completed the Female Sexual Function Index (FSFI), the Global Measure of Sexual Satisfaction (GMSEX), and the Hurlbert Index of Sexual Assertiveness (HISA). The groups were compared using the Chi-square, one-way ANOVA with post hoc analysis. In women seeking LP, the mean FSFI, GMSEX, and HISA score was lower than that of women who had undergone LP (FSFI: 18.41 vs 21.36, p =0.04, GMSEX: 20.36 vs 28.03 p <0.001, HISA: 49.7 vs 62.5 p <0.001). Our finding showed as well that women seeking MP also had lower mean FSFI, GMSEX, and HISA scorecompared to women had undergone MP (FSFI: 23.02 vs 18.02, p <0.001, GMSEX: 19.63 vs 28.94 p <0.001, HISA: 45.72 vs 60.62 p <0.001). Women who had completed FGCS experienced better sexual function, satisfaction, and assertiveness compared with women seeking surgery. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The impact of NICU client-centered, written, and visual reporting on maternal stress and attachment post-infant heart surgery

BackgroundIn this study, we explored the impact of client-centered, written and visual reporting based on the Newborn Individualized Care and Assessment Program (NIDCAP) approach on stress levels and attachment among mothers with neonates hospitalized in Neonatal Intensive Care Unit following open heart surgery. MethodsThe clinical trial involved 70 mothers with an infant in the neonatal intensive care unit following heart surgery at Children's Medical Center in Tehran. Eligible participants were randomly assigned to either the control group (35 mothers) or the intervention group (35 mothers). While the control group adhered to regular daily visits to their sick infant as part of the hospital routine, the intervention group in addition to these visits, received daily written and visual reports, based on the NIDCAP approach standards for a week through WhatsApp messenger. Maternal Stress levels and attachment were assessed on the 7th day and again two weeks post-intervention. Data analysis was conducted using SPSS software. ResultsThe intervention group experienced a significant reduction in stress levels. Mean stress levels decreased from 102.57 ± 30.8 to 72.25 ± 15.81 on the day 7th. Two weeks post-intervention, the average stress level further decreased to 62.08 ± 15.00(p < 0.05). Interestingly there was a slight increase in attachment score in the intervention group after one week. However, at the end of the study, there was no significant difference between the intervention and control groups. ConclusionClient-centered reporting based on the NIDCAP approach could substantially reduce stress levels among mothers with hospitalized newborns in neonatal cardiac surgery units. Especially when the constant presence of parents at the newborn's bedside is not possible, this approach could be considered a practical, innovative, and effective method to reduce maternal stress levels in the NICUs after heart surgery.

Seroprevalence of strongyloidiasis and toxocariasis among hypereosinophilic patients seeking care at diagnostic centers in Tehran, Iran

BackgroundHypereosinophilia is characterized by an increase in eosinophil levels above the normal range. Secondary hypereosinophilia is frequently seen in helminth infections and allergic conditions. If not diagnosed and managed promptly, eosinophilia can result in various complications impacting health. The aim of this study was to explore the seroprevalence of Strongyloides stercoralis and Toxocara spp. among hypereosinophilic patients undergoing evaluation at selected diagnostic centers in Tehran. MethodsA comprehensive questionnaire was completed, and a blood sample was collected from each participant. The seropositivity of helminth infections was ascertained through indirect enzyme-linked immunosorbent assay (ELISA) employing commercially procured kits for discerning anti-S. stercoralis and anti-Toxocara spp. IgG antibodies. Statistical analysis was conducted using SPSS 21 software. ResultsOf the 135 participants in this study, 61 (45.2 %) were male and 74 (54.8 %) were female. The seropositivity rates for strongyloidiasis and toxocariasis were found to be 9.6 % and 0.74 %, respectively. Among the various underlying medical conditions observed in the participants, Type 2 Diabetes (T2D) was the most prevalent, and it showed a significant association with seropositivity for strongyloidiasis (p < 0.05). ConclusionThe seropositivity for S. stercoralis was higher than that for Toxocara spp.. The significant association between seropositivity for S. stercoralis and diabetes underscores the importance of conducting community-based studies and implementing screening initiatives targeting high-risk populations to assess the seroprevalence of strongyloidiasis.

“En bloc” combined 270-degree keratolimbal allograft with central lamellar keratoplasty for severe limbal stem cell deficiency secondary to mustard gas exposure

BackgroundSevere limbal stem cell deficiency (LSCD) resulting from chronic and delayed-onset mustard gas keratopathy (MGK) presents substantial management challenges. This article introduces an “en bloc” surgical procedure combining a 270-degree keratolimbal allograft (KLAL) with central lamellar keratoplasty (CLK) as a novel approach to treat this condition. MethodsA retrospective case series was conducted at Labbafinejad Medical Center in Tehran, Iran, from 2002 to 2019, including 13 eyes from 13 male patients diagnosed with chronic and delayed-onset MGK. Each patient underwent the combined 270-degree KLAL and central LK procedure. A 270-degree peritomy, sparing the superior quadrant, was performed. A lamellar dissection using a crescent blade and a blunt Melles dissector was carried out, extending 2 mm from the limbus. Fresh donor tissue with intact 270-degree limbo-conjunctiva, obtained from a whole globe, was prepared to match the recipient bed and sutured into place. Postoperative outcomes and success including ocular surface integrity, graft longevity, and best-corrected visual acuity (BCVA), were evaluated. ResultsThe average follow-up period was 87.6 ± 49.8 months. Surgical success was achieved in 12 of 13 patients (92.3 %). Preoperative BCVA improved from 1.07 ± 0.24 (approximately 20/250) logMAR to 0.63 ± 0.30 (approximately 20/80) logMAR postoperatively. One patient experienced immune rejection of the KLAL graft, while two patients had episodes of corneal rejection, all successfully managed with aggressive immunosuppressive therapy. ConclusionsThe “en bloc KLAL + CLK” procedure demonstrates promising long-term outcomes in managing chronic and delayed-onset MGK associated with severe LSCD. This approach offers advantages, including reduced surgical complexity, minimized antigenic load, and better anatomical alignment, leading to successful ocular surface restoration and improved visual acuity.

Support Needs of Family Caregivers of Older Patients With Cancer in Iran:A Qualitative Study

Objectives Family members have a significant role in caregiving for older patients with cancer. These caregivers are exposed to a significant caregiving burden. Therefore, it is necessary to support them. In this regard, it is important to know their needs. The present study aimed to explore the support needs of family caregivers of older patients with cancer in Iran. Methods &amp; Materials This descriptive qualitative study was conducted during 2020–2022. Thirty-one participants including family caregivers of older patients with cancer, family members of family caregivers, and healthcare providers were purposefully recruited from healthcare centers in Tehran, Iran. Data were collected through semi-structured interviews until data saturation. Data analysis was performed using Graneheim and Lundman’s content analysis method. Lincoln and Guba’s criteria were used to evaluate the trustworthiness of the data. Results The analysis led to the identification of six main themes, including the need for informational support, the need for physical support, the need to get rid of psychological insecurity, the need for improve spirituality, the need for practical support and the need for the help of a care team. Conclusion Considering the multiple support needs of family caregivers of older patients with cancer in Iran, policymakers, healthcare planners, and healthcare providers should design and implement various interventions based on these needs by using a caregiver-centered approach to support these caregivers.

The Effectiveness of Spiritual Group Therapy on Psychological Well-Being and Self-Efficacy of Patients with Type 2 Diabetes in Tehran in 2023

Introduction: Diabetes, as one of the common causes of mortality worldwide, extends beyond physical aspects and can impact psychological and emotional dimensions as well. Therefore, the present research aimed to determine the effectiveness of spiritual therapy on the psychological well-being and self-efficacy of patients with type 2 diabetes in Tehran. Methods: This study was a semi-experimental research with a pretest-posttest and a three-month follow-up design with a control group. The study population consisted of all the patients with type 2 diabetes who attended treatment centers in Tehran (Masih Daneshvari, Nikan, and the Iranian Diabetes Association) from August to November 2023. Among the patients, 37 were selected using purposive sampling and were randomly assigned to two groups: the experimental group (N=18) and the control group (N=19). The data collection tools included a demographic information form, the standardized Ryff's scale of psychological well-being– short form (Cronbach's alpha= 0/72), and the General Self-Efficacy Scale (Cronbach's alpha= 0/83). Data analysis was conducted using SPSS-21 software. Additionally, given the different stages of measurement (pre-test, post-test, and follow-up), repeated measures ANOVA was used for data analysis. Results: The results indicated that spiritual therapy led to an increase in psychological well-being (F=132/56, P&lt;0/001) and self-efficacy (F=15/51, P&lt;0/001) in patients with type 2 diabetes. Furthermore, the effect size of spiritual therapy on psychological well-being was 79%, and self-efficacy was 31%, and the sustainability of its effects was observed up to three months after treatment. Conclusion: The findings suggest the impact of spiritual therapy on enhancing psychological well-being and self-efficacy in patients with type 2 diabetes. Therefore, it is recommended that, in addition to the routine treatment of patients with type 2 diabetes, spiritual therapy be utilized to enhance the psychological well-being of the patients.