Hospitals In Mashhad Research Articles

Optic nerve head neurovascular assessments in patients with schizophrenia: A cross‐sectional study

AbstractObjectiveThe retina is a protrusion of the brain, so researchers have recently proposed retinal changes as a new marker for studying central nervous system diseases. To investigate optic nerve head neurovascular structure assessed by optical coherence tomography angiography (OCTA) in schizophrenia compared to healthy subjects.MethodsThe study was conducted from 2019 to 2021 at the Ibn Sina Psychiatric Hospital in Mashhad, Iran. We enrolled 22 hospitalized known cases of schizophrenia, treated with risperidone as an antipsychotic drug, and 22 healthy subjects. The two groups were matched in age and gender. In the schizophrenic group, the positive and negative syndrome scale test was used to assess the illness severity. All subjects underwent complete ophthalmic evaluations and OCTA imaging.ResultsWe found that the cup/disc area ratio, vertical cup/disc ratio, and horizontal cup/disc ratio are significantly higher in patients with schizophrenia than in healthy subjects (with p‐values of 0.019, 0.015, and 0.022, respectively). No statistically significant difference in the peripapillary retinal nerve fiber layer and vascular parameters of the optic nerve head was observed between schizophrenia and healthy groups.ConclusionWe found evidence regarding the difference in the optic nerve head tomographic properties in schizophrenia compared to healthy subjects. However, ONH vascular parameters showed no significant difference. More studies are needed for a definite conclusion.

Evaluation of Preventive Pentoxifylline Effect on Acute Respiratory Distress Syndrome (ARDS) Incidence in Traumatic Patients: A Randomized Triple-Blind Placebo-Controlled Trial.

Inflammation is important in the pathophysiology of acute respiratory distress syndrome (ARDS). Traumatic injuries have been assumed to be primary ARDS causes. Recently, pentoxifylline, a phosphodiesterase inhibitor (PEI), was shown to have anti-inflammatory effects and reduce the incidence of ARDS. The present study investigated the impact of preventive pentoxifylline administration in trauma patients prone to ARDS development. A total of 62 trauma patients admitted to the Kamyab Hospital in Mashhad,Iran, with ARDS risk who fulfilled the inclusion and exclusion criteria were included in this study. The patients were randomly divided into treatment and placebo groups. The treatment group received 400 mg pentoxifylline 3 times a day, while the control group received placebo tablets thrice for 1 week. Before the intervention and during the study, factors such as heart rate, blood pressure, respiration rate, continuous pulse oximetry, CRP, PO2, PCO2, and PH were assessed. Finally, the obtained data were analyzed using SPSS Version 26 via a generalized estimating equations model and an independent t test. The heart rate was significantly lower in the treatment group than in the placebo group (P = 0.036). In addition, PO2 levels were remarkably higher in the treatment group (P = 0.040). Changes in respiratory rate (P = 0.064), CRP (P = 0.341), PH (P = 0.910), PCO2 (P = 0.892), HCO3 (P = 0.172), systolic blood pressure (P = 0.302), and SPO2 (P = 0.350) were not significantly different between the 2 groups. In addition, no significant difference was observed in the incidence and severity of ARDS between the 2 groups. The findings of this study revealed that pentoxifylline administration to trauma patients had no beneficial effects on ARDS but improved some vital signs and laboratory variations.

Relationship Between the Incidence of Pulmonary Embolism and the Quantitative Level of Air Pollution (NO2, SO2, CO, O3, and PM10) in Patients Referred to Mashhad Hospitals in 2019

Background: Air pollution is known to be associated with increased levels of inflammatory markers, vascular endothelial damage, and alterations in blood coagulation factors. It represents one of the most significant environmental hazards in urban areas, with adverse effects on the health of the population. Objectives: This study aimed to investigate the relationship between the incidence of pulmonary embolism (PE) and the quantitative levels of various air pollution parameters. Methods: In this descriptive-analytical (cross-sectional) study, we examined all patients diagnosed with PE who were referred to Ghaem and Imam Reza (AS) Hospitals in Mashhad during the year 2019. Daily data on each air pollutant, including NO2, SO2, CO, O3, and PM10, were obtained from the Meteorological Center. For each patient's assessment, we considered the average pollution levels over the past 30 days. The collected data were subsequently analyzed using independent samples t-tests and the Mann-Whitney U test in SPSS 22. Results: The findings of this study revealed a statistically significant association between elevated levels of PM10 and O3 and the occurrence of PE. However, no such relationship was observed for NO2 and CO in relation to the risk of PE. Conclusions: It can be concluded that increased levels of PM10 and O3 are linked to a higher risk of developing PE, while other pollutants showed no evidence of association in this study.

Effect of Respiratory Telerehabilitation on Pulmonary Function Parameters and Quality of Life in Patients with COVID-19: A Randomized Controlled Trial

Background: Given the heightened impact of post-COVID-19, active involvement in the rehabilitation process, particularly in respiratory rehabilitation, is essential for these patients. This study addresses the urgent need for developing and evaluating remote respiratory rehabilitation methods post-COVID-19, focusing on enhancing patients' quality of life and pulmonary function. Objectives: The study aimed to investigate how respiratory telerehabilitation influences pulmonary function and the quality of life in this patient population. Methods: In this randomized controlled clinical trial, 60 COVID-19 patients from two major hospitals in Mashhad were evaluated during 2021 - 2023. The control group received a training booklet and an incentive spirometer, while the intervention group participated in a telerehabilitation program. This program involved four-week daily respiratory rehabilitation exercises conducted online using the Skyroom platform. At the end of each session, the patient's fatigue and shortness of breath were assessed using the Borg Rating of Perceived Exertion (RPE) Scale and the number of physical exercises completed. All patients completed the Quality of Life (QOL) Questionnaire and undertook the 6-Minute Walk Test (6MWT). Heart rate, respiratory rate, blood oxygen saturation (SPO2), maximum inspiratory pressure (MIP), fatigue, and shortness of breath were measured on the day of discharge and two and four weeks post-discharge. Covariance (ANCOVA) and repeated measures analysis of variance (RMANOVA) were analyzed for data analysis. Results: In both baseline-adjusted and fully-adjusted ANCOVA models, the results indicated a significant intervention effect after 4 weeks for MIP (73.43 ± 5.77), SPO2 (96.90 ± 1.21), Borg scale score (9.77 ± 1.59), and MWT6 (455.90 ± 37.70), (all P < 0.0001), with significantly higher changes observed in MIP, SPO2, Borg Scale score, and MWT6 after 2 weeks as well as after 4 weeks in the intervention group than the control groups. Also, in both models, the results indicated a significant intervention effect after 2 weeks as well as 4 weeks for physical functioning, role physical, vitality, social functioning, role emotional, Physical Health Scale score, and total SF36 score (60.37 ± 6.93) (P < 0.001). Conclusions: Using bidirectional audio and video communication in the telerehabilitation of COVID-19 patients significantly improved their pulmonary function and QOL. Based on these findings, it is recommended that this method be considered as an integral component in rehabilitation programs for COVID-19 patients.

The association between vertebral artery hypoplasia and fetal-type variants of the posterior cerebral artery with imaging findings among patients with posterior circulation stroke: A single-center cross-sectional study.

The present study investigated the correlation between vertebral artery hypoplasia and fetal-type variations of posterior cerebral arteries with stroke patterns and imaging findings in individuals with posterior circulation ischemic stroke. In this cross-sectional study, patients with symptoms of acute ischemic stroke in the posterior circulation system referred to Ghaem Hospital in Mashhad between 2016 and 2022 were investigated. Demographic data, including age, gender, systemic diseases, history of previous stroke or transient ischemic attacks, and clinical manifestations of patients, were recorded using questionnaires and checklists from patient files. The results of imaging studies, including magnetic resonance imaging and computed tomography angiography, were also recorded. The obtained data were analyzed by SPSS statistical software. Among 974 patients suffering from posterior circulation ischemic stroke, 155 patients with an average age of 60.44 ± 13.95 years were included in the study, out of which 97 patients (62.6%) were male. Unilateral vertebral artery hypoplasia on the right, left, and bilateral hypoplasia was present in 67 (43.2%), 35 (22.6%), and 5 (3.2%) patients, respectively. There were complete unilateral fetal origin on the right in 38 (24.5%), complete unilateral on the left in 12 (7.7%), partial unilateral on the right in 12 (7.7%), partial unilateral on the left in 6 (3.9%), complete bilateral in 14 (9%), and partial bilateral in 8 (5.2%) patients. There was no significant relationship between vertebral artery hypoplasia and PCA fetal-type variants with different ischemia locations and infarct patterns (p > 0.05). Also, there was no significant relationship between the age and gender of patients with ischemia location and infarct pattern (p > 0.05). Despite previous evidence showing a relation between vertebral artery hypoplasia and PCA fetal-type variants as risk factors for PC stroke, the present study did not establish a significant correlation between these factors and the location of ischemia and infarct patterns.

Evaluation of the hematological inflammatory parameters in the patients with immune thrombocytopenic purpura: A case-control study.

Inflammation is one of the immune thrombocytopenic purpura (ITP)'s aggravating elements due to inflammatory cells' function. This study aims to identify and evaluate hematological inflammatory parameters, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and hemoglobin-to-platelet ratio (HPR), in patients with ITP compared to the control group. We retrospectively analyzed the profile of 190 ITP patients from August 2019 to January 2021 at Imam Reza Hospital of Mashhad, Iran, along with 100 healthy individuals who had no ITP-related clinical or laboratory symptoms. Immune cell counts, NLR, PLR, and HPR were calculated using the complete blood count at the time of diagnosis and after the treatment. The results were analyzed through MedCalc, SPSS software, and the receiver operating characteristiccurve. The result showed that white blood cell (WBC) and neutrophil counts were higher in ITP patients (WBC: p: 0.001, neutrophil: p: 0.001), and conversely, platelet and lymphocyte counts were higher in the control group compared to ITP patients (platelets: p: 0.001, lymphocytes: p: 0.001). The indices analysis between the two groups revealed that NLR was significantly increased in ITP patients (p: 0.001), but PLR was significantly reduced in ITP patients (with the mean platelet count of 23.44 ± 35.26 × 109/L) compared to the control group (with the mean platelet count of 234.04 ± 55.88 × 109/L). The HPR index also significantly increased in ITP patients (p: 0.001). An increase in NLR, PLR, and a decrease in HPR can be considered a valuable diagnostic algorithm in patients with ITP.

Epidemiological and cost analysis of burned patients in Iran

IntroductionConsidering the financial support provided by insurance and the government for burn patients in Iran, and recognizing the substantial economic impact associated with their treatment, there is a pressing need to delve into the epidemiology of these patients and analyze the related costs. This study aims to explore the epidemiological aspects and hospitalization costs of burn patients specifically within the burn ward of Imam Reza 68-bed Hospital in Mashhad, a regional center of referral in the eastern part of the country. MethodsData had extracted from the electronic data collection system, which is used on a daily basis in the hospital. We included patients with a primary or secondary diagnosis of burns, code T20.0-T32.9 and T95 according to the International Classification of Diseases ICD-10. Ultimately, 1151 patients were included in the study. We analyzed 1151 burn cases in terms of patients’ age at the time of the event, gender, type of burn (Chemical, scalds, flame, electrical and contact burns), anatomical location of the burn (head and neck, upper limb, lower limb, multiple regions and part unspecified), burn etiology, burn degree (I, II, III), total burn surface area (%TBSA), Inpatient ward, expenditure ($), burn mortality rate and length of hospitalization. The age group was divided into seven groups by the 10 years intervals. Statistical analysis of the data was performed using SPSS-16 and Excel software. Results1151 patients were included in the study. High-risk groups are pediatric up to nine (0–9) years. According to age, we found that most cases were children, respectively, 25% (291) cases. Men accounted for 743 cases (65%), women for 408 (35%). Major causes of severe burn injury were flame burns (49%) and scalds (43%). Unspecified was the most common burn location (40%), followed by the multiple regions (23%) and upper limb (11%). In cases of head and neck burns, the financial burden on the patient is elevated compared to other types of burns due to increased expenses for medications, disposable medical instruments, and hoteling. The main items for the burned patients are hoteling (38% of total costs), surgeon (24%), medicine (16%), and medical consumables (6%). The per capita expenditure was $9,365 ± $8,100 in pediatrics and $11,179 ± $10,180 in adults Conclusions: Most cases of death were related to burn in multiple areas of the body and then trunk burn (30% and 19%, respectively) and no death was observed in patients with hand and wrist burn. Burns can be incredibly severe and life-threatening, especially when they affect multiple areas of the body, such as the trunk and any burn injury is still a serious matter. It's important to prioritize fire safety and take precautions to prevent such accidents from happening.

Evaluation of the efficiency of nanomicellar formulation of fat-soluble vitamins in patients with cystic fibrosis: the study protocol for a randomized controlled trial

BackgroundCystic fibrosis is an inherited disease, which is caused by the CFTR protein defects due to mutations in the CFTR gene. Along with CFTR dysfunction, exocrine pancreatic insufficiency plays a key role in persistent fat malabsorption in CF patients; therefore, deficiency of fat-soluble vitamins (A, D, E, and K) is still a therapeutic challenge. Even with efficient pancreatic enzyme medication and CF-specific vitamins, many patients with CF have fat-soluble vitamins deficiency. The present study aims to evaluate the efficiency of nanomicelle formulation of fat-soluble vitamins in children with CF in order to achieve the appropriate serum levels of these vitamins.MethodsThis prospective, single-blind control trial will be conducted at the Akbar Children’s Hospital in Mashhad, Iran. Patients with CF will be enrolled based on the eligibility criteria. The control group will receive the standard formulation of fat-soluble vitamins similar to the routine CF treatment, and for the intervention group, the nanomicelle formulation of fat-soluble vitamins will be administered for 3 months. The primary outcome of this study is the measurement of serum levels of fat-soluble vitamins. The secondary outcomes are clinical assessment by the Shwachman-Kulczycki score, anthropometrics, and quality of life. Outcomes will be assessed before and after 3 months.DiscussionDue to persistent fat-soluble vitamin deficiency in CF disease, the nanomicelle formulation could be proposed as a new delivery method of fat-soluble vitamins in the treatment of cystic fibrosis.Trial registrationIranian Registry of Clinical Trials IRCT20220415054541N1. Registered on July 23, 2022.

Main Coping Style of Self-Immolation Patients

Background and Objective: Self-immolation is a terrible method of suicide. Coping skills are important protective measures against suicide. In this regard, the present study aimed to investigate the coping styles of people committing self-immolation and their relationship with demographic characteristics and burn indices. Materials and Methods: This cross-sectional study was performed on people who attempted self-immolation and were admitted to the burn center of Imam Reza Hospital in Mashhad, Iran between 20 February 2018 and 20 February 2020. They filled Jalowiec coping styles questionnaire after their informed consent was obtained. The styles that received the highest score were considered their dominant coping styles. Moreover, the relationships of dominant styles with other variables were investigated. Results: In total, 44 samples were collected, 32 of which were females (72.7%). The mean age of participants in this study was 30.2 ± 13.1 years. Furthermore, the dominant coping style of most of the participants (47.7%) was emotive. Besides, males used emotive coping style more significantly than females (P=0.05). In addition, a negative significant correlation was found between age and emotive coping style (P=0.02, r= -0.35). Conclusion: According to the results, young males who engaged in self-immolation used emotive coping style more significantly, compared to others. It seems that by teaching healthy coping skills to people at risk, the occurrence

Effect of educational workshops related to self-efficacy on drug rehabilitation among addicts visiting drug rehabilitation clinics: A randomized controlled trial

Addiction presents itself as a multifaceted issue encompassing medical, psychological, social, and economic dimensions. The staggering relapse rate, surpassing 80%, underscores an inadequate understanding of addiction treatment approaches and their effectiveness. Self-efficacy represents an individual's belief in their capability to complete a task. This study investigates the correlation between self-efficacy and drug rehabilitation among individuals seeking assistance at a rehabilitation clinic in Mashhad, Iran. This research entails a randomized controlled trial involving 60 clients (30 in the intervention group and 30 in the control group) who were referred to the drug rehabilitation clinic at Imam Reza Hospital in Mashhad, Iran. Data collection tools comprise a demographic questionnaire for patients and a drug rehabilitation self-efficacy questionnaire. Initially, data were collected before the intervention, followed by the implementation of the intervention in the study group, after which a retest was conducted in both groups. Statistical analyses indicated a notable contrast in successful rehabilitation rates between both groups (P<0.05). Additionally, there was a significant variation in the average self-efficacy scores within the study group post-intervention (P<0.05). In summary, the results demonstrate that enhancing self-efficacy contributes to successful and lasting drug rehabilitation. Implementing this approach is advisable for clients referred to rehabilitation clinics during their recovery process.

A Comparison between Enoxaparin and Aspirin in Preventing Deep Vein Thrombosis after Spine Surgery: A Randomized Clinical Trial.

Deep Vein Thrombosis (DVT) is a significant medical concern characterized by the formation of blood clots within the venous system. Surgical procedures are known to increase the risk of DVT. While enoxaparin has proven to be highly effective in treating DVT, concerns about bleeding and accurate dosage regulation may restrict its application. Recent research has focused on aspirin's potential in preventing DVT after various surgeries. This study aimed to determine whether aspirin was as effective as enoxaparin in preventing DVT after spine surgery. This randomized controlled trial enrolled study patients who underwent spine surgery at Shahid Kamyab Emergency Hospital in Mashhad, and had a Caprini score > 5, indicating a higher risk of DVT. In the control group, patients received subcutaneous injections of enoxaparin at a dosage of 40 mg, while the intervention group received oral aspirin tablets with a daily dosage of 81 mg. An experienced radiologist performed a Doppler ultrasound of the lower limbs' veins seven days after surgery to diagnose DVT. The outcomes of the two groups were then compared. A total of 100 patients participated in the clinical trial and were equally assigned to the aspirin and enoxaparin groups. Both groups were homogeneous regarding the basic and clinical characteristics. The incidence of postoperative DVT was 4.0% in the aspirin group and 10.0% in the enoxaparin group (p=0.092). The incidence of hemorrhage was 2.0% in the aspirin group and 4.0% in the enoxaparin group (p=0.610). These findings indicate that aspirin may be a promising alternative to enoxaparin for DVT prevention after surgery, but additional research is essential to validate these results and further assess the benefits and risks associated with aspirin usage in this context.

Proposing a Model for Nurses' Quality of Work Life: A Grounded Theory Approach

Objective: The objective of this study was to develop a model for the quality of work life (QWL) of nurses using a grounded theory approach. Methodology: The study employed a qualitative research method with a grounded theory design. The research sample included 24 nurses from treatment-educational hospitals in Mashhad, selected using snowball sampling until data saturation. Data were collected through in-depth, unstructured interviews and analyzed using open, axial, and selective coding. Findings: The study identified key causal conditions influencing QWL, including the provision of welfare services, participation, career advancement, improvement of environmental conditions, fostering a favorable culture, and organizational justice. Strategic factors such as fair treatment, efficient incentive systems, utilization of competencies, and valuing were also significant. The outcomes of improved QWL were categorized into job satisfaction, productivity, multipurpose use of space, and organizational commitment. Conclusion: The proposed model suggests that improving both causal and strategic factors can enhance the quality of work life for nurses, leading to greater job satisfaction, increased productivity, and stronger organizational commitment.

Psychometric properties of the Persian version of the nursing moral disengagement scale.

Moral disengagement is a set of cognitive mechanisms through which a person violates his/her moral standards without losing his/her dignity. Therefore, a tool has been designed to measure moral disengagement in nurses. This study aims to determine the psychometric properties of the Nursing Moral Disengagement scale. In this methodological study, 440 nurses working in hospitals of Mashhad were selected by the availability sampling method. The translation was carried out using the forward-backward method. The final version of the tool was psychometrically tested for validity (exploratory and confirmatory factor analysis) and reliability (internal consistency and relative stability). Four factors were extracted in the exploratory factor analysis, and since the factor loadings of all the tool items were higher than 0.3, they were all retained. The tool's general fit indices indicated the model's confirmation and optimal fit. Cronbach's alpha and relative stability coefficients for the whole questionnaire were 0.90 and 0.89, respectively. The study results showed that this tool has good validity and reliability and can therefore measure behaviors related to moral disengagement in nurses, so that appropriate interventions can be designed to reduce these harmful behaviors.

Rapid and sensitive detection of SARS-CoV-2 virus in human saliva samples using glycan based nanozyme: a clinical study.

A highly sensitive colorimetric method (glycan-based nano(e)zyme) was developed for sensitive and rapid detection of the SARS-CoV-2 virus based on N-acetyl neuraminic acid (sialic acid)-functionalized gold nanoparticles (SA-Au NZs). A number of techniques were used to characterize the prepared nanomaterials including XRD, FT-IR, UV-vis, DLS, and TEM. DLS analysis indicates an average hydrodynamic size of 34nm, whereas TEM analysis indicates an average particle size of 15.78nm. This observation confirms that water interacts with nanoparticle surfaces, resulting in a large hydrodynamic diameter. The peroxidase-like activity of SA-Au NZs was examined with SARS-CoV-2 and influenza viruses (influenza A (H1N1), influenza A (H3N2), and influenza B). UV-visible spectroscopy was used to monitor and record the results, as well as naked eye detection (photographs). SA-Au NZs exhibit a change in color from light red to purple when SARS-CoV-2 is present, and they exhibit a redshift in their spectrum. N-acetyl neuraminic acid interacts with SARS-CoV-2 spike glycoprotein, confirming its ability to bind glycans. As a result, SA-Au NZs can detect COVID-19 with sensitivity and specificity of over 95% and 98%, respectively. This method was approved by testing saliva samples from 533 suspected individuals at Ghaem Hospital of Mashhad, Mashhad, Iran. Sensitivity and specificity were calculated by comparing the results with the definitive results. The positive results were accompanied by a color change from bright red to purple within five minutes. Statistical analysis was performed based on variables such as age, gender, smoking, diabetes, hypertension, and lung involvement. In clinical trials, it was demonstrated that this method can be used to diagnose SARS-CoV-2 in a variety of places, such as medical centers, hospitals, airports, universities, and schools.

The association of hematological inflammatory markers and psychological function in COVID-19 patients: A cross-sectional study.

Mental health disorders are linked to systemic inflammation. Due to high inflammation and mental health disorders in COVID-19 patients, we aimed to investigate the relationship between blood inflammatory markers such as red cell distribution width to platelet ratio (RPR), platelet-lymphocyte ratio (PLR), neutrophil/lymphocyte ratio (NLR), red cell distribution width (RDW), white blood cell (WBC), and psychological function in COVID-19 patients. In the current cross-sectional study, neuro-psychological function, and a complete blood count (CBC) were measured on 120 COVID-19 patients aged >30 years from the Imam Reza Hospital in Mashhad, Iran. Our results showed that anxiety related to MCHC (mean ± SD: 32.71 ± 1.68, p < 0.05), WBC (mean ± SD: 12.23 ± 5.43, p < 0.05), and PLR (median (IQR): 28.72 (15.88-41.31), p < 0.05) significantly. In the stress subgroup, only RPR was associated with stress (p < 0.05). Linear regression between hematological parameters and psychological score indicated that RDW and PLR had a significantly positive association with depression (β = 0.086; p = 0.045 and β = 1.326; p = 0.016, respectively) and anxiety scores (β = 0.100; p = 0.038 and β = 1.356; p = 0.010, respectively). Moreover, a positive correlation was found between PLR and stress (β = 1.102; p = 0.012). This study showed a positive association between depression/anxiety/stress symptoms and levels of hematological inflammatory markers including PLR and RDW. The findings of this study provide novel insights into mental health and physiological markers, underscoring the potential influence of inflammation on mood disorders. Our findings offer exciting prospects for future research and may lead to innovative approaches in the management and treatment of depression, anxiety, and stress.

Antibiotic Consumption and Bacterial Resistance Pattern During Three Years at a Tertiary Hospital in Mashhad, Eastern Iran

Antibiotic Consumption and Bacterial Resistance Pattern During Three Years at a Tertiary Hospital in Mashhad, Eastern Iran

Antibiotic Use in Patients With COVID-19

Abstract Introduction Antimicrobial resistance is a serious threat to public health. The ongoing antimicrobial resistance pandemic has been fueled by the COVID-19 pandemic. Methods We analyzed patients 15 years or older with COVID-19 who were admitted to a teaching hospital in Mashhad, Iran, during the period between the third and fourth COVID-19 waves. COVID-19 was diagnosed if the SARS-COV-2 (severe acute respiratory syndrome coronavirus 2) polymerase chain reaction test was positive in patients with compatible clinical syndromes. Results Overall, 532 episodes of COVID-19 were diagnosed. The median age of patients was 61 years (interquartile range, 48–73). One hundred twenty-five patients (23.4%) with COVID-19 died, and 165 (31%) experienced major complications. Over the study period, 134 DDD (defined daily dose) per 100 hospital bed days of antibacterial were used. Glycopeptides, third-generation cephalosporins, and carbapenems were the antibacterials most frequently used, based on the DDD per 100 hospital bed days. In a multivariate analysis, factors associated with antibacterial prescription in COVID-19 patients were lung involvement of greater than 50% (odds ratio [OR], 14.6), C-reactive protein of greater than 100 mg/L (OR, 3.35), and hypoxia (OR, 3.06). Univariate but not multivariate analysis showed that antibiotic use in COVID-19 patients was associated with 4 times increase in the chance of death (OR, 4.23). Conclusion Our study highlights a high rate of antibacterial use in COVID-19 patients. Hypoxia, C-reactive protein of greater than 100 mg/L, and severe lung involvement were associated with a higher rate of antibacterial prescription. The patients who received antibiotics died 4.23 times more often than patients treated without antibiotics. These findings emphasize the need for integrating antimicrobial stewardship programs as an integral part of the pandemic response and the need for improving diagnostic tests for early detection of bacterial coinfections in COVID-19 patients.

The efficacy of phase I cardiac rehabilitation training based on augmented reality on the self-efficacy of patients undergoing coronary artery bypass graft surgery: A randomized clinical trial

BackgroundOpen-heart surgery is considered one of the primary treatments for severe coronary artery stenosis, but it comes with its own set of complications. However, these complications can be reduced through the implementation of proper cardiac rehabilitation during phase I. This study aimed to examine the impact of phase I cardiac rehabilitation training, using augmented reality, on the self-efficacy of cardiac management in patients undergoing coronary artery bypass grafting.MethodologyThis randomized clinical trial study involved 60 patients who were admitted to the Cardiac Surgery Intensive Care Unit at Ghaem Hospital in Mashhad. The software used in this study consisted of various videos and educational images demonstrating physical exercises for cardiac rehabilitation. The software was developed to train the patients in the intervention group on the rehabilitation program, starting from their admission to the Intensive Care Unit until their discharge from the hospital. The collected data were analyzed using statistical tests such as independent t-test, Mann-Whitney test, paired t-test, chi-square test, as well as descriptive indicators. Cohen’s d was also used to evaluate the magnitude of the effect size.ResultsThe findings of this study revealed that the total mean score for cardiovascular management self-efficacy significantly increased during the transfer to the Intensive Care Unit and at the time of discharge. Notably, the increase observed in the intervention group was significantly greater than that of the control group (P < 0.001).ConclusionThe results of this study indicated that implementing early rehabilitation programs, using innovative educational technology like augmented reality, enhanced the self-efficacy of patients undergoing coronary artery bypass grafting. These findings suggest that such programs can be effectively employed as educational tools throughout different stages of cardiac rehabilitation.Trial RegistrationThis study was registered in the Iranian Registry of Clinical Trials (no. IRCT20200203046361N1) on 16/02/2020.

Detection of extended-spectrum beta-lactamases and carbapenemases in clinical isolates of Stenotrophomonas maltophilia in the northeast of Iran

PurposeStenotrophomonas maltophilia has emerged as an important pathogen associated with significant mortality in pneumonia and bacteremia of severely immunocompromised, hospitalized patients. The main objectives of the present study are to describe the surveillance of antibiotic resistance and to detect the genes encoding extended-spectrum beta-lactamases (ESBLs) and carbapenemase enzymes in clinical S. maltophilia isolates from blood cultures in the northeast of Iran. MethodsA total of 114 clinical human isolates of S. maltophilia were collected from blood cultures of patients admitted at three teaching hospitals in Mashhad, northeast of Iran. Antimicrobial susceptibility was determined by the Kirby-Bauer disk diffusion test. The extended-spectrum beta-lactamase (ESBL) production was confirmed by the combination disk method. The PCR was applied for molecular epidemiology of ESBLs and carbapenemase coding genes. ResultsOverall, 10 % and 8 % of isolates were resistant to co-trimoxazole and levofloxacin, respectively. The prevalence of the blaTEM, blaSHV, and blaCTX-M-15 genes in the 69 ESBL-producing isolates was 2.9 %, 5.8 %, and 10.14 %, respectively. Moreover, the prevalence of the blaKPC-1, blaIMP, blaVIM, blaNDM, and blaOXA-48 genes was 18.42 % (n = 21), 4.39 % (n = 5), 6.14 % (n = 7), 15.79 % (n = 18), and 14.91 % (n = 17), respectively. ConclusionFor the first time in Iran, ESBLs and carbapenemase coding genes have been identified in human clinical strains of S. maltophilia. Circulation of these resistant strains with transferable genes is a sign of flow of resistome genes from other bacterial genera to S. maltophilia, most probably leading to the evolution of the superbugs of this bacterium.

How do workplace stressors during COVID-19 affect health frontline employees in Iran: Investigating the role of employee resilience and constituent attachment

PurposeThe purpose of the present study is to extend the body of research on healthcare management by examining the effect of workplace stressors, including abusive supervision, customer incivility and the perceived threat of COVID-19 (PCT), on turnover intention. The study also contributes to healthcare management research by examining the mediating role of emotional exhaustion, the moderating role of employee resilience and constituent attachment.Design/methodology/approachThe study developed and tested a model explaining the relationship between abusive supervision, customer incivility, PCT, emotional exhaustion, turnover intention, employee resilience and constituent attachment. Data were collected from a sample of 375 frontline employees who work in private hospitals in Mashhad, the second-most populous city in Iran.FindingsThe findings indicate that abusive supervision and customer incivility, directly and indirectly, affect turnover intention through emotional exhaustion. Furthermore, employee resilience was found to mitigate the relationship between stressors excluding the PCT and emotional exhaustion. Moreover, constituent attachment decreased the likelihood of turnover intention among employees who experienced abusive supervision. The findings suggest that controlling abusive supervision, customer incivility and PCT can lead to less emotionally exhausted employees with lower turnover intention. Furthermore, enhancing employee resilience and constituent attachment can decrease emotional exhaustion and turnover intention.Originality/valueDespite the large body of research on the relationship between the variables mentioned above, few studies have presented a conceptual model based on the relationship between them. This article presents a conceptual model that has not been previously discussed in any other publication to examine the moderating effect of organizational and individual factors in the relationship between workplace stressors and their consequences, which have not been widely covered in existing literature. Drawing upon conservation of resources theory, job embeddedness theory and attachment theory, the present study aims to fill this gap in the literature.