Hospitals In Isfahan Research Articles

Causative Agents and Antibiotic Resistance in Nosocomial Sepsis: A Cross-Sectional Multicenter Study from Isfahan Province, Iran

Background: Nosocomial sepsis is a leading cause of morbidity and mortality worldwide. Understanding the antibiotic susceptibility patterns of pathogens specific to each geographic region is essential for effective patient management. Methods: This cross-sectional study aimed to investigate the microorganisms causing nosocomial sepsis and their antibiotic sensitivity in patients admitted to three referral hospitals in Isfahan, Iran. Clinical information and blood culture results were obtained from hospital records. Results from patients without signs of sepsis, as well as contaminants and community-acquired isolates, were excluded. Stratification was conducted based on sex and age (< 20 and > 20 years) categories. Results: In this study, 267 patients with hospital-acquired sepsis were identified, with gram-negative bacteria accounting for 77.2% of infections. The most common pathogens included Klebsiella spp. (35.2%), Acinetobacter spp. (21.7%), Enterococcus spp. (13.5%), Escherichiacoli (8.6%), Pseudomonasaeruginosa (8.6%), and Staphylococcusaureus (8.2%). The highest resistance among gram-negative bacteria was observed with cefepime (80.3%), ceftazidime (76.5%), cefotaxime/ceftriaxone (70.0%), trimethoprim-sulfamethoxazole (68.6%), ciprofloxacin (68.2%), meropenem (60.0%), and amikacin (50.3%). All gram-negative isolates were sensitive to colistin. Among gram-positive bacteria, the highest resistance was to ciprofloxacin (77.3%), ampicillin (75.7%), clindamycin (74.4%), vancomycin (64.9%), and gentamicin (30.0%). All gram-positive isolates in this study were sensitive to linezolid. Conclusions: The study indicates a high level of resistance among bacterial agents causing nosocomial sepsis in the studied area. Consequently, treatment may necessitate the use of last-line antibiotics, such as linezolid and colistin.

Investigation of Nosocomial Urinary Tract Infections Post Transplantation, Main Pathogens, and Sensitivity Tests

Background: Regarding end-stage organ disease, transplantation is recommended as the best therapeutic management. After organ transplantation, the incidence of nosocomial urinary tract infections (NUTIs) due to multidrug-resistant Gram-negative bacilli increases. Aim: The study aimed to investigate NUTIs post-transplantation, the main pathogens involved, and sensitivity tests conducted in a tertiary hospital in Isfahan, Iran. Methods: A retrospective survey on patients admitted to a tertiary hospital in Isfahan (Alzahra), Iran, was performed between 27 March, 2017, and 9 February, 2022. The information recorded included the date of infection, date of hospitalization, gender, age, type of pathogens, and resistance or sensitivity to antibiotics. Results: 73 kidney transplant recipients (61% females) with a mean age of 43. 2 ± 15.1 years were included. Within this population involving both genders, the main pathogens involved in NUTIs were as follows: Escherichia coli (30%), Klebsiella pneumonia (19%), Candida albicans and non-albicans (14%), Enterococcus faecalis (12%), Enterobacteriaceae (8%), Pseudomonas aeruginosa (6%), Staphylococcus spp. (6%), Acinetobacter baumannii (4%), and Streptococcus spp. (4%). Antibiotic susceptibility testing showed the most sensitivity of isolates against amikacin (n=29; 66%), meropenem (n= 28; 64%), piperacillin/tazobactam (n=26; 54%), cefepime (n= 25; 40%), ceftazidime (n= 27; 30%), ciprofloxacin (n= 40; 18%), and co-trimoxazole (n= 29; 10%). Conclusion: Escherichia coli, Klebsiella pneumonia, and Candida spp. were the major causes of NUTIs within the studied organ-transplanted recipients. Amikacin, meropenem, and piperacillin/ tazobactam have shown more than 50% sensitivity against isolates. Further evidence-based pharmacotherapy investigations associated with the different spectrum antibiotics and overall antimicrobial success rate is recommended to be advantageous.

Life Quality of Pediatric Patients with Central Nervous System Infections: A 1-Year Follow-up

Background: Central nervous system (CNS) infections can lead to long-term motor and cognitive complications in children. Objectives: We aimed to investigate the prevalence of attention deficit-hyperactivity disorder (ADHD) and assess the quality of life in children with CNS infections. Methods: A longitudinal study was conducted on 94 children (aged 6 - 15 years) with CNS infection symptoms who were admitted to referral hospitals in Isfahan, Iran. Parents completed questionnaires assessing quality of life and neurological deficits at 6 and 12 months after discharge. All patients were evaluated by the corresponding physician for a final assessment. Results: Attention deficit-hyperactivity disorder symptoms were diagnosed in 30 patients, with viral encephalitis being the most common infection. The quality of life in children with CNS infections was significantly lower compared to that of healthy children. Conclusions: Central nervous system infections negatively impact the quality of life in children. Screening for ADHD and managing affected children can help improve outcomes. Further research and interventions are needed to mitigate long-term complications.

Optimizing emergency department efficiency: a comparative analysis of process mining and simulation models to mitigate overcrowding and waiting times

ObjectiveOvercrowding and extended waiting times in emergency departments are a pervasive issue, leading to patient dissatisfaction. This study aims to compare the efficacy of two process mining and simulation models in identifying bottlenecks and optimizing patient flow in the emergency department of Al-Zahra Hospital in Isfahan. The ultimate goal is to reduce patient waiting times and alleviate population density, ultimately enhancing the overall patient experience.MethodsThis study employed a descriptive, applied, cross-sectional, and retrospective design. The study population consisted of 39,264 individuals referred to Al-Zahra Hospital, with a sample size of at least 1,275 participants, selected using systematic random sampling at a confidence level of 99%. Data were collected through a questionnaire and the Hospital Information System (HIS). Statistical analysis was conducted using Excel software, with a focus on time-averaged data. Two methods of simulation and process mining were utilized to analyze the data. First, the model was run 1000 times using ARENA software, with simulation techniques. In the second step, the emergency process model was discovered using process mining techniques through Access software, and statistical analysis was performed on the event log. The relationships between the data were identified, and the discovered model was analyzed using the Fuzzy Miner algorithm and Disco tool. Finally, the results of the two models were compared, and proposed scenarios to reduce patient waiting times were examined using simulation techniques.ResultsThe analysis of the current emergency process at Al-Zahra Hospital revealed that the major bottlenecks in the process are related to waiting times, inefficient implementation of doctor’s orders, delays in recording patient test results, and congestion at the discharge station. Notably, the process mining exercise corroborated the findings from the simulation, providing a comprehensive understanding of the inefficiencies in the emergency process. Next, 34 potential solutions were proposed to reduce waiting times and alleviate these bottlenecks. These solutions were simulated using Arena software, allowing for a comprehensive evaluation of their effectiveness. The results were then compared to identify the most promising strategies for improving the emergency process.ConclusionIn conclusion, the results of this research demonstrate the effectiveness of using simulation techniques and process mining in making informed, data-driven decisions that align with available resources and conditions. By leveraging these tools, unnecessary waste and additional expenses can be significantly reduced. The comparative analysis of the 34 proposed scenarios revealed that two solutions stood out as the most effective in improving the emergency process. Scenario 19, which involves dedicating two personnel to jointly referring patients to the ward, and scenario 34, which creates a dedicated discharge hall, have the potential to create a more favorable situation.

Evaluation and Comparison of the Dose Received by the Mandible, Maxilla, and Teeth in Two Methods of Three-dimensional Conformal Radiation Therapy and Helical Tomotherapy.

Using three-dimensional conformal radiation treatment (3D-CRT) and helical tomotherapy (HT), this study examines and contrasts the dosage received by the mandible, maxilla, and teeth. Sixteen patients with head-and-neck cancer (H and NC) were the subject of treatment planning at the Seyyed Al-Shohada Hospital in Isfahan, Iran. This study examined target coverage quality, exposure of healthy tissue, and radiation delivery effectiveness. In terms of a number of measures, including D2%, D50%, Dmean, V95%, conformity index (CI), and homogeneity index (HI) for the planning target volume (PTV) and D2%, D98%, Dmean, V95%, CI, and HI for the nodal PTV, HT showed considerable gains over 3D-CRT. The brainstem, D1cc, and D10cc received considerably lower maximum dosages in HT. Measurements of the right and left cochleas (Dmean, V55, and Dmax) revealed decreases in HT, with Dmean revealing the most significant variations. The Dmean and Dmax values for HT significantly decreased in constrictors as well. In terms of several HT-related indicators, the larynx, optic chiasm, optic nerves, oral cavity, mandible, thyroid, and parotid glands all showed considerable decreases. The findings of the comparison of the two treatment approaches revealed that the HT method was more than 50% more effective than the 3D-CRT method in sustaining organs at risk (OARs) and the target volume dose. In general, dosimetric coverage, homogeneity, conformity indices, and the absence of cold and hot patches showed that HT produced targets with greater accuracy than 3D-CRT. In addition, HT outperformed 3D-CRT in protecting important structures (OARs). HT as a result has the potential to be a more effective method of treatment for those with H and NC and involvement of regional lymph nodes.

Characterization of Clonal Groups of Antibiotic-Resistant Biofilm-Forming Staphylococcus aureus Strains Isolated from Patients with Urinary Tract Infections in Isfahan, Iran

Background: Over the past decades, the role of biofilm-forming Staphylococcus aureus strains in urinary tract infections (UTIs) has garnered significant attention. Objectives: This study aimed to determine the epidemiological characteristics and diversity of S. aureus strains isolated from patients with UTIs in Isfahan, Iran, in 2017, with regard to their antimicrobial resistance, biofilm formation, and phylogenetic profiles. Additionally, the study investigated potential relationships among these factors statistically to develop efficient control and treatment approaches. Methods: All patients with symptomatic UTIs who had positive urine cultures for S. aureus during the study period at the laboratory of a referral hospital in Isfahan were included. All isolates were identified using specific primers for the nucA gene. Their biofilm formation capacity was evaluated using a combination of the microtiter plate and Congo-red agar methods. Antibiotic susceptibility testing was performed using the disk diffusion method. The presence of genes involved in biofilm formation and resistance to cefoxitin, aminoglycosides, and fluoroquinolones was detected using polymerase chain reaction (PCR). Staphylococcal cassette chromosome mec (SCCmec) typing, agr typing, and phene plate (PhP) typing were employed to investigate the diversity of collected strains. Results: Results showed that 19%, 57%, and 24% of confirmed S. aureus strains were strong, intermediate, and non-biofilm formers, respectively. The highest rate of resistance was against nalidixic acid (77%), followed by streptomycin (73%). The icaD and icaA genes had the highest frequency among biofilm-producing strains. gyrA (44%) and grlA (35%) were the most frequent genes among fluoroquinolone-resistant strains, while aph(3′)-IIIa was the most prevalent aminoglycoside-modifying enzyme gene. The majority of bacterial strains harbored SCCmec type III and agr type I. PhP typing of strains revealed the presence of 8 common types (CTs) and 14 single types (STs), with CT2 being the dominant type. Conclusions: The present investigation revealed various biofilm production capacities, antimicrobial resistance profiles, and clonal lineages in S. aureus isolated from patients with UTIs. These findings provide further insights into the epidemiology and pathogenicity of S. aureus strains in Iran, thereby improving the quality of surveillance and therapeutic protocols.

Predicting cervical cancer screening participation using self-care behaviors among women in Iran.

Cervical cancer screening is an effective and accessible method for preventing this cancer. However, low participation rates among women have been reported. Self-care is one of the solutions to improve access to health services. This study was conducted to determine the prediction of cervical cancer screening participation using self-care behaviors among women in Iran. This cross-sectional study was conducted on 310 eligible women who were referred to comprehensive health centers and women's clinics in teaching hospitals in Isfahan, Iran, from November 2020 to April 2021. Participants were enrolled using convenience sampling. The data collection tool included researcher-made questionnaires on personal and fertility characteristics, participation in cervical cancer screening, and self-care behaviors related to cervical cancer and its screening. Descriptive and inferential statistical methods were used for data analysis using the Statistical Package for the Social Sciences (SPSS) version 22 software. The results showed that the intention to undergo screening was low among individuals who had not undergone screening. Lack of awareness and not having enough time were the most common barriers to screening. The results of logistic regression analysis indicated that self-efficacy was the significant predictor of cervical cancer screening. With an increase in the self-care score, the 12% chance of doing a Pap smear increases significantly (P = 0.002). Furthermore, the results of multiple regression showed that with an increase in the self-care score, the chance of women who refer to screening every year, every 2-3 years, and every 4-5 years is increased to 25% (P = 0.001), 34% (P < 0.001), and 11% (P = 0.032), respectively, compared with non-referral. According to the results, self-care was a predictor of performing a Pap smear, and it was related to its regular performance of Pap smear too. Therefore, designing and implementing necessary interventions to increase self-care behaviors can improve women's participation in cervical cancer screening and its regularity.

Home Mechanical Ventilation in Children: Complications and Benefits—A Two-Year Experience at a Referral Children's Hospital

Background: The rising prevalence of chronic respiratory failure in pediatric patients necessitates a detailed evaluation of home mechanical ventilation (HMV). Objectives: This study assesses the advantages of HMV devices, focusing on cases from Imam Hussein Children's Hospital. Methods: This research involved 20 children who required long-term ventilation and were admitted to both general and intensive care units at Imam Hussein Children's Hospital in Isfahan. Before discharge, a team of HMV experts trained the parents on the proper use of the ventilation devices. Post-discharge, the educational needs of the parents were assessed continuously, with regular home visits conducted by a nurse and a representative from the ventilator supplier. Results: Approximately 73% of the children demonstrated therapeutic effectiveness following HMV implementation. About 35% of parents observed no adverse effects in their children. The average cost savings from reduced ICU rehospitalizations was significant at 347.59%, and there was a 65.09% reduction in the costs associated with general ward hospitalizations. Conclusions: The adoption of HMV has led to improved health outcomes, substantial reductions in medical expenses, and shorter hospital stays. It is advisable to plan for broader implementation of HMV in children who require long-term ventilation.

Antibiotic resistance pattern of waterborne causative agents of healthcare-associated infections: A call for biofilm control in hospital water systems

BackgroundIn recent years, the global spread of antimicrobial resistance has become a concerning issue, often referred to as a “silent pandemic”. Healthcare-associated infections (HAIs) caused by antibiotic-resistant bacteria (ARB) are a recurring problem, with some originating from waterborne route. The study aimed to investigate the presence of clinically relevant opportunistic bacteria and antibiotic resistance genes (ARGs) in hospital water distribution systems (WDSs). MethodsWater and biofilm samples (n = 192) were collected from nine hospitals in Isfahan and Kashan, located in central Iran, between May 2022 and June 2023. The samples were analyzed to determine the presence and quantities of opportunistic bacteria and ARGs using cultural and molecular methods. ResultsStaphylococcus spp. were highly detected in WDS samples (90 isolates), with 33 % of them harboring mecA gene. However, the occurrences of E. coli (1 isolate), Acinetobacter baumannii (3 isolates), and Pseudomonas aeruginosa (14 isolates) were low. Moreover, several Gram-negative bacteria containing ARGs were identified in the samples, mainly belonging to Stenotrophomonas, Sphingomonas and Brevundimonas genera. Various ARGs, as well as intI1, were found in hospital WDSs (ranging from 14 % to 60 %), with higher occurrences in the biofilm samples. ConclusionOur results underscore the importance of biofilms in water taps as hotspots for the dissemination of opportunistic bacteria and ARG within hospital environments. The identification of multiple opportunistic bacteria and ARGs raises concerns about the potential exposure and acquisition of HAIs, emphasizing the need for proactive measures, particularly in controlling biofilms, to mitigate infection risks in healthcare settings.

Pedicle subtraction osteotomy in patient with congenital kyphosis

IntroductionA disorder causes congenital kyphosis in the last stages of ossification and cartilage formation during embryonic development. The main treatment for this disease is surgery with various methods. The present study was performed to evaluate the results of the posterior surgery.MethodsThis study was a descriptive study comparing the results before and after surgery which was performed in 2022 on 14 patients with the congenital kyphosis referred to Al-Zahra Hospital in Isfahan. Initial assessments were performed, and the patient underwent surgery. The patients were re-evaluated immediately after surgery which were followed up and evaluated two years after surgery. Data were collected by a checklist and described and analyzed in SPSS software version 22.ResultsThe mean age of the patients was 23.15 ± 13.24 years, 7 patients (50%) were male, and the mean duration of surgery was 405.85 ± 123.99 min. Seven patients (50%) were under 18 years old. No disease died and the highest T12 involvement was in 5 patients (35.8%). Sagittal Vertical Axis, Kyphosis Angle and Lumbar Lordosis decreased in two stages immediately after surgery and follow-up, which were statistically significant (P < 0.05). No associated neurologic abnormalities was found during a physical examination or magnetic resonance imaging. In three phases (before, immediately after surgery, and follow-up), the mean of the Sagittal Vertical Axis, and Lumbar Lordosis in adults (over 18 years) and children (under 18 years) was not substantially different (P > 0.05). The mean Kyphosis Angle were significantly different in adults, and children at follow-up stages (P < 0.05). Because one of the children had a device filler in the follow-up stage.ConclusionsPSO can be used as a safe and effective technique to treat and correct Sagittal Vertical Axis, Kyphosis angle, Lumbar lordosis.

The effect of psychological first-aid virtual education on the communication skills of nurses in disasters: a randomized controlled trial

BackgroundDisasters have affected the physical and mental health of people around the world. Since nurses are frontlines in disasters, it seems necessary to prepare for this responsibility. This study investigates the effect of psychological first-aid virtual education on the communication skills of nurses in disasters such as COVID pandemic.MethodsIn a randomized controlled trial, 55 nurses were selected by purposive sampling method from two hospitals in Isfahan and Tehran, Iran in December—November 2022 and randomly replaced in the intervention group who participated in psychological first aid virtual training and control group. The data were collected through the personal information form and Communication Skills –Test-Revised (CSTR).ResultsTwo groups were homogeneous in terms of communication skills (p = 0.177), the total score of communication skills was significant between the two groups after the intervention (p < 0.0001). Regarding communication skills, in the pre-intervention phase, the subscale of “the ability to receive and send messages” and “insight into the communication process” the difference before the intervention was not significant between the two groups (p > 0.05). However, it was significant between the two groups after the intervention (p < 0.05), and regarding “emotional control”, “listening skills”, and “communication along with assertiveness” the difference before and after the intervention was not significant between the two groups (p > 0.05).ConclusionPre-disaster training and virtual education can increase nurses’ communication skills in their ability to handle a disaster such as COVID pandemic. Virtual education of post-disaster psychological interventions is suggested.Trial registrationIRCT20220923056023N1; date: 2023–01-31.

Frequency of Different Types of Artifacts in Electroencephalography of the Brain of Hospitalized and Outpatient Patients Referred to the Clinics of Al-Zahra Hospital and Khorshid Hospital in Isfahan

Background: Artifact is a common error in patient’s electroencephalogram that if not addressed, it can lead to reduced quality and ultimately misdiagnosis. The aim of this study was to determine the frequency of different types of artifacts in electroencephalography of the brain of hospitalized and outpatient patients referred to the clinics of Al-Zahra Hospital and Khorshid Hospital in Isfahan. Methods: In this cross-sectional study that was performed in Al-Zahra and Noor hospitals in Isfahan in 1399, 256 patients were studied by electroencephalography and examined for their electroencephalography, the presence of physiological and non-physiological artifacts and the source of artifacts in them. Results: Out of 256 patients studied, in 237 cases (92.6%) the artifacts were physiological and 19 (7.4%) were non-physiological. The type of physiological artifacts included 217 cases (91.6%) ocular, 1 case (0.4%) cardiac, 5 cases (2.1%) sweating and 14 cases (5.9%) motor. Among non-physiological artifacts, 11 (57.9%) were electrode and 8 (42.1%) were external artifacts. There was no significant difference in the type of artifacts performed according to the age and sex of the patients. Conclusion: The findings of the present study show that the presence of artifacts in patient’s electroencephalogram is very common, and among them, physiological ocular artifacts and non-physiological electrode artifacts are the most common errors in patients’ electroencephalogram and therefore it is necessary to Investigate the possibility of different types of artifacts and take the necessary strategies to reduce them.

Survival and risk analysis of patients with COVID-19 in Iran

Objective: To evaluate the risk factors of death caused by COVID-19 in Iran. Methods: This study was a retrospective cohort study from February 20, 2020, to August 22, 2022, in the hospitals in Isfahan, Iran. The data were collected through a researcher-made checklist. To determine the risk factors of the death, logistic regression and Cox regression models were used. For each variable, the odds ratio and 95% confidence interval were also reported. Results: 1885 Patients were included. The age of deceased persons was significantly higher than that of the surviving persons. The risk of death for the age group above 60 years was about 14 times higher than that of people aged 19-35 years [95% CI: 14.41 (2.02-102.99), P&lt;0.01]. Hypertension [95% CI: 1.92 (1.47-2.5), P&lt;0.01], diabetes [95% CI: 1.62 (1.23-2.13), P&lt;0.001], and chronic obstructive pulmonary disease [95% CI: 1.92 (1.47-2.50), P&lt;0.01] were also risk factors of mortality. Conclusions: This study reveals that the mortality rate due to COVID-19 is associated with old age, longer hospitalization in the ICU, increased length of stay, and comorbidities of high blood pressure, diabetes, and chronic pulmonary disease.

Preliminary Study of Antibiotics Susceptibility Testing and Pathogens Associated with Nosocomial Infections in a Tertiary Hospital

Background: Health care associated with multiresistant pathogens is rising globally. As nosocomial infections (NIs) could increase hospital stay, morbidity, mortality and disability, therefore the aim of this preliminary study was to define antibiotics and pathogens associated with NIs in a main tertiary hospital in Isfahan, Iran. Methods: The data were extracted from the official database of hospital NIs records. For each patient, the reported infections were abbreviated as: UTI-SUTI, VAE-PVAP, BSI-LCBI, SSI-DIP and so on. For continuous variables, mean ± standard deviation, and for categorical varia-bles, frequency was used. Results: The study population was 5542 patients, comprised of males (n=3282) and females (n=2260). With a minimum of 15 and a maximum of 99, the mean age in 5313 patients was 58.5 ± 19.1 years old. The highest reported NIs (n= 77%) were associated with the ages between 30-80 years old. Sites of NIs in 93% were as: VAE-PVAP- VAE-IVAC; 31%, UTI-SUTI; 30%, SSI-DIP; 19%, BSI-LCBI; 13%, and other individual infection (7%) with the main pathogens associated with Acinetobacter baumannii, Klebsiella pneumonia, Candida and Staphylococcus spp. Antibiotic susceptibilty testing showed the most sensitivity of isolates against Vancomycin (62%), Gentamicin (59%), Ampicillin (44%), Amikacin (35%) and Co-trimoxazol (32%). Conclusion: As most NIs are avoidable, for commissioning an efficient surveillance system, further study of pathogens in relation to evidence-based antibiotic-therapy and advanced infection control program is suggested to be valuable.

Exploring the association between ultra-processed foods and COPD: a case-control study

BackgroundWhile it is known that the overconsumption of ultra-processed foods (UPFs) is associated with a heightened risk of respiratory ailments, the specific effects of UPF intake on COPD remain unclear. This study was designed to explore the potential link between COPD and the consumption of UPFs among adult individuals in Iran.MethodsIn this hospital-based case-control study conducted at Alzahra University Hospital in Isfahan, Iran, we enrolled 84 patients newly diagnosed with COPD, along with 252 healthy controls matched for age and sex. COPD was defined based on the results of spirometry tests, specifically when the forced expiratory volume per second (FEV1) was less than 80% or the ratio of FEV1 to forced vital capacity (FVC) was less than 70%. To evaluate the dietary intake of the participants, we utilized a validated food frequency questionnaire (FFQ) consisting of 168 items. Additionally, we gathered data on potential confounding factors using a pre-tested questionnaire.ResultsThe mean ages for the case and control groups were 57.07 and 55.05 years, respectively. Our study found no significant association between the intake of ultra-processed foods (UPFs) and the likelihood of COPD, with an odds ratio (OR: 0.78, 95% CI: 0.34–1.77). This lack of association persisted even after adjusting for factors such as energy intake, sex, and age (OR: 0.48; 95% CI: 0.19–1.21). Further controlling for potential confounders like body mass index (BMI), physical activity, and smoking status did not alter this finding (OR: 0.367; 95% CI: 0.123–1.1008, P = 0.074).ConclusionsIn our study, we observed no significant association between the intake of Ultra-Processed Foods (UPFs) and the odds of Chronic Obstructive Pulmonary Disease (COPD). This finding remained consistent even after adjusting for factors such as energy intake, sex, age, Body Mass Index (BMI), physical activity, and smoking status. Therefore, within the scope of our study, it appears that the consumption of UPFs does not significantly impact the likelihood of developing COPD. However, we recommend further research to deepen our understanding of the intricate relationship between dietary habits and respiratory health.

Explanation of the sociological patterns of organ donation: An analytical study.

In many countries, the consent of family members is required for organ donation from brain-dead patients who are potential candidates for organ donation. In this regard, knowing the factors affecting family members' decision for organ donation can help improve the conditions. This qualitative study aimed to identify the factors affecting family members' decision-making regarding donation of brain-dead patients' organs. This research applied qualitative research by focusing on the content analysis approach. The study started from April 2021 in Al-Zahra Hospital in Isfahan and Ayatollah Kashani in Shahrekord and continued until data saturation was reached (September 1401). Participants were assigned to one of three groups: brain-dead patients' family members who consented to organ donation, brain-dead patients' family members who declined to consent to organ donation, and people involved in the organ donation process. The sample was selected using the purposive sampling method. The data were collected using unstructured interviews and the field survey method. In this study, a qualitative content analysis with a contractual approach was used to analyze the data. The analysis of the collected data using different methods yielded 11 main categories, including 1) unresponsive healthcare system, 2) inadequate support from government systems, 3) weakness of social work organizations, 4) fear of being stigmatized, 5) cultural values, 6) symbolization, 7) perpetuation and the society's attitude, 8) development of personality system and generalism, 9) human values, 10) spiritual maturity, and 11) belief-religious challenges, leading finally to three themes, including 1) structural and functional weakness of systems, 2) sociocultural factors, and 3) worldview. The findings of the present research were able to identify the roots and social factors affecting Iranian families' decisions regarding the consent or nonconsent of brain-dead patient members. Health system administrators and organ donation committees in medical sciences universities in Iran can try to solve the shortage of donated organs by using the specific social aspects introduced in this study. It is also recommended to design effective models for more satisfaction of family members for brain death patient organ donation in healthcare based on the underlying concepts of this study.

Effect of Silybum Marianum on Reduction of Chemotherapy-Induced Peripheral Neurotoxicity with Cisplatin.

Chemotherapy-induced peripheral neurotoxicity (CIPN) is one of the major complications of chemotherapy regimens commonly used in the treatment of solid and hematologic cancers. Given the high incidence of CIPN in antitumor therapies in patients and limited studies on antioxidants, this study was aimed to investigate the effect of Silybum marianum (SM) on cisplatin-induced peripheral neuropathy. This double-blind randomized clinical trial study was performed on 60 cancer patients treated with cisplatin chemotherapy at Seyyed-o-Shohada Hospital of Isfahan during 2019-2020. The patients were divided into two parallel groups as intervention (treated by SM) and placebo, and DN4 (Douleur neuropathique 4 questions) and CIPNAT (chemotherapy-induced peripheral neuropathy assessment tool) were completed for patients in the before and after intervention groups and compared between the two groups. The mean of DN4 score in the before and after study in the intervention group was in 1.76 ± 1.24 and 2.07 ± 2.03, respectively (P = 0.38), and in the control group was 1.41 ± 1.28 ± 3.11 ± 2.86, respectively (P = 0.012). The mean CIPNAT score in the intervention groups was 5.93 ± 3.65 and 4.20 ± 3.23 (P = 0.01), and in the control group was 4.20 ± 4.22 and 4.16 ± 4.03 (P = 0.39). Based on our data, SM is an effective agent in reducing peripheral neuropathy. The use of SM was associated with decreased scores of peripheral neuropathy and was helpful in patients undergoing chemotherapy with cisplatin.

Antibiotic Susceptibility Pattern of Nosocomial and Community-Acquired Pseudomonas aeruginosa in Isfahan: A Prospective Multicenter Study

Background: Pseudomonas aeruginosa is a ubiquitous bacillus responsible for severe infections in inpatients, especially nosocomial and intensive care unit (ICU) infections. Objectives: This study aimed to determine the antibiotic susceptibility of clinical isolates from inpatients in three referral hospitals in Isfahan, Iran. Methods: Standard tests identified the organism and antibiotic susceptibility testing. Stratification was performed by place of infection (community, hospital), admission ward (ICU, non-ICU), and age group (&lt; 20 versus &gt; 20 years). Results: Pseudomonas aeruginosa showed high susceptibility to colistin (100%) and amikacin (81.8%) followed by tobramycin (69.2%), ciprofloxacin (68.5%), meropenem (67.2%), cefepime (65.7%), ceftazidime (64.3%), and imipenem (63.3%). Community-acquired strains were significantly more susceptible to meropenem (81.6%), ciprofloxacin (77.1%), cefepime (77.1%), imipenem (74.3%), and ceftazidime (72.2%) than nosocomial strains. Non-ICU isolates were more susceptible to carbapenems. Pseudomonas aeruginosa isolates had higher antibiotic susceptibility in less than 20 years. Conclusions: Based on the results, a combination of colistin and amikacin would be appropriate for the empiric treatment of suspected P. aeruginosa infections in severe cases, nosocomial infections, or patients admitted to ICU. Ceftazidime, cefepime, ciprofloxacin, meropenem, or imipenem would be suitable for mild to moderate infections, especially in community-acquired infections.

Evaluation of the effect of montelukast drug in improving the clinical condition of patients with COVID-19 in referral hospitals in Isfahan; a randomized clinical trial

Evaluation of the effect of montelukast drug in improving the clinical condition of patients with COVID-19 in referral hospitals in Isfahan; a randomized clinical trial

Evaluation of Central Nervous System Relapse in Adults with Acute Lymphoblastic Leukemia (ALL) Receiving Hyper-CVAD Treatment in Seyyed Al-Shohada Hospital: Isfahan, 2014-2019.

Background: Recurrence of ALL in the central nervous system, CNS Relapse, is known as a poor prognostic factor. Few studies have been performed on the CNS Relapse in adults with ALL. This study aimed to evaluate the recurrence of acute lymphoblastic leukemia in the central nervous system, CNS relapse, in adults with ALL. Materials and Methods: Seventy newly diagnosed patients with acute lymphoblastic leukemia aged 15 years and older referred to Seyyed Al-Shohada Hospital in Isfahan between 2014 and 2019 were included in this study. All patients treated with the Hyper-CVAD regimen underwent prophylaxis for the central nervous system based on the risk of CNS relapse. All study participants with CNS relapse underwent intrathecal chemotherapy. Results: The median age of patients was 34 years. Four patients (5.7%) had primary central nervous system involvement. Out of 70 patients receiving the Hyper-CVAD regimen, 59 (84.2%) achieved complete remission. Of the 59 patients achieving CR, ten (16.94%) developed CNS relapse. The median duration of CR before CNS relapse was 21 weeks. Out of 10 patients with CNS relapse, seven (70%) achieved complete remission. Of seven patients achieving CR in the central nervous system, one had a second recurrence in the central nervous system, but finally achieved CNS complete remission. The median survival of patients after CNS relapse was four months. The results also showed that out of 10 patients with CNS relapse, four (40%) survived one year. Conclusion: This study shows that the prognosis of CNS relapse in adults with ALL has not improved much. Limited studies have been conducted on the recurrence of the central nervous system in adults with acute lymphoblastic leukemia. Therefore, further studies on CNS relapse after complete remission of ALL are required to clarify more details.