Imam Khomeini Hospital Research Articles

Investigating RTS, TRISS, GCS, and FOUR as measures for predicting the mortality in trauma patients: A prospective study

Background: Some measures have been proposed for the prediction of death after trauma; however, there is a lack of studies on this issue in trauma patients. Therefore, this study was conducted to compare the validity of four scales in predicting the death of trauma patients, and we hypothesized that the accuracies of various scales are different. Methods: This descriptive-analytical study was conducted prospectively on 600 trauma patients admitted at the emergency ward of Imam Khomeini Hospital in Ilam, Ilam province, west of Iran. The subjects were selected by convenience sampling. Data were collected using the checklists developed for trauma patients, including the Full Outline of UnResponsiveness (FOUR) score, Glasgow Coma Scale (GCS), Revised Trauma Score (RTS), and Trauma and Injury Severity Score (TRISS), and then the data were analyzed using the chi-square test and the area under the receiver operating characteristic curve (AUC). Results: Among the 600 patients, most of them were male (76.8%), with a mean and standard deviation of the age of 31.16 ± 18.06 years, and road traffic accident was the most common cause of trauma (73%). The FOUR scale was the most valid in predicting the mortality of trauma patients, and its sensitivity, specificity, positive and negative predictive values, and accuracy were equal to 93.2, 94.5, 64.7, 99.2, and 94.3%, respectively. The AUC was equal to 0.938 for the FOUR scale, followed by the RTS (0.787). Conclusion: Results of the study about the predictive value of the scales for mortality prediction of trauma patients showed that the FOUR scale had the highest accuracy compared to other scales. Thus, for applying this scale in trauma and emergency centers, besides our results, further studies are needed to support the study findings.

Predictors of Daily Life Functioning in HIV-Infected Individuals

Background: Daily life functioning refers to the skills needed to independently perform day to day routines and deficits of daily life functioning common among people living with HIV. This study aimed to investigate the role of immunologic, virologic, cognitive functioning, and demographic variables to predict daily life function in HIV-infected individuals.
 Methods: We recruited 67 HIV-positive individuals who were under the treatment of Anti-Retroviral Therapy (ART) in Imam Khomeini hospital, Tehran, Iran, in 2016. Prospective-retrospective memory questionnaire (PRMQ), Instrumental Activities of Daily Living interview (IADLs), and flow cytometry test to assess CD4 count were used. The data were analyzed with stepwise regression analysis using SPSS-22 software.
 Results: The results of stepwise regression analysis showed that the prospective/retrospective memory complaints are predictive of daily functioning in people living with HIV (p<0.001, F (1,42) =26.86, R2 adj=0.381). Our results also indicated that CD4 cell count, viral load, age, gender, and education do not predict instrumental activities of daily living scores among HIV-infected individuals (p>0.05).
 Conclusion: Future studies should focus on the effects of prospective/retrospective memory rehabilitation to improve the daily function of HIV-infected individuals. Future studies should also focus on the mediating role of muscle mass decreases between the association of daily life functioning with CD4 and viral load.

Evaluation of Relationship Between Risk Factors of Cardiovascular Disease and Morbidity and Mortality of COVID-19 Patients

Background: The coronavirus disease 2019 (COVID-19) global pandemic is a life-threatening condition with high morbidity and mortality rate in Iran. Based on several studies, COVID-19 clinical outcomes are associated with co-morbidities, such as Cardiovascular Diseases (CVD). It appears that there is a relationship between the COVID-19 prognosis and the existence of CVD-related risk factors, for instance hypertension, obesity, diabetes, etc. 
 Methods: A descriptive-analytical cross-sectional study was designed to investigate the relationship between CVD risk factors and COVID-19 with a total of 100 participants in Imam Khomeini hospital, Tehran, Iran. A checklist of anthropometric and prognostic information was filled for each patient and finally the data were analyzed. 
 Results: There was a statistically significant dependence between hospitalization in ICU, reservoir bag-mask, intubation, life-threatening complications, and the final outcome (p<0.01). However, there was no significant correlation between CVD risk factors and prognostic parameters like length of Intensive Care Unit (ICU) hospitalization, the requirement to reserve bag-mask oxygenation, etc. 
 Conclusion: In this investigation, no significant association was observed between CVD-related risk factors and COVID-19 prognosis among Iranian adult COVID-19 cases.

Evaluation of Serum Vitamin D Level and its Effect on the Severity of Disease in Patients with Inflammatory Bowel Disease

Background: Evolving evidence indicates the role of vitamin D deficiency in the progression of IBD and its impact on the severity of the disease, but it remains unclear whether vitamin D deficiency causes IBD or vice versa.
 Methods: This cross-sectional study was conducted to determine the serum levels of vitamin D and its effects on the severity of disease in patients with inflammatory bowel disease in the Imam Khomeini Hospital complex. A questionnaire containing demographic information, records on the use of supplements and medications, disease complications, and criteria for determining the severity of the disease based on the Mayo score and Crohn’s Disease Activity Index (CDAI) and 25 hydroxy vitamin D levels was completed and evaluated.
 Results: Of the 101 participants, 21 were with Crohn’s disease and 80 had ulcerative colitis. The mean age of Crohn’s patients was 33.80±9.5 years and ulcerative colitis was 38.43±10.2 years. Among patients with ulcerative colitis, 37 (46.8%) had a mayo score less than 3 and 42 (53.2%) were 3 and more. Mean vitamin D in the mayo score less than 3 was 32.14 and the mayo score 3 and more was 23.99. Of the Crohn’s patients, 12 (57.1%) were in the recovery phase and 9 (52.9%) were in a non-recovery phase. The mean of vitamin D in the recovery phase was 29.10 and in the others was 27.04
 Conclusion: There is a significant relationship between the level of vitamin D supplementation, the final value of CDAI, and the identification of the patients with the Mayo score.

Engagement of Healthcare Professionals in Voluntary Activities During COVID-19: A Cross-Sectional Study

Background: The coming various disasters, especially probable pandemics, will need a large number of volunteers with different capabilities. Motivation of volunteers, as a driving force, will be very important for future pandemic disaster planning. The aim of this study was to determine the enablers and barriers to the engagement of healthcare professionals in voluntary activities during the COVID-19 pandemic.
 Methods: This cross-sectional study was conducted at the General Internal Medicine Departments of Imam Khomeini Hospital Complex in Tehran, Iran. A 44-item questionnaire was designed based on the Literature Review and Experts Panel. Items were scored on a 5-point Likert scale, ranging from “strongly disagree (1)” to “strongly agree (5)”. Content validity and face validity of the questionnaire were checked by 10 experts and 10 respondents, respectively. Cronbach’s alpha of the items of stimulating and inhibitory factors’ section was calculated 0.83 and 0.92, respectively. A self-administrated paper-based questionnaire has been distributed among healthcare team members. 
 Results: Out of 105 health care professionals, 80 (76.2%) were female and 41 (39%) were married. The most significant demographic predictor of willingness to volunteering was having no child (p-value=0.001). History of infection, admission, or death of family members or friends in the current pandemic was an important factor to reduce the desire to voluntary activities significantly (p-value=0.019). Depressive disorders and using antidepressants had no relation with the attraction to volunteering, but anxiety disorders had a significant relation with the willingness to be a volunteer (p-value=0.04).
 Conclusion: The most important demographic variables influencing the unwillingness to participate in voluntary activities during the COVID-19 crisis are parenting role, history of anxiety disorders, and history of hospitalization or death of relatives or friends. Furthermore, the voluntary participation of healthcare professionals is influenced by facilitating factors such as giving rewards, reducing the period of obligatory military service, having a sense of altruism, and helping others.

Adherence to the Mediterranean Diet Association with Serum Levels of Nitric Oxide, Prostacyclin, and Thromboxane B2 among Prinzmetal Angina Patients and Healthy Persons.

This study aimed to assess the association between adherence to the Mediterranean diet with serum Nitric oxide, Prostacyclin, and Thromboxane B2 among Prinzmetal angina patients and healthy persons. This case-control study was conducted among 100 Prinzmetal angina patients and 100 healthy persons referred to the Ardabil Imam Khomeini hospital between 2021 and 2022. Blood samples were obtained from all study participants for measurement of serum Nitric oxide, Prostacyclin, and Thromboxane B2. To calculate adherence to the Mediterranean diet, the ten-item screener was used. The serum Nitric oxide in patients who adhered more to the Mediterranean diet was higher than patients with less adherence (coeff. = 0.41 p = 0.04). The serum Prostacyclin level in patients with greater adherence to the Mediterranean diet was 0.34 units higher than patients with less adherence (coeff. = 0.34 p = 0.02). The level of serum Thromboxane B2 had a negative association with adherence to the Mediterranean diet (coeff. = -0.48 p = 0.04). The amount of consumption of olive oil, fruits, vegetables, and legumes in healthy people was more than Prinzmetal angina patients. In Prinzmetal angina patients, more adherence to the Mediterranean diet can decrease the serum Thromboxane B2 and increase the serum Nitric oxide and Prostacyclin.

Automatic Diagnosis of COVID-19 Pneumonia using Artificial Intelligence Deep Learning Algorithm Based on Lung Computed Tomography Images.

The lung computed tomography (CT) scan contains valuable information and patterns that provide the possibility of early diagnosis of COVID-19 disease as a global pandemic by the image processing software. In this research, based on deep learning of artificial intelligence, the software has been designed that is used clinically to diagnose COVID-19 disease with high accuracy. Convolutional neural network architecture developed based on Inception-V3 for deep learning of lung image patterns, feature extraction, and image classification. The theory of transfer learning was utilized to increase the learning power of the system. Changes applied in the network layers to increase the detection power. The process of learning was repeated 30 times. All diagnostic statistical parameters of the diagnostic were analyzed to validate the software. Based on the data of Imam Khomeini Hospital in Sari, the validity, sensitivity, and accuracy of the software in diagnosing of affected to COVID-19 and nonaffected to it were obtained 98%, 98%, and 98%, respectively. Diagnostic statistical parameters on some data were 100%. The modified algorithm of Inception-V3 applied to heterogeneous data also had acceptable precision. The proposed basic architecture of Inception-v3 utilized for this research has an admissible speed and exactness in learning CT scan images of patients' lungs, and diagnosis of COVID-19 pneumonia, which can be utilized clinically as a powerful diagnostic tool.

Biofeedback Treatment Can Improve Clinical Condition and Quality of Life in Patients with Pelvic Floor Dyssynergy with Irritable Bowel Syndrome: A Prospective Cohort Study.

Background: Chronic constipation is a common health concern. Defecatory disorders are considered one of the mechanisms of chronic idiopathic constipation. This study aimed to evaluate the effect of concurrent irritable bowel syndrome (IBS) on the success rate and response to biofeedback therapy in patients with chronic constipation and pelvic floor dyssynergia (PFD). Methods: This prospective cohort study was performed at the Imam Khomeini Hospital Complex in Tehran from October 2020 to July 2021. Patients aged 18-70 years with chronic constipation and PFD confirmed by clinical examination, anorectal manometry, balloon expulsion test, and/or defecography were included. All patients failed to respond to treatment with lifestyle modifications and laxative use. The diagnosis of IBS was based on the ROME IV criteria. Biofeedback was educated and recommended to all patients. We used three different metrics to assess the patient's response to biofeedback: 1) constipation score (questionnaire), 2) lifestyle score (questionnaire), and 3) manometry findings (gastroenterologist report). Results: Forty patients were included in the final analysis, of which 7 men (17.5%) and 21 (52.2%) had IBS. The mean age of the study population was 37.7 ± 11.4. The average resting pressure decreased in response to treatment; however, this decrease was statistically significant only in non-IBS patients (P = 0.007). Patients with and without IBS showed an increase in the percentage of anal sphincter relaxation in response to treatment, but this difference was not statistically significant. Although the first sensation decreased in both groups, this decrease was not statistically significant. Overall, the clinical response was the same across IBS and non-IBS patients, but constipation and lifestyle scores decreased significantly in both groups of patients with and without IBS (P < 0.001). Conclusion: Biofeedback treatment appears to improve the clinical condition and quality of life of patients with PFD. Considering that a better effect of biofeedback in correcting some manometric parameters has been seen in patients with IBS, it seems that paying attention to the association between these two diseases can be helpful in deciding on treatment.

A Study of Early Life Experiences, Temperament, Character, and Psychological Pain in Suicide Attempters and Normal Individuals

Background: Studies conducted in different countries have reported a relationship between suicidal tendencies and childhood trauma experiences, personality traits, and psychological pain. It would be valuable to re-examine such a relationship in Iranian culture. Objectives: This study aimed to investigate early life experiences, temperament, character, and psychological pain in suicidal attempters and normal individuals. Methods: This cross-sectional, causal-comparative, basic research was conducted retrospectively on all individuals who had attempted suicide by drug poisoning and were referred to Imam Khomeini Hospital of Kermanshah, Iran. The study sample, consisting of 121 suicide attempters by drug poisoning and 121 healthy individuals (companions of suicide attempters), was selected by purposeful sampling, according to the inclusion and exclusion criteria. The participants completed the questionnaires about early life experiences, temperament, character, and mental pain. A discriminant analysis was also performed to analyze the data. Data analysis was performed in SPSS version 26. Results: Based on the simultaneous discriminant analysis, 4 predicting variables (early life experiences, temperament, character, and psychological pain components) could explain 91.7% of the variance in suicide attempts. Based on the stepwise discriminant analysis, six subscales predicting variables (emptiness/worthlessness, harm avoidance, persistence, worthlessness, cooperation, and self-transcendence) could explain 91.7% of the variance in suicide attempts, as shown in the discriminant function analysis for differentiation of suicide attempters from normal people. Conclusions: Based on the findings of the present study, emptiness/worthlessness, personality traits, and early traumatic experiences can predispose individuals to suicide attempts. Therefore, there is an urgent need for psychological interventions to reduce psychological pain in suicidal attempters.

Antibiotic Treatment in End Stage Cancer Patients; Advantages and Disadvantages

In this study our aim was to elucidate whether advanced cancer patients benefit from antibiotic treatment in the last days of life in addition to reviewing the relevant costs and effects. We reviewed medical records from 100 end-stage cancer patients and their antibiotic use during the hospitalization in Imam Khomeini hospital. Patient's medical records were analyzed retrospectively for cause and periodicity of infections, fever, increase in acute phase proteins, cultures, type and cost of antibiotic. Microorganisms were found in only 29 patients (29%) and the most microorganism among the patients was E. coli (6%). About 78% of the patients had clinical symptoms. The highest dose of antibiotics was related to Ceftriaxone (40.2%) and in the second place was Metronidazole (34.7%) and the lowest dose was related to Levofloxacin, Gentamycin and Colistin (1.4%). Fifty-one patients (71%) did not have any side effects due to antibiotics. The most common side effect of antibiotics among patients was skin rash (12.5%). The average estimated cost for antibiotic use was 7 935 540 Rials (24.4 dollars). Prescription of antibiotics was not effective in symptom control in advanced cancer patients. The cost of using antibiotics during hospitalization is very high and also the risk of developing resistant pathogens during admission should be considered. Antibiotic side effects also occur in patients, causing more harm to the patient at the end of life. Therefore, the benefits of antibiotic advice in this time is less than its negative effects.

Epidemiology, Risk Factors, and Outcome of Cardiac Dysrhythmias in a Noncardiac Intensive Care Unit.

Several extrinsic factors contribute to the development of cardiac dysrhythmias. In intensive care unit (ICU) settings and among critically ill patients who are exposed to a large number of risk factors, cardiac disturbances are more common. This study aimed to examine the epidemiology, risk factors, and outcome of cardiac dysrhythmias in a non-cardiac ICU. This is a retrospective, single-center, observational study conducted in a tertiary noncardiac ICU at Imam Khomeini Hospital in Ahvaz, Iran. Out of the 360 adult patients aged 18 years and older who were admitted to ICU for longer than 24 h, 340 cases who met the study inclusion criteria were recruited between March 2018 until October 2018. The most common nonsinus dysrhythmias were new-onset atrial fibrillation (NOAF) (12.9%) and ventricular tachycardia (21 patients-6.2%). According to our results, previous percutaneous coronary instrumentation, acute kidney injury, sepsis, and hyperkalemia act as risk factors in the development of cardiac dysrhythmias. Additionally, we found out that thyroid dysfunction and pneumonia can predict the development of NOAF in critically ill patients. The estimated mortality rate among patients with NOAF in this study was 15.7% (p < .05). Cardiac dysrhythmias are common in ICU patients and treating the risk factors can help to prevent their development and improve patient management and outcome.

Efekat edukativne kompilacije u formi video zapisa i vizuelnih pomagala na kvalitet pripreme creva kod bolesnika koji se podvrgavaju kolonoskopiji

Background/Aims. High-quality bowel preparation is a prerequisite for colonoscopy. The aim of this study was to determine the effect of educational compilation through educational videos and visual cards on the quality of bowel preparation in colonoscopy. Materials and methods. The present study was carried out in Imam Khomeini Hospital in Urmia, Iran, 2018. In this experimental study, 180 colonoscopy candidate outpatients, who were eligible to participate in the study, were selected. Next, the participants were randomly assigned to an intervention group (n = 90) and a control group (n = 90). The data collection tools included a demographic questionnaire and Boston Bowel Preparation Scale. Before the colonoscopy, the intervention group was provided with the educational videos and visual cards. However, the control group received the usual education. After collecting the data, they were statistically analyzed using SPSS software version 16. The researcher used Chi-square, independent t-test, and logistic regression tests to analyze the data. Results. The bowel preparation score in the intervention group (8.46±0.90) was higher than the bowel preparation score in the control group (4.34 ± 2.09) (t178 = -17.10, p &lt; 0.001). Multivariate analysis controlled the effect of demographic variables and showed that the intervention significantly increased the quality of bowel preparation in the intervention group (odds ratio 141.70, p &lt; 0.001). Conclusion. Education compilation through educational videos and visual cards was effective in increasing the quality of bowel preparation in the case of patients who received colonoscopy. Therefore, it is recommended that this kind of education be used during invasive diagnostic and treatment methods such as colonoscopy.

Genetic relationship, antibiotic resistance pattern and virulence factors of Klebsiella pneunoniae strains isolated from meningitis patients

Backgroud: Meningitis due to Klebsiella pneunoniae is increasingly reported from several Asian countries. Microbiological characteristic of K. pneumoniae strains causing meningitis is not yet explored in Iran. The aim of this study was to demonstrate antibiotic resistance pattern and virulence factors, as well as the genetic relationship of K. pneumoniae strains isolated from meningitis patients. Materials and Mehtods: Eight K. pneumoniae isolates were collected from hospitalized patients at Imam Khomeini hospital, Tehran-Iran from 14 May 2018 to 15 Mar 2020. The antibiotic resistance pattern was determined by disc diffusion method. Antibiotic resistance genes and virulence-associated genes were traced by Polymerase Chain Reaction. Repetitive Extragenic Palindromic Polymerase Chain Reaction was used for evaluation of the genetic relationships among isolates. Findings: Six out of eight isolates were resistant to almost all the 15 antibiotics tested. These six isolates harbored triple antibiotic resistance genes: blaOXA-48, blaSHV, and aac (6’)-Ib. Five of these isolates co-harbored aac (3)-IIa gene. Besides, blaTEM and blaCTXM-1 were detected in five and three isolates respectively. blaNDM-1 was identified in one isolate. All isolates harbored acrAB, ompK36, and tolC resistance genes. None of the isolates were related to K1 or K2 capsular serotypes. The most commonly detected virulence genes were entB (100%), mrkD (100%), ybtS (62.5%) and kfu (25%). rep-PCR fingerprinting discriminated seven isolates into three clusters. Conclusion: Simulations presence of the genes coding for Extended Spectrum Beta Lactamases, Carbapenemases, and Aminoglycoside Modifying Enzymes narrows therapeutic alternatives and imposes a heavy load on the public health system. Antibiotic susceptibility test is recommended however, Carbapenems can still be considered as first-line medications for preliminary empirical treatment of K. pneumoniae meningitis before obtaining susceptibility test results. Low genetic diversity suggests the circulation of certain K. pneumoniae clones in hospital which highlights the establishing of effective infection observation and prevention program.

Effectiveness of life enrichment and advancement program on improving emotional adjustment of women with M.S.

This study aimed at determining the effectiveness of life enrichment and advancement program on emotional adjustment of women with M.S. It was a quasi-experimental study with experimental and control groups and pre-post-test design. Statistical population included women with M.S. referred to Loghman Hakim Hospital and Imam Khomeini Hospital. A sample of 30 women was randomly selected and assigned to experimental and control groups. The experimental group received 6 sessions of group intervention and the control group was on the waiting list. Both groups responded to Bell's adjustment scale before and after the experiment. Descriptive statistics and co-variance analysis were used to analyze the data. The results showed that life enrichment and advancement program had an effect on emotional adjustment (F = 26/74), (P &lt;0/001) so that it improved emotional adjustment in women with M.S.

Evaluation of TSH level in the first trimester of pregnancy in women with no history of thyroid Disorder referred to Imam Khomeini and Razi Hospital of Ahvaz

Evaluation of TSH level in the first trimester of pregnancy in women with no history of thyroid Disorder referred to Imam Khomeini and Razi Hospital of Ahvaz

Organizational Ethics Indicators in Iranian Hospital: An Importance-Performance Analysis.

Organizational ethics focuses on the importance of how organizations behave when faced with specific situations and decisions. This study aims to identify and prioritize organizational ethics indicators in Imam Khomeini Hospital Complex (IKHC) in Iran. This was a mixed-method research project. To recognize hospital ethics indicators, 18 semistructured interviews were conducted and 38 indicators were identified through thematic analysis. In the next stage, a quantitative approach was adopted to use the importance-performance matrix for data analysis. This part was a descriptive survey with a statistical population consisting of nurses, medical, clinical, and administrative staff. The questionnaire was distributed using the random sampling method, and a total of 349 samples were collected. Based on the interviews and open coding, 73 themes were identified for organizational ethics indicators and classified into two main groups: "ethics drivers in hospital" and "personal ethics." After measuring content validity, 35 indicators of organizational ethics in IKHC were examined in terms of importance and performance. The results showed that nine indicators had high importance and poor performance, 11 had high importance and performance, nine had low importance and performance, and finally six indicators had low importance and high performance, and according to these findings, practical suggestions were put forward. Based on the identified indices and by applying importance-performance analysis, it is recommended to continually assess the status of ethics in hospitals and offer strategies for improving organizational ethics.

C-Reactive Protein and D-dimer as Prognostic Markers for Clinical Outcomes in Patients with Mild Traumatic Brain Injury: A Cross-Sectional Study.

To investigate the use of prognostic markers such as C-reactive protein (CRP) and D-dimer for clinical outcomes in patients with mild traumatic brain injury (TBI). This cross-sectional study was conducted on patients with mild head trauma who were admitted to the Emergency Department of Imam Khomeini Hospital (Sari, Iran). Data were collected from 2018 to 2019. Age, sex, the time of injury hospitalization, length of hospitalization, length of unconsciousness, blood pressure, heart rate, respiratory rate, and concomitant symptoms were all recorded using a pre-designed checklist. The patient's Glasgow Coma Scale (GCS), CRP, and D-dimer were also measured. Moreover, all patients underwent CT scan. This study included 74 patients with TBI. The mean age of the participants was 36.92±3.54. The mean CRP and D-dimer values were 5.69±0.77 and 0.58±0.11 in these patients, respectively. At the cut-off point of 11.50 for CRP, the sensitivity and specificity to detect the pathological lesions in CT scan were 75% and 95.50%, respectively (p<0.001). Additionally, with a D-dimer cut-off point of 0.90, the sensitivity and specificity for diagnosing pathological lesions in CT scan were 100% and 98.50%, respectively (p<0.001). In general, the CRP and D-dimer levels of patients with mild TBI (GCS≥13) can be assessed to protect against CT-induced radiation exposure and subsequent disorders; if they do not exhibit clinical signs to increase the risk of adverse brain damage, such as reduced level of consciousness, drowsiness, and prolonged periods of unconsciousness.

Effect of an Intervention Based on the Family-centered Empowerment Model on the Resilience of Family Caregivers of Hemodialysis Patients: A Randomized Controlled Clinical Trial

Background and Objectives: Chronic kidney disease is a debilitating disease that can also affect the family caregivers of patients. Increasing awareness and empowering caregivers can improve the physical and mental condition of patients and the resilience of caregivers. This study aims to evaluate the effect of an intervention based on the family-centered empowerment model (FCEM) on the resilience of family caregivers of hemodialysis patients. Methods: This is a randomized controlled clinical trial. Sixty family caregivers of patients in the hemodialysis department of Imam Khomeini Hospital in Kermanshah, Iran were selected by a random sampling method using a random number table. Then, they were randomly divided into two groups of intervention (n=30) and control (n=30). The assessment tools were a demographic form and the Connor-Davidson resilience scale. Descriptive and inferential statistics were used to analyze the data in SPSS software, version 18. Results: The results of independent t-test showed that the mean resilience score at baseline was not significantly different between the two groups (P=0.29). After the intervention, it was significantly increased in the intervention group compared to the control group (P&lt;0.001). In addition, there was a statistically significant difference between pre- and post-intervention scores of resilience in the intervention group (P&lt;0.001), but no significant difference was found in the control group (P=0.17). Conclusion: The FCEM-based intervention increases the resilience of family caregivers of hemodialysis patients. Therefore, it is recommended that the planners in nursing education should make nurses aware of the importance of providing family-centered care to hemodialysis patients’ families for increasing their resilience.

Antibacterial and Anti-Biofilm Activities of Silver Nano Particles Conjugated to Chitosan Against Multi-Drug Resistant Bacteria.

Nowadays, most of the traditional and conventional antibiotics are not effective against drug resistant bacterial strains. The emergence and spread of drug resistant bacterial cells calls for new therapeutic agents and strategies to control and treat the infections caused by these bacteria. In this regard, the application of nano-technology in medicine is an interesting approach. Therefore, the aim of this study was to evaluate the antibacterial and anti-biofilm activities of Ag Np conjugated to chitosan against multidrug resistant isolates of Staphylococcus aureus and Acinetobacter baumannii. Synthesis of the Ag Np and chitosan Np were performed according to the Turkevich and Ionic gelation methods, respectively. Then conjugation of nanoparticles was carried out by standard method. FTR analysis and transmission electron microscopy were used for validation of nanoparticle conjugation. Twenty clinical isolates of methicillin-resistant Staphylococcus aureus (MRSA) and 20 clinical isolates of carbapenem resistant Acinetobacter baumannii (CRAB) were obtained from the microbial bank of Imam Khomeini hospital of Tehran, Iran. MIC values of the nanoparticles alone and in conjugation were determined using the microbroth dilution method. Then, fractional inhibitory concentration of agents was concluded by standard method. Finally, anti-biofilm activities of the conjugated Ag Np-chitosan at sub-MIC concentrations was tested against bacterial isolates. Synthesis of Ag Np resulted in the formation of nanoparticles with 10 nm dimensions. MIC90 of the chitosan, Ag Np and their conjugated form were respectively 64, 16, and 8 μg/mL against CRAB isolates. Also, MIC90 of the tested agents, in the same order as mentioned above, were 32, 16, and 4 μg/mL against MRSA. Combination of the agents had additive (0.625) and synergistic (0.375) effects against CRAB and MRSA. Ability of biofilm formation was dramatically reduced by ¼ MIC concentration (2 μg/mL) against the CRAB and ½ MIC concentration (2 μg/mL) in the case of the MRSA isolates. Ag Np-chitosan conjugation, an ideal alternative for ineffective antibiotics, exhibits great antibacterial and anti-biofilm effects against CRAB and MRSA isolates.

The effectiveness of positive treatment on distress tolerance and rumination in patients with chronic hypertension

Background and Aim: It is necessary to identify psychological treatments effective in improving the mental health of patients with chronic blood pressure, so the aim of this study was to determine the effectiveness of positive therapy on the tolerance of distress and rumination in patients with chronic blood pressure Methods: The present research was a quasi-experimental type of pre-test-post-test with a control group. The statistical population of the present study was all patients with high blood pressure who referred to the specialized and super-specialized center of Imam Khomeini Hospital in 2021. Among the qualified people who volunteered to participate in the research, 30 people were selected by available sampling method and randomly placed in two experimental and control groups (15 people in each group). The experimental group participated in nine 90-minute sessions of positive therapy training based on Marrero et al.'s (2016) therapy package, but the control group did not receive therapy. Data collection tools included Simons and Gaher (2005) distress tolerance scale and Nolen Hoeksema and Morrow (1991) rumination scale. Data were analyzed using SPSS version 24 software and multivariate analysis of covariance at a significance level of α=0.05. Results: The results showed that positive treatment significantly increased distress tolerance (F=75.29, P&lt;0.001) and decreased rumination (F=24.73, P&lt;0.001) in patients with chronic hypertension. Conclusion: The results emphasize the importance of positive therapy in patients with chronic hypertension and providing new horizons in clinical interventions. Therefore, positive therapy can be used as a complementary treatment to create a positive and appropriate change in patients with chronic hypertension.