Imam Khomeini Hospital Complex Research Articles

Childhood-Onset Systemic Lupus Erythematosus: How Is It Associated with Breastfeeding and Mode of Delivery?

AbstractBreast milk is a rich source of infants' nutrition and also known to be a source of immune-enhancing molecules. The perinatal factors might have long-term effects on the immune system and also, breastfeeding may have an important role. Systemic lupus erythematosus (SLE) is a multisystemic autoimmune disease that leads to various organ damages. This idiopathic disease is characterized by high levels of autoantibodies in the circulation. In this case–control study, we have evaluated the association between the breastfeeding and mode of delivery and SLE incidence. In this case–control study, SLE cases were identified in Children's Medical Center and Imam Khomeini Hospital Complex between 2011 and 2017. The control group was chosen from the schools of Tehran and Sari cities. The questionnaires were completed by one of the parents. Seventy-nine cases and 301 controls were included. There was no association among breastfeeding, duration of breastfeeding or exclusive breastfeeding and SLE, the age of diagnosis, or its major organ involvements (p > 0.05). The cesarean section (C-section) method was significantly associated with higher disease incidence (p < 0.005). The feeding method during infancy had no significant impact on SLE incidence and onset, while the C-section method increased the incident rate.

Evaluation of concentric periareolar subcutaneous mastectomy outcomes in transsexual patients during 2016–2017 in Iran: A clinical study

Background: Transsexual (TS) people are those who assigned one sex at the birth but identified their gender in what society considers the opposite direction. Studies showed that gender reassignment surgery (GRS) had greatly improved the quality of life in TS patients. Materials and Methods: We studied 20 patients who had legally the permission of being underwent the sex reassignment surgery in Imam Khomeini Hospital Complex of Tehran, Iran. For all patients, concentric periareolar subcutaneous mastectomy was performed. The patients were followed up for 1 year and the results were evaluated. Results: Our findings show an acceptable scar formation after 1 year of the sex reassignment surgery. There was only one complication which was managed conservatively. About 90% of patients were satisfied from the results of surgery, and no one was less/unsatisfied. The average score of nipple sensation was 7.9 and no changes in nipple pigmentation was observed. Conclusion: Concentric periareolar mastectomy is probably a good technique of subcutaneous mastectomy in female to male GRS in patients with small and medium size of the breast and poor skin elasticity. The result scar in this method is acceptable and gives the patients a good feeling of having male chest.

Delay in anesthesia assessment time – A cause of postponement in orthopedic trauma surgery

Background: Postponement of surgery increases the length of hospitalization and medical expenses, the mortality rate, and the prevalence of major medical complications. There is a limited study about the role of anesthesia assessment in developing these complications. Thus, the aim of the present study was to examine the anesthesia assessment time for traumatic patients aged over 50 years and also to investigate the role of anesthesia service in surgery postponement. Materials and Methods: This descriptive retrospective study was performed on 110 patients with traumatic injuries referred to Imam Khomeini Hospital Complex (Tehran, Iran) from March to September 2017. The information was extracted retrospectively from the hospital information system. The standard definitions in the International Classification of Diseases 10 code S00-T88 were used to identify traumatic injuries and fractures. Results: The results of the present study showed that the mean of anesthesia assessment time was significantly different in terms of the type of trauma, and femoral fractures had a higher anesthesia assessment time (P = 0.009). Furthermore, the anesthesia assessment time in patients who underwent echocardiography was significantly higher than those with no echocardiography (P

Comparison between Patellar Resurfacing and Retention in Total Knee Arthroplasty Regarding the Postoperative Satisfaction of Patients and Patellar Crepitus.

Patellar crepitus after total knee arthroplasty (TKA) is not uncommon. The choice between patellar resurfacing or retention in TKA has remained controversial. Therefore, this randomized controlled trial aimed to evaluate the impact of patellar resurfacing on the incidence of patellar crepitus. In addition, we compared the clinical outcomes and satisfaction between the patients who underwent patellar retention or resurfacing. A total of 63 patients randomly received patellar resurfacing or non-resurfacing TKA by one surgeon at Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Iran during May 2014-February 2017. Finally, 29 patients in the resurfaced group and 44 subjects with retained patella were evaluated pre-op and in an average follow-up period of 8.68 months using the clinical Knee Society Score (KSS), functional KSS, and Knee injury and Osteoarthritis Outcome Score (KOOS). Our findings demonstrated no significant difference between the two groups regarding the satisfaction of patients, KSS, and KOOS. It was shown that the latter scores improved in both groups in the follow-up period. Nonetheless, patellar crepitus was not statistically different between the two groups. According to the results of the present study, patellar resurfacing did not lead to decreased patellar crepitus or enhanced clinical outcomes of TKA.

Comparison of Assisted Reproductive Technology Cycle Outcomes Among Daily Buserelin, Daily, and Every Other Day Triptorelin in Infertile Patients Referring to Imam Khomeini Hospital Complex: A Randomized Controlled Trial

Comparison of Assisted Reproductive Technology Cycle Outcomes Among Daily Buserelin, Daily, and Every Other Day Triptorelin in Infertile Patients Referring to Imam Khomeini Hospital Complex: A Randomized Controlled Trial

Severe Pericardial Effusion Heralding Scleroderma Renal Crisis: A Case Report and the Literature Review

Introduction: Both scleroderma renal crisis and severe pericardial effusion are rare and life-threatening complications of systemic sclerosis. This article describes a case of scleroderma renal crisis heralded by severe pericardial effusion. Case Presentation: The patient was a 39-year-old woman with a history of 8 years diffuse cutaneous scleroderma and extensive skin involvement who referred to Imam Khomeini Hospital Complex, Tehran, Iran, with worsening dyspnea and pleuritic chest pain. Echocardiography revealed severe pericardial effusion, which was drained by the pericardial window. Thereafter, the patient became gradually anuric and her blood pressure was uncontrolled despite maximum doses of antihypertensive agents, including captopril. The serum creatinine level was increased progressively; thus, hemodialysis started. Concomitantly, microangiopathic hemolytic anemia complicated the course of the disease, which responded to plasma exchange. Kidney biopsy revealed pieces of evidence indicating thrombotic microangiopathy. Conclusions: This case report denotes to a probable association between scleroderma the renal crisis and severe pericardial effusion. Therefore, physicians should be vigilant about the renal crisis in patients with systemic sclerosis and pericardial effusion.

Positive Role of Procalcitonin Level in the Diagnosis of Infectious Diseases After Liver Transplantation

Background: Procalcitonin (PCT) has been shown as a reliable diagnostic biomarker for identifying sepsis and bacterial infection. Objectives: The present study examined the sensitivity and specificity of PCT evaluation in the diagnosis of infectious diseases after liver transplantation. Methods: The present prospective cohort study was conducted on postoperative liver transplant (LT) patients in the liver transplant ward of Imam Khomeini Hospital Complex affiliated to Tehran University of Medical Sciences between January 2014 and March 2015. Serum PCT levels were evaluated before transplantation and one, two, and six or seven days post-operation by semi-quantitative kits with a 30 seconds response. Results: A total number of 28 LT patients were enrolled in this study. The mean patients’ ages were 48.6 ± 10.9 (range 26 - 66) years old. Serum PCT levels in all patients were < 0.5 ng/mL prior to the operation. At first and second days post-operation, PCT levels were more than 2 ng/mL in all patients and decreased to 0.5 ng/mL after 6 or 7 days in 23 patients. Serum PCT level of higher than 5 ng/mL on the first and second days post-surgery with a sensitivity of 77.8% and specificity of 79% had the most accuracy for the infection diagnosis. The PCT level more than 5 ng/mL in the sixth and seventh days had a 100% positive predictive value in the infection prediction. Conclusions: Serial evaluations of serum PCT after liver transplantation had good sensitivity and specificity to predict postoperative infection. Increased serum PCT level within the first days after transplantation and/or failure to decrease after one week, predicts infectious complications and undesirable outcome.

The Effects of Acupuncture on Hemodynamic Changes During Endotracheal Intubation for General Anesthesia.

Objective: The goal of this research was to investigate the efficacy of perioperative manual acupuncture in the LV 3 and LI 4 points for lessening hemodynamic changes during endotracheal intubation in patients who were receiving anesthesia. Materials and Methods: This double-blinded randomized controlled study enrolled patients who were undergoing endotracheal intubation, in 2015-2016, during general anesthesia in the general surgery department of the Imam Khomeini Hospital complex, in the Tehran University of Medical Sciences, Iran. The patients were randomly allocated into 2 groups with 30 patients in each group. In the treatment group, acupuncture needles were placed at LV 3 and LI 4, whereas, in the control group, the needles were placed 1 cm lateral to these points. Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial blood pressure (MAP), and heart rate (HR) before and after placing the acupuncture needles, after induction, immediately, 1 minute, and 3 minutes after intubation were measured and recorded prospectively. Results: The patients had a mean age of 44.45 ± 12.72 years and included 35 (58.3%) males. Before acupuncture, demographic data, mean blood pressure (BP), and mean HR of the patients were not significantly different in the treatment and control groups. The mean SBP, DBP, MAP, and HR of all patients changed over time significantly (P < 0.001 for all). In the treatment group, mean SBP, DBP, and MAP changes immediately after the needles were placed were significantly less than those in the control group (P = 0.033, 0.024, and 0.024, respectively). Conclusions: Although acupuncture could have a very-short-term effect that reduces BP during endotracheal intubation, hemodynamic changes might not be prevented during endotracheal intubation.

Electron microscopic findings suggestive of focal and segmental glomerulosclerosis in patients with steroid-resistant nephrotic syndrome

ABSTRACTDistinction between minimal change disease and unsampled Focal Segmental Glomerulosclerosis is a challenging concept in kidney biopsy of patients with nephrotic syndrome with minimal histopathological findings. This study was performed to compare electron microscopic findings in patients with steroid-resistant nephrotic syndrome with minimal histopathological abnormalities and cases with Focal Segmental Glomerulosclerosis. This Cohort study was conducted in Cancer Institute, Imam Khomeini Hospital Complex, Tehran, Iran. Twenty patients with steroid-resistant nephrotic syndrome and minimal changes on the light microscopic study were selected as case group. Similarly, 20 patients with Focal Segmental Glomerulosclerosis were selected as the control group. Ultrastructural findings were re-evaluated and scored qualitatively (0–3+). In patients with minimal changes on light microscopic evaluation, clinical course of the disease was followed after 5 years. Mean ages of the patients (8 women and 12 men) in case and control groups were 12.9 and 15.9 years, respectively (p > 0.05). There was no significant difference in number of examined glomeruli and sampling from cortico–medullary junction area between the groups. The mean percentage of sclerotic glomeruli in control group was 15.4%. Tubular atrophy and interstitial fibrosis were more frequent in control patients. Podocyte proliferation, GBM duplication (involving more than 10% of capillary walls), and moderate to severe multifocal expansion of mesangial matrix were significantly more obvious in FSGS patient samples (p < 0.05). No statistically significant difference was found in severity of cytoplasmic vacuolization, GBM wrinkling and splitting between the groups. Most of (80%) the patients with minimal changes improved during the 5-year follow-up. Generally, we concluded that Podocyte proliferation, GBM remodeling, and moderate to severe mesangial matrix expansion are the most reliable findings on electron microscopic examination in favor of FSGS.

Epidemiology and Outcomes of Candidemia in a Referral Center in Tehran.

Background:Bloodstream infection with Candida, or candidemia, is the most common Candida systemic infection. In this study, we investigated the characteristics of patients with candidemia to provide appropriate perspectives on these patients and reduce the associated mortality and morbidity.Methods:In this cross-sectional study, all patients with at least one positive blood culture of Candida spp. were investigated from April 2015 to March 2016 in Imam Khomeini Hospital Complex, Tehran, Iran.Results:A total of 74 patients (44 men and 30 women), with the mean age of 53.15±17.89 years, were enrolled in this study. Non-albicans Candida species was responsible for candidemia in 67.6% (50.74). The mean therapy intervals were 7 and 5.6±1.5 days in patients who died and were discharged, respectively. The differences in frequencies of urinary catheter and mechanical ventilation were statistically significant among patients who died and survived (P<0.001). Among the discharged patients, antifungal therapy was administered to 30.8% (12.39). The mortality rate was 54.3% (19.35) in the medical ward, 5.7% (2.35) in the surgical ward, and 40% (14.35) in the intensive care unit (P=0.041). The treatment was significantly associated with lower mortality than those with no treatment (OR=0.150 [0.023-0.996], P=0.05).Conclusion:The number of candidemia cases caused by non-albicans Candida species is continuously increasing in our center. We demonstrated the epidemiologic characteristics of patients with candidemia and the significant effects of timely and appropriate treatment on their outcomes. Further studies are needed to illuminate more aspects of this healthcare problem.

Reconstruction following Excision of Malignant Scalp Tumors with Split Thickness Skin Graft with and without Acellular Dermal Matrix: A Comparative Study.

Background:Basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) are the most common malignancies, which occur on the scalp. There are various therapeutic methods for managing these malignancies in which the standard treatment method of both is surgical excision with a good margin. Sometimes, the patients need full-thickness excision due to the deep invasion, so exposing the underlying calvarium may be a challenge for surgeons.Objectives:We evaluated the outcomes of using the combined therapy of acellular dermal matrix and split-thickness skin graft (STSG) in comparison with using only STSG in the treatment of defects caused by the excision of scalp malignant tumors among the patients who attended Imam Khomeini Hospital Complex and Razi Hospital of Tehran, Iran. We also evaluated the satisfaction of both surgeons and patients among these two methods of treatment.Materials and Methods:All the candidates were divided into the two groups, that is, of case and control, randomly. The case group underwent the treatment using acellular dermal matrix and STSG, whereas the control group underwent the treatment by only STSG on the wound. In both groups, BCC and SCC were excised with a margin of 6 and 10 mm, respectively, on the skull bone. Then, a layer of bone was removed by osteotomy in order to reach the bleeding points. All patients were followed up for 7, 30, and 90 days after the surgery, and the results were recorded.Results:A significant difference in Manchester Scar Scale, wound contour formation, the mobility of the repair site, and patients and surgeon satisfaction was observed among both groups based on visual analog scale. We found better outcomes in the case group, especially in wound contour formation during 90 days of follow-up. However, the satisfaction of both surgeons and patients was achieved in the case group. Satisfaction of surgeons was achieved in the case group with a relative superiority to the control group according to the Manchester Scar Scale.

Herpes Simplex Virus Type 1 Encephalitis: A Descriptive, Cross Sectional Study, 2011 - 2016, Iran

Background: Encephalitis may arise from infectious or non-infectious etiologies. Infections, predominantly viruses, are the most common causes of encephalitis. Herpes simplex virus (HSV) is the most prevalent cause of viral encephalitis in the developed countries. HSV encephalitis occurs equally in both genders and most cases are caused by HSV type 1 (HSV-1). Methods: The current descriptive, cross sectional study was conducted on patients admitted with HSV-1 encephalitis from 2011 to 2016 to Imam-Khomeini hospital complex in Tehran, Iran. The patients with clinical diagnosis of encephalitis whose cerebrospinal fluid (CSF) HSV-1 polymerase chain reaction (PCR) was positive were included. All clinical, laboratory, and imaging characteristics of patients along with their outcomes were evaluated and analyzed. Results: In the current study, of 12 cases with encephalitis manifestations and positive CSF HSV-1 PCR results, 5 were male and 7 were female with mean age of 42 years. Fever and headache were the most common complaints. Headache was more common in the cases admitted earlier (P value = 0.001). The patients were studied by brain magnetic resonance imaging (MRI) and the findings confirmed encephalitis in all the cases. Five cases had unilateral temporal lobe lesions and 6 cases had bilateral lesions. There was a clear relationship between bilateral temporal lobe lesions and higher protein level in CSF (P value = 0.001); 25% of patients (3 cases) needed stay in the intensive care unit (ICU). Three patients died and 5 patients developed disabilities. Conclusions: HSV encephalitis is a devastating disease. Clinical findings along CSF analysis and neuroimaging may result in the appropriate diagnosis. Despite appropriate treatment, undesired outcomes are common.

Mitochondrial DNA copy number instability in ERBB2-amplified breast cancer tumors.

Increase in the copy number of ERBB2, a Tyrosine Kinase Receptor (TKR) leads to the overexpression of oncogene product and consequently uncontrolled cell proliferation which has been reported in different aggressive cancers with mitochondrial malfunctions. Although, amplification of ERBB2 has been reported in different studies; however, the association between changes in mitochondrial DNA content and the ERBB2 gene copy number is poorly understood. The relative mitochondrial DNA content of breast cancer tumor tissues of 70 patients who were referred to Imam Khomeini Hospital Complex was determined using quantitative Real-time PCR. Multiplex ligation-dependent probe amplification (MLPA) was conducted to evaluate the ERBB2 gene copy number variation and finally, two-sample Wilcoxon rank-sum (Mann-Whitney) test was used to investigate the possible association between mitochondrial DNA (mtDNA) content and the ERBB2 gene amplification. Seventeen out of 70 breast cancer tumor tissues were found with ERBB2 gene amplification. Comparison of the mitochondrial DNA content of the aforementioned samples with the rest of the cases showed a significant decrease in the mitochondrial DNA content of the ERBB2-amplified samples (P=0.01). Our data provided evidence that ERBB2 have the potential to have a regulatory role over mitochondrial activity by controlling the mtDNA content.

Impact of Protocol Implementation on Rationalization of Albumin Use in a Tertiary Care Teaching Hospital in Tehran, Iran.

Objective:With respect to the high cost and limited availability of albumin, its use must be restricted to indications strongly supported by solid scientific evidence. It was anticipated that with the implementation of the National Health Reform Plan (NHRP), the consumption of albumin would increase as the result of decreasing patients' out-of-pocket costs. This study aimed to evaluate the efficacy of protocol implementation on the rationalization of albumin use in surgery wards of Cancer Institute of Imam Khomeini Hospital Complex, Tehran, Iran.Methods:This pre-post interventional study was conducted in 32-month phases from January to November 2014 in an Iranian University hospital. The first phase was before the implementation of NHRP, the second phase was after NHRP, and the last one was after the intervention. The first and second phases were conducted retrospectively. Data extraction was performed by a hospital pharmacist. During the third phase, the physicians were mandated to adhere to a local albumin protocol which had been prepared by clinical pharmacy service and approved by drug and therapeutic committee. Appropriateness of prescriptions regarding indication, dose, and duration based on local guideline was compared among groups.Findings:Although hospital bed-days of care remained consistent among phases, albumin was prescribed for 40, 45, and 8 patients during first, second, and third phases, respectively. This shows about 80% reduction of drug prescriptions in the last phase. The mean duration/dose of albumin in inappropriate indications reduced significantly from 11.3 ± 8.2 days/24.7 ± 21.2 vials in the second phase to 2.6 ± 1.7 days/5.6 ± 3.5 vials in the third phase, respectively (P = 0.001 and P = 0.003).Conclusion:Interactive collaboration through guideline implementation seems effective in rationalizing the use of high-cost medications such as albumin.

Antibiotic stewardship program in Intensive Care Unit: First report from Iran.

Introduction:Few data regarding antibiotic stewardship programs in critically ill patients are available. In the present study, the consequence of changing an empirical antibiotic regimen from a carbapenem (meropenem) to a noncarbapenem antibiotic (piperacillin-tazobactam) was evaluated in critically ill patients with a suspicion of sepsis.Methods:This open-label randomized clinical trial was conducted during May 2015–January 2017 at the general Intensive Care Unit of the Imam Khomeini Hospital Complex, Tehran, Iran. In this study, a carbapenem (meropenem) or a noncarbapenem (piperacillin-tazobactam) antibiotic was considered as an empirical antibiotic regimen in 100 critically ill patients with a suspicion of sepsis. Clinical response and bacterial eradication were defined as primary and secondary outcomes of the study, respectively. Chi-square, Mann–Whitney, and independent sample t-tests were used for comparing variables between the groups. ANOVA was used to compare changes in the mean differences of parameters between the groups. Meaningful difference was indicated as P ≤ 0.05.Results:During the first 72 h of the antibiotic course, the number of patients with clinical response was comparable between piperacillin-tazobactam and meropenem groups (21 [42%] and 25 [50%], respectively, P = 0.31). Also, at this time, microbial eradication occurred in 13 (54.16%) and 9 (40.90%) patients in piperacillin-tazobactam and meropenem groups, respectively (P = 0.67).Conclusions:Using a carbapenem (meropenem) instead of a noncarbapenem (piperacillin-tazobactam) as an empirical antibiotic regimen did not affect clinical response and bacterial eradication rates in critically ill patients with a suspicion of sepsis.

Association between detrusor muscle function and level of the spinal cord injury.

IntroductionTraumatic spinal cord injury (TSCI) is among the most severe disabilities with an estimation of 2.5 million people affected worldwide. The purpose of this study was to investigate the association between detrusor muscle function and the level of the spinal cord injury.Material and methodsAll patients with TSCI who underwent urodynamic evaluation at the Brain and Spinal Injury Research Center (BASIR) of Imam Khomeini hospital complex from March 2014 to March 2016 were retrospectively entered in this cross-sectional study. The patients were divided into three groups of suprasacral (C1-T12), sacral (L1-S5) and combined (both suprasacral and sacral) lesions.ResultsMedical records of 117 patients with spinal cord injury were reviewed. The mean age of the patients was 35.64 (±12.01) years. 86 patients (73.5%) were male and 31 female (26.5%). While 66 (56.4%), 28 (23.9%) and 19 (16.2%) patients had suprasacral, sacral, and combined suprasacral and sacral lesions, respectively. The relationship between the level of injury and emptying disorder (P = 0.50), storage disease (P = 0.20), first desire to void (P = 0.82), hypocompliance (P = 0.95), voided urine volume (P = 0.38) and residual urine volume (P = 0.76) were not significant. We found a significant association between the level of injury and the type of detrusor function (P = 0.019).ConclusionsOur study showed an association between detrusor muscle function and level of the spinal cord injury. However, there was no exact relationship between the level and the completeness of the spinal cord injury with the urodynamic characteristics.

Comparison of the Prevalence of Helicobacter pylori Infection Between the Exclusively Breastfed and Formula- or Mixed-Fed Infants in the First Six Months of Life

Background: Helicobacter pylori is a common gastrointestinal pathogen in human. The mechanism of its acquisition and transmission is unclear, although the most likely mode of transmission is fecal-oral or oral-oral. Most of infections occur in childhood. The current cohort assessed the prevalence of infection in infants with different feeding strategies (exclusive breastfeeding, formula, or mixed feeding). Methods: The current study was carried out in Vali-Asr hospital of Imam Khomeini hospital complex, Tehran, Iran, from 2012 to 2015.The study population included infants born in this hospital and registered in breastfeeding research center during the first 6 months of life. They were compared in 2 groups; exclusively breastfed, and formula or mixed fed. Mothers’ H. pylori infection was checked serologically using the enzyme-linked immunosorbent assay (ELISA) technique and those of infants by monoclonal antibody test using ELISA technique on stool samples at 1st and 6th month of life. Results: A total of 102 infants in 2 groups (54 exclusively breastfed and 48 formula or mixed fed) completed the study. Mothers’ serological assessments were positive in 68% of exclusively breast-fed subjects and 60% of formula or mixed fed subjects. All 1-month-old infants were negative for the infection and in the 6-month-old infants 10 cases (18.5%) were positive, 1 case was at borderline in the exclusively breastfed, and 13 cases (27%) were positive in formula- or mixed-fed subjects. This difference was not statistically significant (P = 0.302). The Mantel-Hanzel test was used to find a relationship in H. pylori positivity in mothers and infants during the first 6-month of life in each of the 2 groups. It was found that out of 37 serologically positive mothers in the breastfed group, 8 infants (22%) were H. pylori positive and in the formula and mixed-fed group, of 29 serologically positive mothers 10 infants (34%) were also H. pylori positive, but the difference between the groups was not statistically significant (P = 0.727). It meant that the prevalence of infantile H. pylori infection was similar in the 2 groups. Conclusions: The current study findings showed that exclusive breastfeeding had no role in protection or facilitation of H. pylori infection.

The grounded theory of "trust building".

Despite the growing importance of spiritual care, the delivery of spiritual care is still an area of disagreement among healthcare providers. To develop a grounded theory about spiritual care delivery based on Iranian nurses' perceptions and experiences. A qualitative study using the grounded theory approach. Data were collected through holding 27 interviews with 25 participants (17 staff nurses, 3 physicians, 3 patients, 1 family member, and 1 nurse assistant). The study setting was the Imam Khomeini Hospital Complex. Sampling was started purposively and continued theoretically. Data analysis was performed by the method proposed by Strauss and Corbin. The study was approved by the Ethics Committee of Tarbiat Modares University and the agreement of the administrators of the study setting was got before starting the study. The core category of the study was "Trust building" which reflected the nature of spiritual care delivery by nurses. Trust building was the result of eight main categories or strategies including creating a positive mentality at hospital admission, understanding patients in care circumstances, having a caring presence, adhering to care ethics, developing meaningful relationships, promoting positive thinking and energy, establishing effective communication with patients, and attempting to create a safe therapeutic environment. Poor interprofessional coordination negatively affected this process while living toward developing greater cognizance of divinity and adhering to the principles of professional ethics facilitated it. The outcome of the process was to gain a sense of partial psychological security. The "Trust building" theory can be used as a guide for describing and expanding nurses' roles in spiritual care delivery, developing care documentation systems and clinical guidelines, and planning educational programs for nursing students and staff nurses.

Understanding the factors associated with nonreporting of needlestick injuries in nurses at Imam Khomeini Hospital Complex, Tehran 2016: A case study

Introduction: Needle in the body creates one of the potential problems which put people working in the health-care environment at risk of exposure to infection. The number of contaminated needlestick injuries among health-care workers as a result of underreporting of these injuries is unknown. The aim of this study is to investigate factors related to nurses reporting of needlestick in Imam Khomeini in Tehran. Materials and Methods: The present research method is a descriptive–analytic survey. The statistical population included all nurses in Tehran Imam Khomeini Hospital Complex consisting of three centers (Imam Khomeini Hospital, Vali-Asr, and Cancer Institute) in 2016. According to the Statistics center of Tehran University of Medical Sciences and Human Resources, on-duty nurses are 1100. Two hundred and eighty-five nurses stratified randomly sampling table and using Morgan were selected. To collect the data, in this study, a standard questionnaire reporting Azadi and Anoushe (2007) was used. Research data analysis, descriptive and inferential statistics were performed using SPSS software. Results: The results of descriptive statistics showed that 61.5 percent of nurses had experienced a needlestick exposure, while fending off contaminated needles has been the most frequent (RF = 61.5). Inferential statistical findings showed that the average area of individual and organizational affecting the reporting of needlestick respectively was 2.14 and 2.26. Also, there was a significant difference between individual and organizational factors affecting the reporting of needlestick injury based on education and work experience. Conclusion: The results of this study showed that contaminated needlestick injuries and underreporting of injuries among nurses include a high rate and larger studies need to be done in this regard. Interventions such as a standard protocol as well as reporting, staff training, and postexposure prophylactic standard treatments can be effective in improving the reporting percentage of these injuries.

Protective Effects of L-Carnitine Against Delayed Graft Function in Kidney Transplant Recipients: A Pilot, Randomized, Double-Blinded, Placebo-Controlled Clinical Trial

Delayed graft function (DGF) is an early complication after deceased donor kidney transplantation with significant adverse effects on graft outcomes. Ischemia-reperfusion injury during transplantation is a major cause of DGF. Tissue concentrations of carnitine, an antioxidant and regulator of cellular energy supply, decrease in the kidney following ischemia-reperfusion insult. Based on promising animal data, this study evaluated the possible protective effect of L-carnitine against DGF. This study is a pilot, randomized, double-blind, placebo-controlled clinical trial that was conducted on kidney transplantation patients in kidney transplant ward of Imam Khomeini hospital complex affiliated to Tehran University of Medical Sciences, Tehran, Iran. Patients older than 14years old undergoing their first kidney transplantation from a deceased donor were evaluated for eligibility to take part in this study. Fifty-six patients were randomly assigned to L-carnitine or placebo groups. During this trial, 3g of oral L-carnitine or placebo was administered in 3 divided doses each day for 4 consecutive days starting the day before kidney transplantation (i.e., days -1, 0, 1, and 2). The need for dialysis within the first week after transplantation, serum creatinine and urine output were assessed daily. After hospital discharge, patients were followed for 3months regarding organ function. DGF incidence did not differ between the L-carnitine and placebo groups (18.51% vs. 23.8%, respectively; P=.68). Total allograft failure within 3months after kidney transplantation happened in 6 patients in the placebo and 1 patient in the L-carnitine group (P=.05). This study showed no protective effects of oral L-carnitine supplementation against DGF occurrence recipients; however, 3-month graft loss was lower in the L-carnitine supplemented group.