The experiences of psychiatric patients, their caregivers and companions in upholding patient dignity during hospitalization: A qualitative study

INTRODUCTION

The quality of care and patient satisfaction is closely linked with dignity, which is a crucial component of therapy and care. However, there is very little study on dignity in the context of mental health care. Planning for ongoing patient care might benefit from an understanding of the notion of dignity by exploring the experiences of patients, caregivers and companions of patients who have a history of hospitalization in mental health institutions. To retain patients' dignity while they were being treated in mental wards, this study sought to understand the experiences of patients, caregivers and companions of patients.

MATERIALS AND METHODS

This investigation was qualitative. Semistructured interviews and focus groups were utilized to collect the data. The purposeful sampling method was employed for participant recruitment, which continued until data saturation. Two focus group discussions and 27 interviews were conducted. Participants included 8 patients, 2 patients' family members (companions), 3 psychologists, 4 nurses and 11 psychiatrists. Two focus group discussions were held with seven family members or companions of patients. Thematic analysis was used for data analysis.

RESULTS

The primary theme that emerged was the infringement of patients' dignity, through negative guardianship, dehumanization and violations of their rights. Subthemes included dehumanization, worthlessness and namelessness, patient rights violations and stripping patients of authority.

CONCLUSION

Our results suggest that, regardless of the severity of the illness, the nature of psychiatric illness significantly compromises patients' dignity. Mental health practitioners, due to their sense of guardianship, may unintentionally treat patients with mental health disorders, thus compromising the patient's dignity.

PATIENT OR PUBLIC CONTRIBUTION

The research team's experiences as a psychiatrist, doctor and nurse informed the study's objectives. Nurses and psychiatrists who work in the healthcare industry designed and conducted the study. The primary authors, who are healthcare providers, collected and analysed the required data. Furthermore, the entire study team contributed to the writing of the manuscript. Study participants were involved in the data collection and analysis.

Cardio-Pulmonary Histopathology with Clinical Correlations of Deceased Patients with COVID-19: A Case Series in Tehran, Iran

BACKGROUND

SARS-CoV-2 may affect vital organs. The present study investigated the histopathology of pulmonary and cardiac tissues with clinical correlation in deceased patients with COVID-19.

METHODS

We obtained pulmonary and cardiac tissues from 30 deceased patients with COVID-19 in Tehran, Iran, from January to May 2021. Sampling was performed through a percutaneous needle biopsy. After slide preparation, two expert pathologists studied them. We assessed the correlation between clinical and pathological data by Fisher's exact test.

RESULTS

The mean age of the patients was 73.8±13.4 years, and the male-to-female ratio was 23/7. The most common underlying disease was hypertension (HTN) in 25 patients (83%). Fifty-five tissue samples were achieved, including 28 pulmonary and 27 cardiac samples. Our results showed that all patients (100%) developed diffuse alveolar damage (DAD), and 26 (93%) developed hyaline membrane formation. The most common phase of DAD was the exudative-proliferative phase in 16 (57.1%). Three cardiac samples (11%) revealed myocarditis, and seven (26%) showed cardiomyocyte hypertrophy. In univariate analysis using Fischer's exact test, myocarditis had significant relationships with C-reactive protein (CRP) levels higher than 80 mg/dL (P=0.008) and elevated cardiac troponin levels higher than two-fold (P=0.01).

CONCLUSION

COVID-19 can affect the major vital organs. However, only myocarditis had a significant relationship with the circulating levels of inflammatory factors.

Association of Echocardiographic Findings with in-Hospital Mortality of COVID-19 Patients and Their Changes in One-Month Follow-Up; a Cohort Study

INTRODUCTION

Evidence showed that cardiac complications may occur in coronavirus disease-19 (COVID-19) during the acute and post-infection phases. This study aimed to evaluate the association between the echocardiographic characteristics and in-hospital mortality of COVID-19 patients as well as the changes after one-month follow-up.

METHOD

All adult (≥18 years old) hospitalized COVID-19 patients in need of echocardiography based on the guideline of the Iranian Society of Echocardiography for performing various types of echocardiography during the COVID-19 pandemic were included in this study. An expert cardiologist performed the echocardiography on all patients and also on all available patients one month after discharge.

RESULTS

146 hospitalized cases of COVID-19 and 81 cases available for 1-month follow-up echocardiography were studied in this prospective study. Left ventricle wall hypokinesia, aorta valve stenosis, dilated Inferior Vena Cava (IVC), and Pulmonary Artery Systolic Pressure (PASP) of more than 35 were associated with 3.59 (95% CI: 1.19-10.79, p = 0.02), ‎11 (95% CI: 3.3 - 36.63, p = 0.001), ‎5.58 (95% CI: 1.04-29.41, p = 0.041)‎, and 2.91 (95% CI: 1.35 - 6.3, p = 0.001) times higher odds of mortality than healthy subjects. In 1-month follow-up of patients, deterioration in LVEF (p = 0.03) was detected in the not-fully vaccinated patients, and a significant decrease in PASP was observed in all cases (p = 0.04); but these changes were not clinically important.

CONCLUSION

Left ventricle wall hypokinesia, aorta valve stenosis, dilated IVC, and PASP ≥ 35 were predictors of in-hospital mortality in our study. There were not any potential clinically significant differences in one-month echocardiographic follow-ups of the studied patients.

Immunological evaluation of patients with 2019 novel coronavirus pneumonia: CD4+ and CD16+ cells may predict severity and prognosis

Purpose

Available but insufficient evidence shows that changes may occur in the immune system following coronavirus disease 2019 (COVID-19). The present study aimed at evaluating immunological changes in patients with severe acute respiratory syndrome coronavirus‐2 (SARS-CoV-2) pneumonia compared with the control group.

Method

The present study was performed on 95 patients with COVID-19 (32 severe and 63 moderate cases) and 22 healthy controls. Relationship between immune cells, disease severity and lung involvement was assessed. Binary logistic regression and ROC curve tests were used for statistical analysis.

Results

A significant decrease was observed in CD20⁺ cell counts of the patients. To differentiate patients from healthy individuals, the cutoff point for the CD4⁺ cell count was 688 /μL, sensitivity 0.96, and specificity 0.84. An increase in CD4⁺ cells reduces the odds of severe disease (odds ratio = 0.82, P = 0.047) and death (odds ratio = 0.74, P = 0.029). CD4⁺ cells play a pivotal role in the severity of lung involvement (P = 0.03). In addition to CD4⁺ cells, Fc gamma receptor III (FcγRIII) (CD16) also played a significant prognosis (odds ratio = 0.55, P = 0.047). In severe cases, C-reactive protein, Blood urea nitrogen, and Creatine phosphokinase levels, as well as neutrophil counts, were significantly higher than those of moderate ones whereas lymphocyte count in severe cases was lower than that of moderate ones.

Conclusion

The number of total T-cells and B-cells in patients with COVID-19 was lower than that of controls; however, their NK cells increased. FcγRIII and CD4⁺ cells are of great importance due to their association with COVID-19 prognosis.

Efficacy of Red Blood Cell Exchange as Adjunctive Treatment for Hypoxemia and Survival Rate of Patients With Severe Coronavirus-2 Disease: An Open-Labeled Phase 2 Randomized Clinical Trial

Background

Severe acute respiratory syndrome (SARS) coronavirus-2 may infect red blood cells (RBCs) and impact oxygenation. We aimed to evaluate the efficacy of RBC exchange as an adjunctive treatment for hypoxemia and the survival rate of patients with severe coronavirus disease 2019 (COVID-19).

Methods

In a randomized clinical trial, we divided sixty patients with severe COVID-19 into two groups. The intervention group received the standard treatment of severe COVID-19 with RBC exchange three to four times in 2 days. The control group only received the standard treatment. Our primary outcomes were improving hypoxemia in 7 days, recovery or discharge, and death in 28 days. We conducted Chi-square test, independent samples t-test, and Fisher’s exact test to analyze the results. The ethical committee of Aja University of Medical Sciences approved the study (IR.AJAUMS.REC.1399.054), and the Iranian clinical trial registration organization registered it (IRCT20160316027081N2).

Results

Twenty-nine men and thirty-one women with a mean age of 67.5 years entered the study. The frequency of hypertension and diabetes mellitus was 86.7 and 68.3%, respectively. The most common symptoms of severe COVID-19 were dyspnea (91.6%), cough (75%), and fever (66.6%). Our results showed that hypoxemia improved in 21 of the 30 patients (70%) in the intervention group and 10 of the 30 patients (33.3%) in the control group (P < 0.004). The recovery and discharge rates were 19 of 30 patients (63.3%) in the intervention group and 2 of 30 patients (6.7%) in the control group (P < 0.001).

Conclusion

The RBC exchange improved the oxygenation and survival rate in patients with severe COVID-19.

Thalamic hemi-chorea: a rare complication after receiving the adenoviral vector-based COVID-19 vaccine: a case report

Lacunar strokes occur when a branch of a large cerebral artery is blocked. The thalamus is often affected, causing uncontrollable motions. A 72-year-old previously healthy man presented with involuntary motions in the right limbs, which were present at rest, and exacerbated during voluntary actions. He had received the first dose of the adenoviral vector-based coronavirus disease 2019 vaccine (ChAdOx1 nCoV-19) 9 days ago. Severe thrombocytopenia and elevated levels of lactate dehydrogenase, ferritin, C-reactive protein, and D-dimer were found, without any evidence of connective tissue disease. Electromyography demonstrated typical choreiform movements, and the brain magnetic resonance imaging indicated a small high signal lesion on the left side of the thalamus. Detection of the immunoglobulin G antibodies against platelet factor 4 in the blood, negative heparin-induced platelet activation (HIPA) test, and positive modified HIPA test confirmed the thalamic stroke due to the vaccine-induced prothrombotic immune thrombocytopenia (VIPIT). He was admitted to the intensive care unit and received nadroparin, sodium ozagrel, edaravone, methylprednisolone, and haloperidol. His hemi-chorea improved gradually over 2 weeks, and he was discharged after 21 days with rehabilitation advice. VIPIT due to the ChAdOx1 nCoV-19 is a novel immune-mediated response that needs clinicians' awareness and further investigations.

Efficacy and safety of acetylcysteine for the prevention of liver injury in COVID-19 intensive care unit patients under treatment with remdesivir

AIM

The present double-blinded placebo-controlled randomized clinical trial evaluated prophylactic use of acetylcysteine for the prevention of liver injury in patients with severe COVID-19 pneumonia under treatment with remdesivir.

BACKGROUND

Liver injury is reportedly common in patients with severe COVID-19 pneumonia and can occur not only as a result of disease progression, but as an iatrogenic reaction to remdesivir.

METHODS

A total of 83 adult patients with severe COVID-19 pneumonia were randomly assigned in parallel groups to receive either acetylcysteine or placebo. All the patients received standard care according to institutional protocols, including remdesivir for a total of five days. One gram acetylcysteine was administered intravenously every 12 hours for 42 patients, and 41 patients received the same volume of 0.9% sodium chloride as placebo (Trial Registration: www.irct.ir identifier, IRCT20210726051995N1).

RESULTS

After 5 days, median aspartate transaminase (AST) and alanine transaminase (ALT) levels were significantly lower in the acetylcysteine than in the placebo group. Of those who received the placebo, 30 (73.2%), 4 (9.7%), and 3 (7.3%) patients had serum AST levels elevated between 1-2.5, 2.5-5, and over 5 times the upper limit of normal (ULN), respectively; while in the acetylcysteine group, 33 (78.6%) and 0 patients had AST levels between 1-2.5 and over 2.5 times ULN, respectively (p-value=0.037). In the acetylcysteine group, 23 (54.8%), 1 (2.4%), and 1 (2.4%) patient had serum ALT levels elevated between 1-2.5, 2.5-5, and over 5 times ULN, respectively; in the placebo group, however, 24 (58.5%), 7 (17.1%), and 1 (2.4%) patient had serum ALT levels between 1-2.5, 2.5-5, and over 5 times ULN, respectively (p-value=0.073).

CONCLUSION

Intravenous administration of acetylcysteine significantly prevents liver transaminases elevation and liver injury in seriously ill COVID-19 patients treated with remdesivir.

Efficacy of a standardized herbal formulation from Glycyrrhiza glabra L. as an adjuvant treatment in hospitalized patients with COVID-19: A Randomized Controlled trial

Introduction

As no specific pharmacological intervention has been known for COVID-19, medicinal plants may be a suitable candidate for management of this disease. The aim of this study was to investigate the efficacy of a herbal syrup from licorice as an adjuvant treatment in hospitalized patients with COVID-19.

Materials and methods

213 hospitalized patients diagnosed with COVID-19 were assigned to receive either standardized licorice syrup as an adjuvant treatment plus standard care [Syrup Group (SYRUP), N = 91], or standard care alone [Standard Group (STANDARD), N = 104], for 7 days. The primary endpoint was duration of hospitalization in survivors. The secondary endpoints included 25% increase in oxygen saturation, C-reactive protein (CRP) difference and lymphocyte difference from baseline, number of death and number of patients transferred to ICU.

Results

Mean duration of admission was 5.24 days in SYRUP and 7.14 days in STANDARD (p < 0.001). Oxygen saturation increased in 86 of 91 patients (94.5%) in the licorice group, compared to 83 of 104 patients (79.8%) in the control group (p = 0.002). There was no significant difference between the two groups in the number of patients died during hospitalization (p = 0.837). Five patients in SYRUP and 16 patients in STANDARD were transferred to ICU (p < 0.026). Mean reduction in CRP (p < 0.001) and mean increase in the number of lymphocytes (p = 0.008) in SYRUP were significantly higher than STANDARD.

Discussion

Licorice syrup as an adjuvant treatment demonstrated promising results on duration of hospital admission, O2 saturation as well as inflammatory markers in COVID-19 patients; however, further clinical studies with larger sample size are suggested to achieve more conclusive results.

Vitamin D Insufficiency in Disease Severity and Prognosis of the Patients With SARS Corona Virus-2 Infection

The global crisis caused by the SARS Corona virus-2 infection is continuing through 2021, with more than 3.5 million deaths. Several risk factors for this virus’s severity and death were documented, including diabetes, hypertension, and ischemic heart disease. To evaluate the relation between serum vitamin D3 level, the disease severity, and prognosis of the patients with SARS Corona virus-2 infection. Patients with COVID-19 were evaluated for serum vitamin D levels and laboratory data. Correlation between vitamin D levels and laboratory data with disease severity and prognosis was assessed. Cox and logistic regression tests, as well as ROC curves, were used for data analysis. Ninety-eight patients with Corona virus-2 disease (COVID-19), which consisted of sixty patients with moderate COVID-19 in the general wards, and thirty-eight patients with severe COVID-19 in the intensive care unit (ICU), were evaluated. The mean age in the general wards was lower than in ICU (60.96±14.86 compared to 67.94±16.46, P=0.001), and the mean serum vitamin D level in the patients admitted in the general wards was higher than in the ICU (31 ng/mL compared to 20.57 ng/mL, P=0.003). Furthermore, vitamin D deficiency (25 (OH) D <25 ng/ml) significantly increased the risk of severe disease. (odds ratio=2.91, P=0.019) and mortality (odds ratio=3.64, P=0.026). Vitamin D deficiency is a risk factor for disease severity and poor prognosis in COVID-19. Vitamin D levels of 25 ng/mL can be used as a cut-off value for predicting severity and prognosis.

Validating the Self-assessed Wisdom Scale (SAWS) in an Iranian Sample: Psychometric and Developmental Findings

This study aimed to investigate the validity and factor structure of the Self-Assessed Wisdom Scale (SAWS; Webster in J Adult Dev 10:13-22, 2003) in an Iranian population. Participants (235 male, 340 female) were recruited in Tehran, Iran and ranged in age from 17 to 88 years. Cronbach alpha's for the subscales ranged from .63 to .81, and their inter-correlations ranged from .42 to .53. Exploratory factor analysis extracted 5 factors that were similar with the original structure. Confirmatory factor analysis supported 5-factor model of the SAWS. The SAWS's total and subscale scores positively correlated with two other measures of wisdom (indicating convergent validity). The SAWS correlated weakly with age. Women scored higher in the SAWS subscales of emotional regulation, reminiscence/reflectiveness, and humor, which accounted for a significant gender difference in total wisdom. Although the age differences are consistent with prior research, the gender differences are relatively novel. Overall, results indicate that the SAWS has excellent psychometric properties and can be used in cross-cultural work.

Therapists' perspectives on a new portable hand telerehabilitation platform for home-based personalized treatment of stroke patients

OBJECTIVE

Patients who have sustained a stroke suffer from residual motor impairments. Stroke can limit their ability to employ their impaired upper limb properly. Hand function is particularly one of the most frequently persisting consequences of stroke. This paper introduces a new portable hand telerehabilitation platform (PHTP) for home-based personalized treatment of stroke patients. The aims of this study are (1) to document the iterative design and development process of the PHTP, and (2) to explore the therapists' perspectives on implementing home-based treatment of stroke patients.

MATERIALS AND METHODS

Local therapists were involved early in designing and developing the PHTP. We collected views of 84 therapists practicing in North America via an online survey.

RESULTS

Therapists' perspectives on the introduced prototype support the use of the PHTP to provide home-based telerehabilitation for stroke patients. The System Usability Scale score was 70 for the PHTP, indicating that the platform is usable. The rest of the qualitative results obtained from custom questionnaires showed consistency in the platform design, high perceived usability and good acceptability among the therapists' community.

CONCLUSIONS

In sum, the results encourage and support fine-tuning of the PHTP, commercializing it, and conducting prospective clinical studies.

Comparison of the extent of pediatric inflammatory bowel disease based on endo-colonoscopy and histological findings

Introduction: Paris classification for the extent of inflammatory bowel disease (IBD) in children is based solely on macroscopic findings obtained via endo-colonoscopy. However, in some cases histologic findings may indicate more severe cases. Objectives: The aim of the present study was to compare the extent of pediatric IBD based on endo-colonoscopy and pathological findings. Methods: Data on 67 hospitalizations were collected from 51 children with IBD who had been admitted to the children’s medical center of Tehran. All subjects underwent endoscopy or colonoscopy and had a histological report. Results: Comparison of the endoscopic and histological findings in ulcerative colitis showed that, in 37% of cases, gastric involvement was reported in histology, while these cases were reported normal in endoscopy. In colonoscopy, the transverse colon was more involved, as compared with the results of histology, while in other parts of the colon, the histological involvement showed more severe findings. Considering Paris classification, in 25% of cases, the extent of the disease was higher in colonoscopy, and in 16% of cases, it was higher in histology. Of all children with Crohn’s disease, gastric involvement in 20% of cases and esophageal and duodenal involvement in 13% of cases were more reported in histology than in endoscopy. In the ascending colon, descending colon, and rectosigmoid, histological involvement was more than that observed in colonoscopy. Considering Paris classification, in 5% of cases, the extent of the disease was higher in colonoscopy, and in 9% of cases, it was higher in histology. Conclusion: Concurrent use of histological findings and endoscopic findings may help to better determine the severity and extent of the disease and facilitate the process of treatment.

Expression of RND efflux pumps mediated antibiotic resistance in Pseudomonas aeruginosa clinical strains

Resistance-Nodulation-Division (RND) efflux pumps are responsible for multidrug resistance in Pseudomonas aeruginosa. The present study aimed to evaluate the overexpression of RND efflux pumps and its role in the antibiotic resistance of P. aeruginosa clinical isolates. A number of 122 isolates were obtained from three military hospitals in Tehran, Iran. In order to determine the antibiotic resistance, the isolates were identified and assessed by the disk diffusion and agar dilution methods. This study investigated the gene expression of four multi-drug efflux pump systems (MexAB-OprM, MexCD-OprJ, MexEF-OprN and MexXY (-OprA)) and its correlation with antibiotic resistance. The isolates indicated that the highest resistance rate was against ticarcillin (80%), followed by ciprofloxacin (74%) and meropenem (71%). Most of them expressed mexB (69%), mexC (28.7%), mexE (43.4%), and mexY (74.6%), suggesting that mexB and mexY were highly expressed in the studied strains. The overexpression of mexB and mexY was significantly more prevalent in the ICU wards (p = 0.033). Furthermore, there was a significant correlation between the expression of RND-type efflux pumps and the resistance to most anti-pseudomonal antibiotics.

Investigating the effective annual dose of radiation angiography department of Afshar Hospital in Yazd and providing radiation protection strategies to better manage the dose received by staff

Introduction: Due to the increasing use of angiography procedures and the higher risk of deterministic and stochastic effects for radiation workers of these sections than other radiological procedures, radiation safety is very important among angiography staff. Therefore, this study aimed to obtain the effective dose of angiography staff, compare them with the standard dose limit, and finally outline the strategies for occupational dose reduction in angiography. Methods: In this study, the report of film dosimetry of angiography staff was studied and the effective periodic and annual doses of 34 radiographs were reported from the year 2015 to 2018. The relationship between effective dose and body mass index, work experience, gender and age of staff was also evaluated. Results: The results showed that the average effective dose of the physicians, nurses and radiographers in 2 months period were 0.2 mSv and their average annual effective dose were 1.6, 1.2 and 1.2, respectively. In addition, there were no significant relationship between effective dose and work experience, age, sex and BMI of the radiation workers. Conclusion: The effective dose of radiation in this study is less than the annual dose.. Low effective doses do not make their radiation protection less important because this reduction can be due to radiation protection by personnel in this ward. Therefore, as far as possible, radiation protection measures should be taken to reduce the radiation exposure of catheterization lab staff. In these radiologists thyroid protection, eyes, gonads, and the organs that are usually outside the lead apron is of great importance.

The Role of Quality in Higher Education and Lifelong Learning in Entrepreneurship Competencies of Undergraduate Students

The main objective of this research is to investigate the role of quality in higher education and lifelong learning competencies in entrepreneurship competencies of undergraduate students. The statistical population of this study was all undergraduate students. The descriptive correlational research method was used. For collecting data these questionnaires were used: the Liberal Entrepreneurship Competency Questionnaire (2007), Mantz Academic Quality in Higher Education (1995) and the Life-Long Learning of Wielkiewicz and Meuwissen (2014). The results showed that the entrepreneurial and lifelong learning competencies are at a good level. There is also a positive and significant relationship between lifelong learning and entrepreneurship competencies.

Home Learning Environments: A Cross-Cultural Study Between Germany and Iran

The home learning environment (HLE) index is composed of seven questions regarding educational parent–child interactions. To compare the psychometric characteristics of the six items of HLE index between the two different contexts of Germany and Iran, a sample including 468 preschool children from the National Educational Panel Study (NEPS), Germany, and 465 preschool children from the Longitudinal Study of Iranian Children (LSIC; Growing Up in Iran) were examined. Rasch analysis supports the fitness of the five items of HLE into the model in both countries. However, differential item functioning (DIF) results revealed significant differences between items functioning across the two samples. According to the item difficulty maps, reading to children was the most reported item in the German families, while Iranian parents tended to paint and draw with their children more. While findings support the construct validity and reliability of five of the six items in both samples, different Rasch results may reveal the effects of the cultural dimensions of each country on HLE items.

Are the Domains Considered by ICF Comprehensive Enough to Conceptualize Participation in the Patient with Hand Injuries?

Background  Although participation is a core concept in multiple models of disability, there is no consensus on its definition. Objective  The aim of this study was to extract participation domains based on review of theories, available outcome measures, and interviews with experts and the person with hand injuries to compare with the ICF domains of participation. Methods  A qualitative approach using a deductive content analysis was employed to extend definitions of participation from theories. Later on, inductive qualitative method using semistructured interview with five experts in different fields and 30 patients with different hand injuries was used. Coding was performed with extracted domains from the content of data, and finally, the extracted domains were compared with the ICF domains of participation. Results  Some of the extracted domains were not considered in ICF. Conclusion  Subjective participation is the main forbearance part. Role, leisure, domestic life, environment, and others are also main missing meanings. This limitation can hinder measuring disability and health.

Using the Rasch Model to Develop a Measure of Participation Capturing the Full Range of Participation Characteristics for the Patients with Hand Injuries

Objective  The purpose of this paper was to report on the first step in the development of a new instrument to measure participation including the full range of its characteristics. Methods  The 30-item participation behavior questionnaire (PBQ) was developed from four main sources (a literature review of the theatrical basis of participation, available participation measures, and interviews with patients and experts about participation). Item selection and the reliability and validity of the measure were explored using Rasch measurement modeling for analysis. Participants  A total of 404 individuals referred to rehabilitation after hand, wrist, or upper extremity surgery to reduce impairment from trauma, at least 2 months post-injury. Results  An initial pool of 100 items; reflecting 14 characteristics of participation was initially reduced to 91 items after review by 15 participation experts and then further reduced to 30 items by three rounds of Rasch analysis removing misfitting items. The final PBQ has a person reliability of 0.91 with separation of 3.22, indicating it can reliably differentiate four levels of participation. There are no misfitting items and the instrument is unidimensional. All 14 characteristics of participation were retained in the PBQ, and none of the 30 items refer specifically to upper extremity issues. Conclusion  The 30 participation behavior items of the PBQ show promise of being a psychometrically sound measure of participation. Further research is needed to validate the PBQ in samples of people with a range of other disabilities.

Iranian Version of Speech, Spatial, and Qualities of Hearing Scale: A Psychometric Study

Evaluation of communication abilities in the elderly is crucial for activities which will be performed to improve their quality of life. A valid and reliable questionnaire is needed for assessing communication abilities. We aimed to translate and validate the speech, spatial, and qualities of hearing scale (SSQ) in Iran. The forward-backward procedure was applied to translate the questionnaire from English into Persian. After linguistic validation and pilot study, a cross-sectional study was carried out, and psychometric properties of the Iranian version of the SSQ were tested. Number of 333 elderly individuals with impaired hearing completed the questionnaire. Number 48.3% were hearing aid users and 51.7% was not. Reliability was assessed by internal consistency (Cronbach's alpha) and test-retest analysis. Exploratory factor analysis was performed for extracting factor structure of the Persian version of SSQ. Confirmatory factor analysis was performed to compare different models of factor loadings. The Mean age of participants was 62.00 years (SD=9.58 years), and the mean SSQ score was 5.1 (SD=1.2, ranged: 3.17-6.27). Reliability evaluation revealed high internal consistency and good test- retest reliability. Cronbach's alpha coefficient was 0.96 and the Pierson Correlation at test-retest analysis was 0.73 for Quality of hearing factor, 0.88 for Spatial and o.73 for Speech understanding factor. The results of exploratory factor analysis (EFA) indicated a four-factor solution for P-SSQ that jointly accounted for 52.40% of the variance observed. Confirmatory factor analysis approved the three factor solution but proposed a possible fourth factor. The Iranian version of the SSQ has acceptable psychometric properties, and it will be helpful for assessing different kinds of communication abilities in the Iranian elderly population.

A Qualitative Exploration of Voice Oriented Quality of Life in Iranian Patients: A Cultural Explanation

<p><strong>PURPOSE: </strong>The phrase<strong> </strong>“health-related quality of life” (HRQOL) refers to patients’ perceptions of the influence of disease and treatment on their physical, psychological, and social function. Also, cultural aspects should be taken into account when evaluating quality of life and should be considered in related surveys.  In the current study, the most prominent voice-related QOL dimensions, including culture-based items in Iranian individuals was examined.</p><p><strong>METHODS:</strong> A convenience sample (n= 23) of adults was interviewed addressing voice related quality of life areas. Participants consisted of 15 people (13 men and 2 women) over 18 years with voice disorders lasting at least 6 months with mean age 41.46±16.06, 3 people (2 men and 1 woman) with mean age 47.66±6.65 who worked as radio broadcasters with over 20 years of experience in the field, and 5 experienced specialists in voice disorders (3 speech therapists and 2 otolaryngologists). A semi-structured interview method was used. The components of voice quality of life based on the interviews were extracted by a fourteen stage process content analysis.</p><p><strong>RESULTS:</strong> Many of the extracted components were common to both the interviews and those found in the relevant literature and some of them are new. Some of the new components appear to fit best under the category of “cultural”. Eleven cultural elements are “religious beliefs in disease tolerance and promotion of quality of life”, “More support expectation from family”, “Fear about pain and thinking about serious problems (such as Cancer)”,  “Throat strain results in more disappointment  ” “Fatalism in coping with problem and promotion of Quality of life”, “Traditional home remediation”, “Hope for spontaneous recovery”, “Discrimination because of sound problems”, “Pain and globus sensation as a factor in finding remediation more quickly”, “Negative judgments”, “Negative thoughts about people with voice disorders”. These elements appear to have a potentially strong effect on health quality of life especially in the voice domain.<strong></strong></p><p><strong>CONCLUSIONS: </strong>Relative to the development of a Quality of Life questionnaire for voice, important cultural components of Iranian patients were identified in the current study. Identifying these components may help Iranian voice clinicians obtain a more accurate understanding of health-related quality of life aspects within the Iranian culture. This may lead to more effective remediation for voice patients. </p>

Brain regions involved in swallowing: Evidence from stroke patients in a cross-sectional study

Background:

Limited data available about the mechanisms of dysphagia and areas involving swallow after brain damage; accordingly it is hard to predict which cases are more likely to develop swallowing dysfunction based on the neuroimaging. The aim of this study was to investigate the relationship between brain lesions and dysphagia in a sample of acute conscious stroke patients.

Materials and Methods:

In a cross-sectional study, 113 acute conscious stroke patients (69 male mean [standard deviation (SD)] age 64.37 [15.1]), participated in this study. Two neurologists and one radiologist localized brain lesions according to neuroimaging of the patients. Swallowing functions were assessed clinically by an expert speech pathologist with the Mann Assessment of Swallowing Ability (MASA). The association of brain region and swallowing problem was statistically evaluated using Chi-square test.

Results:

Mean (SD) MASA score for the dysphagic patients was 139.61 (29.77). Swallowing problem was significantly more prevalent in the right primary sensory (P = 0.03), right insula (P = 0.005), and right internal capsule (P = 0.05).

Conclusion:

It may be concluded from these findings that the right hemisphere lesions associated with occurring dysphagia. Further studies using more advanced diagnostic tools on big samples particularly in a perspective structure are needed.

Leisure time activities of Iranian patients with multiple sclerosis: a qualitative study

BACKGROUND

Leisure time is one of the most important aspects of life, especially for people with chronic diseases. The concept and types of leisure have frequently been evaluated in different socio-cultural populations. The aim of this study was to identify the nature of leisure activities among a sample of Iranian patients with multiple sclerosis (MS) and classify the identified types of activities in the context of Iranian culture.

METHODS

In this qualitative study, semi-structured interview was applied to gather data from 34 MS patients that were selected through purposive sampling. The interviews were continued up to the point of saturation. Content analysis was used to explore experiences of the interviewees regarding their leisure activities.

RESULTS

Six categories of leisure activities were extracted for the studied patients with MS i.e.physical, social, individual, art/cultural, educational and spiritual/religious.

CONCLUSION

The results represented the range and heterogeneity of leisure activities amongst the MS patients. Considering participation in spiritual/religious and social activities as leisure time undertaking might reflect cultural diversity in the perception and use of time for recreation. For mental health promotion purposes, paying special attention to the types of activities that people of different socio-cultural background choose for their refreshment could help health care providers in giving tailored advice for patients with MS and other chronic debilitating disease.

Tuberculous ventriculitis: A rare complication of central nervous system tuberculosis

Tuberculous ventriculitis is an inflammatory infection of the ventricular system of the brain, and is caused by Mycobacterium tuberculosis. We herein present the case of an immunocompromised patient with brain tuberculomas who developed ventriculitis during treatment. The patient was successfully treated with a high dose of steroid, long-term antituberculosis drugs, and aggressive supportive care.

Modeling of carrier dynamics in InGaAs/GaAs self-assembled quantum dot lasers

In this study, a theoretical model is used to simulate the lasing characteristics of InGaAs/GaAs self-assembled quantum dot lasers. The rate equation for InGaAs/GaAs is numerically solved using the fourth-order Runge-Kutta method. We consider the homogeneous and inhomogeneous broadening of the optical gain, both with and without considering the nonlinear gain. The results indicate that for a certain injected current, there is a specific homogeneous broadening (HB) with the best lasing performance when HB is near, comparable, or equal to inhomogeneous broadening for every laser-injected current. We show that if the linear optical gain is replaced by the total gain, the output power will reduce a little and the peaks will be more broadened and the maximum of the gain spectrum decreases. The time evolution of the photon number for different currents and different HBs is shown. The results indicate that by increasing the HB, the number of photons in the steady state and the delay in the starting oscillation will increase. In addition, we show that there is threshold coverage for quantum dots to begin lasing and an optimum quantum dot coverage in which the self-assembled quantum dot lasers operate with the lowest possible threshold current and maximum output power.

Exploring the Relation Between Impairment Rating by AMA Guide and Activity and Participation Based on ICF in the Patients with Hand Injuries

The aim of this paper is to analyze the relation between components of disability with distinguished score of impairment, activity and participation questionnaire based on clinical data of persons with hand injuries. Impairment was evaluated by use of AMA guide 6th edition and disability by DASH questionnaire on Convenience sample of patients (N = 117), with chronic hand injuries. Linking and allocating items of the DASH were done based on the ICF Core Set for Hand Conditions and the opinions of a group of experts from different related fields. Data was analyses by using Kappa index, Chi square test and a set of Pearson, Part and Partial correlations coefficient. Most of the DASH items were allocated to the activity; one to four of the items could not be classified and 0 to 22 were classified as having overlap. Participation and activity scores correlated positively with each other (r > 0.80). Impairment had high correlation with activity and participation scores (>73). With controlling the effect of each or both construct, this relation between them with impairment diminished but still significant between activity and impairment. There is a huge overlap in definition of activity and participation. The most effecting item in relation of disability and impairment is activity restriction. Participation had no relation with impairment.

Gender as a Moderator of the Relation Between Age Cohort and Three-Dimensional Wisdom in Iranian Culture

This study examined whether gender moderated the association between age cohort and the cognitive, reflective, and compassionate dimensions of wisdom, using an Iranian sample of 439 adults from three age cohorts: young (18-34), middle-aged (35-54), and older (55 and above). Results indicated that the interaction effect between gender and age cohort was significant for three-dimensional wisdom and all three wisdom dimensions. Compared with younger women and older men, older women tended to have less education and to score lower on the cognitive wisdom dimension, but they had similar average scores as older men on the compassionate wisdom dimension. Overall, the association between age and wisdom was only positive for men, due mainly to the positive relation between age and the reflective and compassionate wisdom dimensions for men after adjusting for education. The results are interpreted with reference to generation gaps, socialization of men versus women, and life experiences and opportunities.

Resistant Strains of Enterotoxigenic Staphylococcus aureus; Unknown Risk for Multiple Sclerosis Exacerbation

Background:

Despite all advances in neurological sciences, there are unknown aspects in the epidemiology of multiple sclerosis (MS). Based on this hypothesis, the enterotoxigenic strains of Staphylococcus aureus (S. aureus) are possible risk factors for exacerbations of MS.

Objectives:

The present study was carried out to investigate the role of resistant strains of enterotoxigenic S. aureus in MS exacerbation.

Materials and Methods:

Two-hundred nasal swab samples were collected from non-MS (n = 80), MS stable (n = 60) and MS exacerbation (n = 60) groups. Samples were cultured and those that were S. aureus-positive were analyzed for the presence of enterotoxins, using polymerase chain reaction (PCR). Antimicrobial susceptibility was performed using disk diffusion method.

Results:

Ninety out of 200 nasal samples (45%) were positive for S. aureus. The highest levels of nasal colonization were seen in MS exacerbation group (68.33%). The most commonly detected enterotoxins were sea (30%), sec (15.55%) and seb (11.11%). There were significant differences between S. aureus colonization and type of samples (P = 0.026) and, also, between type of samples and prevalence of enterotoxins (P = 0.022). The highest levels of enterotoxigenic genes were seen in MS exacerbation group. The S. aureus strains had the highest levels of resistance against tetracycline (80%), ampicillin (72.22%), methicillin (66.66%), erythromycin (66.66%), oxacillin (63.33%), trimethoprim-sulfamethoxazole (61.11%) and cotrimoxazole (55.55%).

Conclusions:

Our findings should raise awareness about the role of sea and sec enterotoxins, in resistant strains of S. aureus, as a risk factor for MS exacerbation. It is better to keep MS patients away from polluted environments of hospitals and health centers.

High doses of garlic extract significantly attenuated the ratio of serum LDL to HDL level in rat-fed with hypercholesterolemia diet

Background

Hypercholesterolemia is associated with an increased risk of heart disease. In this study, we investigated the antihyperlipidemic effects of garlic (Allium sativum L.) in rat models of hypercholesterolemic.

Methods

Wistar male rats were randomly divided into 4 diet groups with garlic supplementation. Male Wistar rats were fed by standard pellet diet (group I), standard diet supplemented with 4 % garlic (group II), lipogenic diet (containing sunflower oil, cholesterol and ethanol) equivalent to 200 mg raw garlic/kg body weight (raw) (group III) and lipogenic diet equivalent to 400 mg raw garlic/kg body weight (raw) (group IV).

Results

Rats fed 400 g/kg garlic extract(GE), had a significantly lower concentration of serum low-density lipoprotein cholesterol (LDL-C) cholesterol and elevated HDL –C cholesterol at day 28 (P < 0.05).In addition,serum levels of LDL-C was lower in the III and IV group than those in the IV group (P < 0.001 for each). However, cholesterol efflux capacity was positively correlated with HDL cholesterol concentration (P < 0 · 0001). It was also directly correlated with garlic supplementation (P < 0 · 0001).

Conclusion

Together Taken, the results are clearly indicative of the beneficial effects of garlic in reducing lateral side effects of hyperlipidemia. Our data demonstrate that GE has protective effects on HDL in rats with high LDL intake. Therefore, it could be used to remedy hypercholesterolemia with help reduce risk of coronary heart disease

Virtual slides

The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1834155749171141

Association between Hepatitis G and Unknown Chronic Hepatitis

Background:

Hepatitis G virus (HGV) is a hepatotrope virus with unknown importance. The genome of the virus has been detected in patients with acute or chronic non-A-E hepatitis, cirrhosis, and hepatocellular carcinoma. The aim of this study was to determine the association between hepatitis G and unknown chronic hepatitis.

Methods:

This case-control study was performed in Ebne-Sina military hospital in Hamadan, Iran. The cases were 35 military staff with unknown chronic hepatitis. The control group consisted of 59 healthy subjects who had normal levels of serum alanine aminoteransferase (ALT). The data were analyzed by SPSS, version18, using Fisher’s exact test, the Student’s t-test, and multivariate logistic regression analysis.

Results:

Only one patient in the case group (2.9%) tested positive for HGV antibodies, and no one was infected in the control group. There was no association between HGV infection and unknown chronic hepatitis in our study (P=0.37). A significant association was found between the male gender and unknown chronic hepatitis (OR=14.9, P=0.01).

Conclusion:

No association between HGV infection and unknown chronic hepatitis was found in our study, so it was not necessary to evaluate these patients for HGV infection.

A prospective randomized controlled trial of controlled passive mobilization vs. place and active hold exercises after zone 2 flexor tendon repair

PURPOSE

The rehabilitation program after flexor tendon repair of zone II laceration varies. We designed a Prospective Randomized Controlled Trial of controlled passive mobilization (modified Kleinert) vs. Place and active hold exercises after zone 2-flexor tendon repair by two-strand suture (Modified kessler).

METHODS

Sixty-four fingers in 54 patients with zone 2 flexor tendon modified Kessler repairs were enrolled in a prospective randomized controlled trial comparing place and active hold exercises to controlled passive mobilization (modified Kleinert). The primary outcome measure was total active motion eight weeks after repair as measured by an independent and blinded therapist.

RESULTS

Patients treated with place and active hold exercises had significantly greater total active motion (146) eight weeks after surgery than patients treated with controlled passive mobilization (114) (modified Klinert). There were no ruptures in either group.

CONCLUSIONS

Place and hold achieves greater motion than controlled passive mobilization after a two-strand repair for zone 2 flexor tendon repairs.

Investigation of subwavelength grating structure for enhanced surface plasmon resonance detection

A metallic subwavelength grating structure built on a thin gold film is studied for surface plasmon resonance (SPR) detection of refractive index variations of biological buffer solutions. By employing finite element analysis as a numerical method, characteristics of the angle interrogated SPR sensor were calculated and discussed in a broad operating wavelength varying from visible to near-infrared (NIR). The effects of grating structural parameters such as grating depth, grating period, and grating fill factor in different operating wavelengths have been evaluated on the sensor performance parameters of sensitivity, full width at half-minimum, minimum reflectance at resonance, and resonance angle. Numerical results indicate that adjusting grating geometrical parameters can enhance the performance parameters of the sensor especially in the NIR wavelengths. The enhanced sensor performance parameters for optimizing grating geometry have been explored in detail for visible and NIR wavelengths of 633 and 984 nm, respectively. These findings are important for developing localized surface plasmon sensors with enhanced performance.

Design study of nanograting-based surface plasmon resonance biosensor in the near-infrared wavelength

A key issue with surface plasmon resonance (SPR) biosensors, which are the focus of many researchers, is improving their sensitivity to detect lower amounts of analyte in a solution. Most SPR developments have focused on the grating-based sensitivity-enhancement approach. In addition to sensitivity, a substantial enhancement of other sensor characteristics such as resolution and signal-to-noise ratio (SNR) is desired for designing a practical sensor. So, in this paper, the characteristics of surface plasmon polaritons sustained by 1D subwavelength metallic gratings on a thin metal slab (under the Krestchmann configuration) have been investigated numerically for the analyte-ligand interactions detection. Effects of different structural parameters, such as grating period, grating depth, metal film thickness, and fill factor have been evaluated on the sensor sensitivity as well as resolution and SNR. Numerical results indicate that the sensor working in the near-infrared wavelength has a better performance than that in the visible one. The result of numerical investigation has been used to design an optimized sensor with the best figure of merit.

Evaluation of Non Diseased Specified Outcome Measures in Hand Injuries to Assess Activity and Participation Based on ICF Content

The objective of the study is to provide information about non disease specified outcome measures which evaluate disability in patients who have impairments in hand and upper extremity and to find the extent to which they are evaluating "disability" based on ICF hand Core Set (activity limitation and participation restriction). MEDLINE, CINAHL, GOOGLE SCHOLAR , OVID and SCIENCE DIRECT databases were systematically searched for studies on non disease specified outcome measures used to evaluate upper extremity function; only studies written in English were considered. We reviewed titles and abstracts of the identified studies to determine whether the studies met predefined eligibility criteria (eg, non disease specified out come measures used in hand injured patients). All the outcome measures which had eligibility included. After full text review ,7 non disease specified outcome measures in hand were identified. Studies were extracted, and the information retrieved from them. All the outcome measures which had incuded, were linked with ICF hand core set disability part (activity and participation). All of them only linked to 16 (42 %) components of ICF hand Core Set, which were most activity and less participation from ICF. None of the non disease specified out come measures in hand injuries cover all domains of disability from the ICF Hand Core Set.

Construct Validity and Factor Structure of the Persian Occupational Self-Assessment (OSA) With Iranian Students

This study aimed to investigate construct validity and factor structure of the Persian Occupational Self-Assessment (OSA; Baron, Kielhofner, Iyenger, Goldhammer, & Wolenski, 2003 ) based on the model of human occupation (MOHO). Three hundred and thirty-six (179 male and 157 female) Iranian junior high students were measured using the OSA. The data were analyzed using a Confirmatory Factor Analysis (CFA) and the Rasch Rating Scale Model (RSM). In combination, the CFA and RSM results provided strong evidence for the construct validity of the Persian version. The CFA indicated that the hypothesized second-order model could explain the relationship of the OSA items to the latent variables of occupational competence and value for occupations. However, RSM item hierarchies did not replicate those found in previous international studies.

High performances III-Nitride Quantum Dot infrared photodetector operating at room temperature

In this paper we present a novel long wave length infrared quantum dot photodetector. A cubic shaped 6nm GaN quantum dot (QD) within a large 18 nm Al(0.2)Ga(0.8)N QD (capping layer) embedded in Al(0.8)Ga(0.2)N has been considered as the unit cell of the active layer of the device. Single band effective mass approximation has been applied in order to calculate the QD electronic structure. The temperature dependent behavior of the responsivity and dark current were presented and discussed for different applied electric fields. The capping layer has been proposed to improve upon the dark current of the detector. The proposed device has demonstrated exceptionally low dark current, therefore low noise, and high detectivity. Excellent specific detectivity (D*) up to approximately 3 x 10(8)CmHz(1/ 2)/W is achieved at room temperature.

Apexification of non-vital pre-molar stemming from possible dens evaginatus

Dens evaginatus is a dental anomaly that occurs more commonly in pre-molar teeth. Although not a cause for alarm in most instances, it can lead to serious consequences if it is damaged. This paper explores the treatment of a necrotic pre-molar with an open apex that caused serious facial swelling in an adolescent patient. It is believed that this swelling was the result of an enamel tubercle, or dens evaginatus, which was knocked off or traumatized.

Type of cell death and the role of acetylcholinesterase activity in neurotoxicity induced by paraoxon in cultured rat hippocampal neurons

Organophosphate (Ops) neurotoxicity is attributed both to its well-known cholinergic and non-cholinergic effects. In the present study we compared enzymatic and morphologic changes in neurons exposed to paraoxon during one day and one week. The effect of exposure time is important in neurotoxicity of Ops. The longer the exposure time is the more damage is observed in neurons, although there are few investigations about the effect in the post-exposure period. Hippocampal cells were obtained from rat neonates and cultured in Neurobasal/B27. Paraoxon at 50 and 100 microM were added. Inverted microscope and electron microscope were used to study cell morphology and Neutral Red staining was used to measure viability. We also assayed caspase-3 and (acetylcholinesterase) AChE activity. Hoechst staining was utilized to determine the type of cell death. Culture medium was replaced after 24 h in one-day group, however, tests were all carried out at the end of the first week in both group. The results indicate that paraoxon reduced the viability in a dose-dependent manner. Our results do not confirm apoptosis in either group; it seems that the cell death in one-day exposure group was not AChE dependent. In conclusion, present data imply that the toxicity of paraoxon is both dose and duration dependent, which may even remain after the cessation of exposure.

Modeling and simulation of ammonia removal from purge gases of ammonia plants using a catalytic Pd-Ag membrane reactor

In this work, the removal of ammonia from synthesis purge gas of an ammonia plant has been investigated. Since the ammonia decomposition is thermodynamically limited, a membrane reactor is used for complete decomposition. A double pipe catalytic membrane reactor is used to remove ammonia from purge gas. The purge gas is flowing in the reaction side and is converted to hydrogen and nitrogen over nickel-alumina catalyst. The hydrogen is transferred through the Pd-Ag membrane of tube side to the shell side. A mathematical model including conservation of mass in the tube and shell side of reactor is proposed. The proposed model was solved numerically and the effects of different parameters on the rector performance were investigated. The effects of pressure, temperature, flow rate (sweep ratio), membrane thickness and reactor diameter have been investigated in the present study. Increasing ammonia conversion was observed by raising the temperature, sweep ratio and reducing membrane thickness. When the pressure increases, the decomposition is gone toward completion but, at low pressure the ammonia conversion in the outset of reactor is higher than other pressures, but complete destruction of the ammonia cannot be achieved. The proposed model can be used for design of an industrial catalytic membrane reactor for removal of ammonia from ammonia plant and reducing NO(x) emissions.