Isfahan University Of Medical Sciences Research Articles

The Effect of Tranexamic Acid Local Injection on Bleeding during and after Tonsillectomy: A Double-Blind Randomized Placebo-Controlled Trial.

Tonsillectomy-related bleeding is one of the most prevalent and potentially fatal complications of this common surgical procedure. We aimed to assess the effect of tranexamic acid (TXA) local injection on bleeding during and after tonsillectomy. This double-blind, randomized placebo-controlled trial included 20 candidates for tonsillectomy referred to Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran, in 2022. The subjects were randomized into two groups. Ten patients received TXA on their left side and the other ten on their right side 10 min before surgery. Placebo was administered to the contralateral side. The primary outcome was the volume of blood loss during tonsillectomy and up to 24 hours post-tonsillectomy. The secondary outcomes were surgeon satisfaction (rated 0-10), hemodynamic complications (patients' heart rate (HR) and mean arterial pressure (MAP) were recorded every 10 min), and rebleeding. The duration of surgery was also noted. The mean age of the patients was 21.35 ± 3.16 years, of whom 8 (30%) were male and 12 (60%) were female. there was no significant difference between groups in terms of HR and MAP at any time point. The median of surgery duration did not differ significantly between the two groups; however, the surgeon satisfaction with the procedure was significantly higher with TXA compared to placebo. None of the patients developed hemodynamic complications, and rebleeding did not occur in any of the subjects. TXA local injection was not superior to placebo in terms of bleeding control during and after tonsillectomy, hemodynamic complications, rebleeding, and surgery duration.

Predicting the Incidence of Bedsores in Intensive Care Units: Braden Scale versus Waterlow Scale

Background and Objectives Bedsores are one of the major problems observed in patients admitted to intensive care units. Two common tools for assessing the risk of bedsores are Braden and Waterlow scales. Evidence for the agreement between these two scales in predicting the incidence of bedsores is scarce. Subjects and Methods This was a prospective cohort study conducted from July to November 2017 in the ICUs of hospitals affiliated to Isfahan University of Medical Sciences. The risk of bedsores was assessed every two days using two scales, namely Braden and Waterlow, for a maximum of one month or until the patient died or was discharged. Results The findings of the study showed that the mean score of Braden scale in patients who developed bedsores was significantly lower than that of patients who did not develop bedsores (P = 0.002). Also, the mean score of Waterlow scale in patients who developed bedsores was significantly higher than that in patients who did not have bedsores (P <0.001). The sensitivity and specificity of the Braden scale were 82.6% and 53.6%, respectively, and its positive and negative predictive values were 29.7% and 92.9%, respectively. Waterlow scale had a sensitivity of 73.9% and a specificity of 68%, and its positive and negative predictive values were 35.4% and 91.7%, respectively. Conclusion Considering the area under the curve of the two scales and the sum of the two sensitivity and specificity indices, the Waterlow scale is a more suitable tool, compared with the Braden scale, for predicting bedsores in patients.

Multiple sclerosis is associated with worse COVID-19 outcomes compared to the general population: A population-based study

BackgroundWe carried out the current study to compare COVID-19-related hospitalization and mortality rates between people living with multiple sclerosis (PLWMS) and MS-free controls from the Isfahan general population. MethodIn this retrospective population-based study, we used available data from four datasets of Isfahan University of Medical Sciences from January 1, 2020, to August 22, 2021. Data on all PLWMS, SARS-CoV-2 polymerase chain reaction (PCR) and rapid antigen test, hospitalization, and death were included. We compared the odds of COVID-19-related hospitalization and mortality between PLWMS and the control group before and after adjustment for age and sex. We categorized all people into young (18–49 years) and old age (50–79 years) groups and compared the hospitalization rate between people with and without MS. ResultsIn total, 829 PLWMS and 2494 MS-free controls with confirmed COVID-19 were included. Hospitalization rates among PLWMS and MS-free controls were 16.2% and 16.5% (crude OR= 0.978, 95%CI: 0.79, 1.21). In the adjusted model, PLWMS with COVID-19 had 56% increased odds of hospitalization (OR=1.56, 95%CI: 1.23, 1.97). During follow-up, there were 11 (1.3%) and 49 (2%) COVID-19-related deaths among PLWMS and MS-free controls, respectively. No significant difference between people with and without MS in COVID-19-related mortality rate was observed (crude OR= 0.678, 95%CI: 0.351, 1.31; adjusted OR=2.013, 95%CI: 0.95, 4.26). We found increased odds of hospitalization in young PLWMS compared to those without MS at the same age (OR=1.699, 95%CI: 1.289, 2.240). But, no difference between older people with and without MS was detected (OR=1.005, 95%CI: 0.662, 1.524). ConclusionThis study revealed higher odds of hospitalization and mortality due to COVID-19 among PLWMS in comparison to age- and sex-matched controls from the general population. Nevertheless, it remains unclear whether the elevated odds are directly associated with MS itself or if they are influenced by factors such as rituximab using, comorbidity, and disease severity.

The Evaluation of Treatment Adherence and Its Association with Perceived Social Support in Patients with Mood Disorders in Hospitals Affiliated with Isfahan University of Medical Sciences in 2022

Background: Considering the importance of perceived social support and adherence to treatment in improving the treatment process of mood disorders, our aim was to determine the degree of adherence to treatment and its relationship with perceived social support in patients with mood disorders. Methods: This was a cross-sectional correlational study performed on 120 patients with mood disorders recruited by the convenience sampling method. Data were collected using the treatment adherence questionnaire developed by Heydari et al. and the multidimensional scale of perceived social support. The collected data were analyzed by SPSS 16 software using descriptive indices, Pearson correlation, ANOVA, and independent t-test. Results: The results revealed that the average age of the participants was 39.54 ± 13.13 years. Patients with mood disorders had a moderate level of treatment adherence and perceived social support (mean ± SD of 51.53 ± 8.31 and 54.75 ± 11.23, respectively). The Pearson correlation test indicated a significant association between the treatment adherence level and perceived social support among patients with mood disorders (P < 0.001), meaning that with an increase in the level of adherence to treatment, the level of perceived social support increased as well. Conclusions: Perceived social support has a significant impact on treatment adherence in patients with mood disorders. Larger studies with larger sample sizes are necessary to confirm our findings.

Organizational Climate of the COVID-19 Intensive Care Units: A Qualitative Content Analysis Study.

To manage the psychological consequences of providing services in the COVID-19 intensive care units (ICUs), it is necessary to identify the experience of nurses from the organizational climate. The current study was conducted to explain the nurses' experience of the organizational climate of the COVID-19 ICUs. This qualitative study was conducted in three teaching hospitals affiliated to Isfahan University of Medical Sciences. 17 individual and semi-structured interviews with 12 nurses working in three selected COVID-19 centers were included in the data analysis. The participants were selected by purposive sampling and interviewed in one or more sessions at a suitable time and place. Interviews lasted for 45 to 90 minutes and continued with conventional content analysis until data saturation. Data analysis was done using conventional content analysis of Graham and Leideman model. Guba and Lincoln criteria (including validity, transferability, consistency, and reliability) were used to ensure reliability and accuracy. The results of data analysis were classified into 82 primary concept codes and 10 sub-categories in the form of 3 categories: "positive climate of attachment and professional commitment", "emotional resonance in the work environment" and "supportive environment of the organization". This study led to the identification of nurses' experiences of the organizational climate during the COVID-19 which provides appropriate information to nursing managers to create a favorable organizational climate and increase the quality of work-life of nurses.

Evaluation and relation of oral health-related quality of life and oral health status in Thalassemia Major patients, a cross-sectional study

BackgroundBeta-Thalassemia is the most common human inherited disease, directly impacting patients’ physical and psychosocial aspects. The present study evaluated oral health status, oral health-related quality of life (OHRQoL), and their correlation in Thalassemia Major patients.MethodsTwo hundred Thalassemia Major patients aged 12–49 participated in this cross-sectional study. Subjects were selected among the patients referred to the Faculty of Dentistry of Isfahan University of Medical Sciences using simple sampling. Oral Health Impact Profile 14 (OHIP 14) was used to assess OHRQoL. The decayed, Missing, and Filled Teeth (DMFT) index was used as an oral health index. SPSS 22 was used for analysis, using T and Pearson Correlation tests.Results53% of participants were female, and 47% were male. The mean OHIP-14 score (± SD) was 13.20 (± 7.01). The mean DMFT score was 9.54 (± 5.72). DMFT and total OHIP 14 scores correlated significantly (p < 0.001, r = 0.78). All domains of the OHIP-14 score were also significantly correlated with DMFT (p < 0.05).ConclusionsPoor oral health conditions might adversely affect OHRQoL in TM patients. It seems necessary to provide oral treatment needs in order to improve OHRQoL in patients suffering from this particular disease.

Follow-up of Methanol-related Visual Defects in a Cohort Study: Initial Severity Predicts Long-term Outcome.

Methanol poisoning can occur either intentionally through the consumption of methanol-containing products or accidentally through ingestion, resulting in visual impairment. We assessed the long-term visual sequelae in patients with methanol poisoning. This prospective cohort study was conducted at referral centers, Khorshid and Alzahra University Hospitals, affiliated with Isfahan University of Medical Sciences, Isfahan, Iran. The study included patients hospitalized for methanol poisoning from June 22, 2018, to June 21, 2020, with follow-up extended until June 2021. Toxico-clinical and ophthalmologic examination data were collected from patients upon hospital admission, discharge, and during follow-up. Thirty-nine patients were assessed in this study. The majority of them (94.9%) were male, with an average age of 34 years. Patients who presented with reduced visual acuity (VA) upon admission subsequently showed abnormalities (in acuity and visual fields) during follow-up (n = 13). Among the patients who displayed visual field defects on admission, bilateral optic disc atrophy was observed in follow-up (n = 13). Conversely, patients who reported blurred vision, with or without photophobia upon admission, had normal results in their follow-up eye examinations. Among the 36 patients who underwent dialysis, 14 (38.9%) exhibited visual impairment during follow-up examinations. Additionally, 38 patients received sodium bicarbonate, and 14 of them (36.85%) also presented ocular abnormalities. Patients who demonstrated VA deficits upon admission are more likely to experience long-term VA and visual field defects, as well as optic disc atrophy. Patients who solely complained of blurred vision, with or without photophobia, during admission were less likely to develop long-term visual defects.

Treatment adherence and its relationship with health literacy in patients with mood disorders in hospitals affiliated with Isfahan University of Medical Sciences in 2022: A cross-sectional study

Background and aims: Mood disorders include major depression and bipolar disorder. Treatment adherence and health literacy are very important in these patients because they may affect their quality of life, performance, and recovery. Therefore, this study aims to determine the level of treatment adherence and its relationship to health literacy in patients with mood disorders. Methods: This cross-sectional-correlation study was conducted on 120 patients with mood disorders in 2021-2022. Data were collected using the treatment adherence questionnaire of Ziaee et al and the Health Literacy of Iranian Adults (HELIA) questionnaire. Finally, the collected data were analyzed in SPSS-16 software. Results: Findings showed that patients with mood disorders had moderate treatment adherence (51.53±8.31) and insufficient health literacy (61.31±15.91). The results indicated that treatment adherence had a significant relationship with health literacy in patients with mood disorders (P&lt;0.05, r: 0.298). Conclusion: Inadequate health literacy in patients with mood disorders shows that health literacy should be considered in improving mental health. Therefore, it is recommended that by promoting the health literacy of these patients and identifying its challenges, treatment adherence in patients with mood disorders be improved.

Sedation Quality of Low – Dose Ketamine Combined with Dexmedetomidine versus Propofol in Phacoemulsification under Local Anesthesia: A Triple-Blinded Randomized Clinical Trial

Purpose: To compare the hemodynamic effects of low-dose ketamine combined with dexmedetomidine versus propofol in phacoemulsification under local anesthesia. Place and Duration of Study: School of Medicine, Isfahan University of Medical Sciences during 2020-2021. Methods: Sixty patients admitted for cataract surgery were included. Those with history of systemic diseases, insufficient pupil dilation, sensitivity to drugs and uncooperative patients were excluded. Participants were randomly allocated to two groups; group which was administered ketamine with dexmedetomidine (Ketodex) and group which was given ketamine with propofol (Ketofel). Effect on blood pressure, pulse and sedation was recorded. Results: Mean age was 65 ± 9.9 years. Sixty-five were females. Ketodex increased the risk of hemodynamic disorders compared to Ketofel (P = 0.04). The risk of nausea and vomiting was higher in the Ketodex group although not significant. The effect of drug course on heart rate, blood pressure and sedation was significant in both groups (P &lt; 0.05). Neither at baseline, nor in the 1st and 5th minutes of surgery, was the mean arterial pressure (MAP) was significantly different between the two groups. From 10th minute of surgery until the end of surgery and from the beginning of recovery until the 30th minute of recovery, the MAP and pulse rate were higher in Ketofol group. Sedation effect during surgery was higher in the Ketodex group compared to the Ketofol group, and the difference was statistically significant at minutes 10, 20 and 30 of surgery. Conclusion: There is higher effect of sedation and fewer side effects of ketamine-dexmedetomidine combination compared to the ketamine-propofol combination.

Analysis of the concept of nurses' autonomy in intensive care units: A hybrid model.

To analyze the concept of autonomy of nurses in Intensive Care Units (ICU). The hybrid model approach proposed by Schwartz-Barcott and Kim, which includes theoretical, fieldwork and analytical phases, was used for this study. For the theoretical and fieldwork phases, the Graneheim and Lundman stages and the CORE-Q checklist were used, and the results were combined in the final analysis phase. For the theoretical phase, 46 related articles, two instruments and four books were identified after using a search strategy in 7 bibliographic databases in English and one in Persian with the terms MESH: 'nursing', 'autonomy' and 'intensive care'. The information extracted in the theoretical phase served as the basis for the design of the questions used in the semi-structured interviews in the fieldwork phase. Eight nurses with ICU experience working in hospitals affiliated to Isfahan University of Medical Sciences (Iran) participated in the fieldwork phase. The antecedents of the concept of nurse autonomy in ICUs were: empowerment of the workforce, organizational platform, and social and individual views of the profession. Its attributes were professionalism and high personal capabilities. Finally, increased personal competencies, promotion of quality of care, improved attitudes towards the profession and professional outcomes were noted as consequences. The autonomy of nurses in the ICU can facilitate their empowerment, which translates into the promotion of their caring behaviours, followed by the improvement of patient outcomes and quality of care.

The Effect of Impostor Syndrome on Job Involvement with Mediating Role of Structural Empowerment regarding the Employees of Isfahan University of Medical Sciences

Background: Empowerment allows health managers to make a conscious choice to improve the quality of care. On the other hand, one of the factors that may affect psychological aspects of employees and decrease job participation of employees is imposter syndrome. The main goal of this research was to determine the effect of imposter syndrome on job involvement with the mediating role of structural empowerment of employees.&#x0D; Methods: This was a descriptive-analytical study conducted cross-sectionally in 2021. The statistical population of the present study included all employees (1300) working in Isfahan University of Medical Sciences. The sample size was estimated to be 297 people through Cochran method and stratified random sampling method. Data collection tools included the standard imposter questionnaires of Klans and Ames (1987), Shafli et al.'s job involvement questionnaire (2006), and Maleki et al.'s structural empowerment questionnaire (2012). Face validity was confirmed by professors and experts, convergent validity with a mean variance of greater than 0.5, and divergent validity was confirmed using Fornell and Larker methods. Also, the reliability of the instrument was confirmed with the Cronbach's alpha of greater than 0.7. Data analysis was done with descriptive and inferential statistical tests using structural equation method and SPSS 22 and PLS 3 statistical software.&#x0D; Results: Based on the analysis of research variables, imposter syndrome had a negative and significant effect (P &lt; 0.001) on job involvement and structural empowerment of employees with path coefficients of - 0.349 and - 0.856, respectively. There was a positive and significant correlation (P &lt; 0.001) between structural empowerment of employees' job involvement and a path coefficient of 0.452. Finally, self-destructive syndrome with the mediating role of structural empowerment had a significant and negative effect (P &lt; 0.001) on job involvement of employees with a path coefficient of - 0.386.&#x0D; Conclusion: Structural empowerment is associated with higher work efficiency and engagement among employees. Accordingly, structural empowerment may increase work engagement by stimulating employees' intrinsic and extrinsic motivation. But the presence of employees with imposter syndrome leads to the opposite effect.

Cancer nurses’ perspective of error disclosure from nurses to patients: A qualitative descriptive study

PurposeThis study aims at exploring Cancer Nurses’ Perspective of Error Disclosure. MethodsThis qualitative descriptive study was conducted in 2022, Iran. Data collection methods included observation (121 h), and semi-structured interviews (12 interviews with nurses, and nursing managers). Data analysis was performed using Graneheim and Lundman's approach. This study obtained ethical approval from Ethics Committee of Isfahan University of Medical Sciences. The COREQ checklist was used for study report. ResultsData analysis resulted in three categories and nine subcategories: Error disclosure as a professional necessity (error disclosure as one of the patient's rights and error disclosure for self-and peer-learning), Error disclosure barriers (cancer-related factors, individual deterrents, nurses' intragroup culture, and organizational deterrents) and Error disclosure facilitators (culture of transparency, managerial support for error disclosure and development of error disclosure protocol). ConclusionCreating a culture of error disclosure requires removing barriers, and providing facilitators. By reevaluating their professional performance and responsibilities, nurses may help foster a culture of error disclosure, and managers can do the same by encouraging employees and creating a clinical error disclosure manual. The promotion of an error disclosure to the patient culture may be greatly aided by managers. They facilitate this role by providing practical guidance (based on Iranian culture, needs and conditions of cancer patients and their families) to address nurses' concerns about managers' and the organization's negative responses.

Comparison of the effect of a combination of low dose ketamine and dexmedetomidine with a combination of low dose ketamine and midazolam on hemodynamic changes and pain in electroconvulsive therapy.

Background: Currently, electroconvulsive therapy (ECT) is used as an effective treatment method in many psychiatric disorders. The basis of a successful electroshock session is to create a seizure with the precise intensity, quality and duration. In addition to the appropriate method of shock induction, appropriate anesthesia methods should be used to cause such seizures. The present study compared a combination of low-dose ketamine and dexmedetomidine (Ketodex) with a combination of low-dose ketamine and midazolam (Ketomid) on hemodynamic changes in electroshocks applied to patients referred from the psychiatric ward.&#x0D; Methodology: This study was a randomized triple-blind clinical trial performed after obtaining permission from the Medical Ethics Committee of the Isfahan University of Medical Sciences. For this purpose, 70 patients were selected for electroshock therapy and randomly distributed into two groups of 35 people. In the first group, 0.04 mg/kg midazolam was combined with ketamine 0.1 mg/kg and in the second group, 0.5 μg/kg dexmedetomidine with 0.1 mg/kg ketamine. The patients were placed under complete cardiovascular monitoring. Hemodynamic changes of patients were measured and recorded before injection, after injection, after shock, and at 5 and 10 min after the end of seizures.&#x0D; Results: In this study, 70 patients who were candidates for receiving ECT were equally divided into two groups of 35: one group received a mixture of Ketodex and the second group a combination of Ketomid. The two study groups showed no significant difference in terms of systolic pressure (P = 0.883), diastolic (P = 0.443), mean arterial pressure (P = 0.443), oxygen saturation (P = 0.018), and heart rate (P = 0.286). Complications such as headache, muscular pain (P = 0.01), bradycardia, nausea and vomiting were reported in the dexmedetomidine and ketamine groups.&#x0D; Conclusion: Our study showed that although systolic, diastolic and mean arterial blood pressure, heart rate and oxygen saturation were significantly reduced in both study groups, no significant difference was observed between the two groups in terms of hemodynamic changes and neither drug group in our study population was different from the other in terms of these parameters. In addition, neither option was superior to the other. However, due to the fact that complications such as headache, muscular pain, bradycardia, nausea and vomiting were reported in the dexmedetomidine and ketamine groups, the combination of midazolam and ketamine appeared to be a more appropriate combination in patients undergoing electroconvulsive therapy.&#x0D; Key words: Electroshock therapy; Midazolam; Ketamine; Dexmedetomidine; Hemodynamic changes; Headache pain&#x0D; Citation: Nazemroaya B, Manian N. Comparison of the effect of low dose ketamine plus dexmedetomidine vs low dose ketamine plus midazolam on hemodynamic changes and pain in electroconvulsive therapy. Anaesth. pain intensive care 2023;27(3):364−370; DOI: 10.35975/apic.v27i3.1981&#x0D; Received: September 02, 2022; Reviewed: December 03, 2022; Accepted: April 23, 2023

Identifying the Challenges of Intensive Care unit Caregiving in the Face of COVID-19 Pandemic: A Qualitative Study

Background: The COVID-19 pandemic created an unprecedented challenge for intensive care units (ICUs) compared to other clinical wards. In addition, it caused stressful conditions due to the increased mortality rates in these wards. Objectives: Since the identification of these challenges can serve as a road map for managers in future planning against crises, the present study aimed to identify the challenges of ICU caregiving during the COVID-19 pandemic. Methods: This qualitative study used conventional content analysis and was conducted using unstructured deep interviews with an open question and several co-constructive questions in 2023. A total of 23 ward heads, head nurses, nurses of ICU wards, nursing managers, and supervisors of six teaching hospitals affiliated with Isfahan University of Medical Sciences and Yazd Universities of Medical Sciences were included in the study through a purposive sampling method. Data analysis was performed with MAXQDA10 using qualitative content analysis with a conventional approach. Results: The challenges of ICUs in the COVID-19 pandemic were identified and categorized into six main categories and 14 sub-categories. The main categories included: inefficient management of resources, weaknesses in organization, challenges to laws and regulations/policies, structural challenges, weaknesses in educational processes, and mental challenges. Conclusion: The findings of this study showed that it is possible to provide quality services to patients by identifying the challenges affecting the management and provision of nursing services and taking appropriate measures to improve the quality of nursing services in the intended wards.

Effectiveness of corticosteroid therapy in patients with moderate to severe coronavirus disease 2019: a retrospective study

Introduction: Ne An acute respiratory infection started in Wuhan city of China in December 2019. The pathogen was discovered as a novel coronavirus from the Coronaviridae family and called the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). According to clinical symptoms and laboratory tests, coronavirus disease 2019 (COVID-19) patients are categorized as asymptomatic, mild, moderate, severe and critical state. Suggested therapies used in moderate to severe COVID-19 disease include corticosteroids, anticoagulation and antiviral drugs (e.g., remdesivir). Objectives: We reviewed the clinical outcomes associated with corticosteroid treatment for COVID-19. Patients and Methods: We planned a retrospective study with 859 patients diagnosed with SARS-CoV-2 infection who were under treatment at Khorshid hospital affiliated with Isfahan University of Medical Sciences, Isfahan, Iran (from February to May 2020). Results: A total of 859 patients were included in this study. The mean age was 63.33±15.45 years of which 43.8% (n=376) were women. We subcategorized corticosteroids by dose prescribed in smaller groups to show better results. The secondary outcome including the rate of intensive care units (ICUs) admission and death was less with corticosteroid prescription. This study showed, mortality and ICU admission were fewer in patients with ≥51 mg/d and ≥201 mg/d of methylprednisolone therapy, respectively. Conclusion: Based on this study, corticosteroid treatment can reduce both the need for ICU admission and mortality in moderate to severe COVID-19 patients. However, clinical trials are needed to investigate the effect of corticosteroid therapy on the need to mechanically ventilate a patient.

Decreased or Absent B Cells in patients with Severe Reduction in All Serum Immunoglobulin Isotypes, a registry based study

BackgroundSevere Reduction in All Serum Immunoglobulin Isotypes with Profoundly Decreased or Absent B Cells is a subgroup of inborn error of immunities (IEI). 80 to 90% carry mutations in X-chromosomal Bruton tyrosine kinase (BTK) and around 5–10% of the cases are autosomal recessive Agammaglobulinemia (ARA). Very few of Hypogammaglobulinemia with no B cells classified in other subgroups. All of these patients benefit from a genetic evaluation, especially in highly consanguine populations. Materials and Methods27 patients from 11 families with hypogamma-globinemia and no B-cells registered in Immunodeficiency Diseases Research Center registry, Isfahan University of Medical Sciences were phenotypically and genetically evaluated. ResultsThe most prevalent genetic cause was mutations in BTK. The novel mutations in BTK gene includes c.176 G>A (p. Glu89Lys); c.115T>C (p. Tyr39His); c.685-686insTTAC (p. Asn229llefs5), in ARA includes a homozygous stop mutation in Immunoglobulin Heavy Constant Mu Chain (IGHM) gene, a frameshift mutation of B-Cell Antigen Receptor Complex-Associated Protein (CD79A), a bi-allelic stop-gain mutation in Transcription Factor 3 (TCF3), and in PIK3CD also in others IEI includes :novel homozygous silent mutations in Phosphoinositide-3-Kinase Regulatory Subunit (RASGRP1), homozygote SAMD9 mutation. DiscussionWe did not observe any phenotypically significant differences in XLA patients.The main clinical manifestation of ARA cases is, recurrent infections. However, patient with IGHM deficiency had earlier onset of the disease and more severe complications. In CD79A deficient case with 5 affected members and four deaths in her family, the symptoms started very early but managed properly according to the family history. Due to the late diagnosis of PIK3CD cases, more severe complications like bronchiectasis, neurologic sequels after poliomyelitis, and SLE nephropathy has been developed. Our novel SAMD9 had quite different phenotype and the novel RASPGR2 case with no B cells unfortunately managed as ARA before genetic diagnosis and has died of lymphoma as her 3 siblings. However, we observed that in families with more than one affected family member, the disease was better controlled in the second patient. ConclusionOur study broadens the genetic spectrum of hypogammaglobulinemia with no B cells in Iran. This helps differentiate phenotypes and genotypes and manage patients appropriately.

The Relationship Between Attitudes Towards Caring for Dying Patients and Self Compassion in ICU Nurses.

The study aims to investigate the relationship between ICU nurses' attitudes towards caring for dying patients and self compassion.This cross-sectional study (Aug-Oct 2022) was conducted with the volunteer participation of 219 ICU nurses in Isfahan University of Medical Sciences, Iran. Data were collected through the Socio-demographic Form, the Frommelt Attitude toward Care of Dying Scale (FATCOD), and the Self-Compassion Scale (SCS).The mean score of attitude of end-of-life care and self-compassion were 92.77 ± 21.5 and 47.83 ± 7.69 respectively. A statistically significant difference was found between nurses' education level and attitudes of end-of-life care (p < 0.001) and self-compassion. (p < 0.04) A significant difference was found between end of life care training experience and self-compassion (p < 0.03). A positive, statistically significant relationship was found between the attitudes of end-of-life care total score and self-compassion total score (p < 0.001). A significant relationship between the self-compassion and attitude toward caring for dying patients is an important finding for quality of care in ICU nurses.

The effect of sage (Salvizan gel) compared to triamcinolone acetonide on the treatment of recurrent aphthous stomatitis: a double-blinded randomized clinical trial

BackgroundRecurrent Aphthous Stomatitis (RAS) is one of the most common lesions of the oral mucosa. Herbal medicine can be used for the treatment of this disease. The present study aimed to compare the effects of topical application of Sage (Salvizan) and triamcinolone acetonide gels on RAS.MethodsThis double-blind clinical study recruited sixty patients with minor aphthous ulcers. Half of the patients were treated with Salvizan gel, and the other half were treated with oral triamcinolone acetonide gel. The effect of Salvizan topical gel was evaluated and compared with that of oral triamcinolone acetonide gel. Factors such as Pain recovery time, wound healing time, and pain level was evaluated. Data were analyzed by SPSS version 22 using independent t-test, paired t-test, repeated measures ANOVA, and survival analysis, including Kaplan-Meier and Cox regression.ResultsThe mean duration of pain recovery was 1.5 days for Salvizan and 2.5 days for triamcinolone acetonide (p < 0.001). Moreover, the duration of wound healing was 3.3 days for Salvizan and 6 days for triamcinolone acetonide (p < 0.001). Patients’ satisfaction from factors such as taste and smell had no significant difference between the two groups.ConclusionThe results of this study showed that Salvizan gel is very effective in the treatment of RAS. It was significantly better than triamcinolone acetonide in the pain recovery and wound healing. These promising results favor herbal treatments and show that they can be used more commonly for treating diseases such as RAS.Trial registrationThis study was approved by the ethics committee of Isfahan University of Medical Sciences (IR.MUI.RESEARCH.REC.1399.834) on 17/03/2021. It was also registered in the Iranian Registry of Clinical Trials (IRCT20100202003251N7).

Evaluation of Dentists’ Attitudes Towards Principles of Professional Ethics

The aim of this research was to investigate attitudes towards principles of professional ethics (PPE) amongst Iranian dentists working in Isfahan, Iran. This pilot cross-sectional study was conducted amongst 273 dentists in Isfahan, Iran. A validated, comprehensive questionnaire including principles of respect for patient autonomy, nonmaleficence, beneficence, and justice was used to evaluate dentistry professional ethics aspects. Age, gender, marital status, type of graduate university, level of education, specialised field of study, work experience, workplace, and participation in ethics workshops and courses were registered from participants. Total and domains scores of used questionnaires were calculated and compared across categories of study participants' characteristics. Mean ± SD age of participants was 35.4 ± 10.7 years, and 57% were female; about 73% graduated from Isfahan University of Medical Sciences, and 65% were general dentists. The attitude total score of dentists towards PPE was 133.02 ± 13.16. Mean total score of the questionnaire and its domains was different significantly (P < .05) across categories of level of education, marital status, and passing the ethical courses. The attitude of dentists towards PPE was rated at a good level. However, improvement in attitudes of some specific subgroups such as general dentists and newly graduated ones is needed. Conducting specific workshops about professional ethics and incorporating these principles into university curricula can be beneficial.

Relationship Between Stress and Anxiety Regarding COVID-19 with Some Individual-Familial Characteristics Among First-Semester Students

Background: The coronavirus disease 2019 (COVID-19) pandemic has had many effects on various aspects of individuals’ lives, including causing physical and mental problems. One of the most common psychological problems, especially among first-semester students, is stress and anxiety related to COVID-19. Objectives: This study aimed to investigate the relationship between stress and anxiety with some individual-familial characteristics of first-semester students. Methods: The current descriptive-analytical study was conducted on 106 first-semester nursing students with different educational levels at Isfahan University of Medical Sciences, Isfahan, Iran, in 2021. The sampling method in this study was census sampling. A researcher-made demographics questionnaire, the Perceived Stress Reactivity Scale, and the Corona Disease Anxiety Scale were used for data collection. In the current study, the data were collected online using electronic questionnaires. SPSS software (version 26.0) and independent t-test, Spearman’s correlation, and analysis of variance (ANOVA) were used for data analysis. Results: The mean age of the participant was 22.3 ± 10.94 years. The total scores of anxiety and stress were 8.23 ± 5.85 and 19.38 ± 5.62, respectively. The results of Spearman’s correlation test showed a significant relationship between age and stress (P = 0.001, r = 0.290). The results of the t-test showed that there were significant differences between gender (P = 0.034), marital status (P = 0.003), and work experience (P = 0.008) with stress. In addition, a significant difference was observed between educational level and stress using ANOVA (P = 0.029). Conclusions: Paying more attention to the psychological health of first-semester students provides a favorable environment for their educational success during the COVID-19 pandemic because stress and anxiety affect students’ performance in various aspects of their individual and social lives.