Fear of the unknown, anxiety, and social isolation in Iranian patients with Covid-19, the grounded theory

BACKGROUND

Coronavirus 2019 (COVID-19) pandemic has incurred a health challenge. Patients suffer from many physical and mental disorders. To accurately identify the experience of patients with Covid-19 in the Iranian society.

MATERIALS AND METHODS

This qualitative research was conducted using the grounded theory. The data of this grounded theory study were collected using 32 semi-structured interviews with participants and field notes including the patients with Covid-19, nurses, physicians, and the patients' families. Data analysis was performed using Corbin and Strauss (2008) approach for concepts, context, process, and categories' integration.

RESULTS

Qualitative analysis of data led to the extraction of 54 sub-categories and 7 final categories. "Isolation, fear of death, and fear of infection of relatives and family members" were identified as the main issue. The context to this concern was the "unfamiliarity with the virus due to its ambiguous nature that was obtained with a wide range of symptoms." Facing this issue, the patients used the strategy of "adherence to health protocol in the coronavirus infection process" that was recognized as the central variable.

CONCLUSION

The ambiguous and complex nature of the emerging virus, the appearance of different symptoms in different people, and the fear of infecting others, death and anxiety due to unknown complications of the disease make patients go through the most difficult experience of their lives. That requires ongoing training on up-to-date prevention and treatment protocols, along with the emergence of mutated viruses and new symptoms.

Synbiotic supplement for treatment of iron deficiency anaemia in haemodialysis patients: A randomized controlled trial

BACKGROUND

There is evidence that probiotics can increase the availability of iron. The aim of current study was to determine the effects of synbiotic supplementation on the haematological parameters and anaemia in haemodialysis patients.

METHODS

This study was a randomized, double-blind, placebo-controlled trial. Fifty patients were randomly selected from the haemodialysis section of Vaseii Hospital, Sabzevar, Iran. Subjects in the symbiotic and control groups received 2 capsules of synbiotic supplement or placebo, respectively, once a day for 8 weeks. Blood samples were divided into two test tubes in equal volumes. Blood haemoglobin, haematocrit, transferrin saturation, red blood cells (RBCs), and total iron binding capacity (TIBC) were measured with auto-analyser. Ferritin was determined using Sandwich enzyme-linked immunosorbent assay (ELISA).

RESULTS

Twenty tree patients in each group completed the study. Significant results were recorded in synbiotic groups regarding the concentration of blood haemoglobin, haematocrit, transferrin saturation, the number of RBCs, and serum ferritin compare to placebo group (P < .05). At the end of week 8, TIBC significantly decreased in synbiotic than placebo group (P < .05).

CONCLUSION

Synbiotic supplementation could be a safe and promising candidate in improving anaemia in CKD patients.

The Effects of Nigella Sativa Oil on Serum Levels Inflammatory Markers, Oxidative Stress Markers, and Lipid Profile in Dialysis Patients: A Double-Blind Clinical Trail

Background: High concentrations of serum inflammatory and oxidative stress markers and lipid abnormities are important risk factors for cardiovascular diseases in hemodialysis patients. This study aims to investigate the effects of Nigella sativa oil on serum levels inflammation and oxidative stress markers and lipid profile in hemodialysis patients. Methods: Fifty hemodialysis patients participated in this randomized, double-blind, placebo-controlled clinical trial. The patients were randomly assigned into two groups, including receiving 2 tablets of Nigella sativa oil (1000 mg/day, NG) and receiving placebo (PG), for 8 weeks. Blood samples were taken from the patients at the beginning and the end of the study after 12 to 14 hour fasting for measuring serum markers. Then, levels of triglycerides (TG), total cholesterol (TC), LDL-c, HDL-c, high sensitivity C-reactive protein (hs-CRP), and malondialdehyde (MDA) were measured. Results: Consumption of Nigella sativa oil as a supplement decreased levels of TC (P = 0.0002), LDL-c (P = 0.001), mean serum hs-CRP, and MDA compared to the PG (P = 0.001). Conclusion: The Nigella sativa oil supplement may reduce serum hs-CRP and MDA, TC, LDL-c, and risk factors for cardiovascular diseases in hemodialysis patients.

Investigation of radiation dose around C-arm fluoroscopy and relevant cancer risk to operating room staff

This study aimed to evaluate the ambient dose equivalent around a C-arm device during spinal surgeries and determine the optimum locations for the surgeon and staff to keep radiation exposure as low as reasonably achievable. Furthermore, cancer risk incidence was estimated using the excess relative risk (ERR) concept of the biologic effects of ionizing radiation VII report for operating room (OR) staff. A lateral projection of the C-arm setup was considered in the current study. The ambient dose equivalent rate was measured using an electronic dosimeter in 30° steps all around for 1, and 1.6-m heights as well as 1, and 2-m distances away from a water tank (scattering medium). By assuming a typical workload, the annual ambient dose and a maximum number of permissible operations were determined. For a worst-case scenario, the dose was used to estimate the ERR for various organs including prostate, ovary, breast, lung, thyroid, and colon for attained ages of 35, 40, and 50 years. The maximum ambient dose equivalent rate was seen at 330° and 30° (about 600 µSv/h at 1 m height and a distance of 1 m from the scattering medium). The corresponding permissible workload for an OR staff was about 30,660 operations. Based on the obtained results, 60° next to the image intensifier was the optimum position for the surgeon, while 30° next to the tube was the worst position because of backscattered radiation. The ERR results showed that the lung and colon have the highest cancer risk incidence among the considered organs for both males and females, respectively.

Quality of life and asthma control in pregnant women with asthma

Background

Asthma is the most commonly occurring respiratory illness during pregnancy. Associations with complications of pregnancy and adverse perinatal outcome have been established. However, little is known about quality of life (QoL) in pregnant women with asthma and how it relates to asthma control particularly for Iran.

Objective

To determine the relationship between asthma related QoL and asthma control and severity.

Methods

We conducted a prospective study in pregnant women with asthma. We used the Asthma Control Questionnaire and the Asthma Quality of Life Questionnaire (AQLQ) and the guidelines of the Global Initiative for Asthma for assessment of asthma severity.

Results

Among 1603 pregnant women, 34 were diagnosed with asthma. Of these 13 had intermittent, 10 mild, 8 moderate and 3 severe persistent asthma. There was a significant decrease of QoL with poorer asthma control (p = 0.014). This decline could be due to limitations of activity in those with poorer asthma control, which is underlined by the significant decline of QoL with increasing asthma severity (p = 0.024).

Conclusion

Although the majority of pregnant women with asthma had a favorable score in AQLQ, reduced QoL was related to increased asthma severity and poor asthma control. This underlines the importance of controlling asthma during pregnancy not only for the prevention of adverse pregnancy outcomes but also for the preservation of QoL.

Using Local Nigella Sativa Oil to Relief Premenstrual Syndrome Symptoms

Background: Premenstrual Syndrome (PMS) is a common problem in women. Nigella sativa has been suggested for its anti-inflammation and analgesic effects. This study was conducted to evaluate the effect of Nigella sativa oil on PMS. Methods: This double-blind clinical trial was conducted on 124 female students within the age range of 18-25 years living in the dormitories of Sabzevar University of Medical Sciences. Participants were randomly divided into two groups. The intervention group (IG) rubbed 1-2 drops of Nigella sativa oil on their fontanels at night for sev­en days before their three menstrual cycles. The placebo group (PG) rubbed placebo in the same way. After three cycles, pain severity was measured by the visual analog scale. Data analysis was carried out using the Mann-Whitney U test and analysis of covariance. Results: The mean age of participants, the mean age of menarche, and the mean age of PMS onset were 20.55 ± 0.2, 13.52 ± 0.15, and 15.35 ± 0.3 years old, respectively. The results showed that Nigella sativa oil reduced the severity of all PMS symptoms except in terms of depression and abdominal bloating in IG compare to the PG. Conclusion: Nigella sativa oil in women with premenstrual syndrome can be a promising, safe, and easily available analgesic supplement.

Designing a comprehensive clinical competency test for operating room technology student: Using Delphi technique and CIPP model evaluation

BACKGROUND

The ultimate goal in educating medical students is to train skilled workforce who by obtaining the required knowledge of the discipline, personal and professional skills, and attitudes to enter the national health-care system. This study was conducted with the goal of designing a comprehensive clinical competency test of operating room technology student using the Delphi technique, and then, the clinical skills of the operating room technology students of the paramedical school were assessed using the CIPP evaluation model.

MATERIALS AND METHODS

The present study was conducted in the University of Medical Sciences to evaluate clinical skills with Delphi technique and CIPP evaluation model. This was a mixed methods study. Purposive sampling method was employed in the qualitative stage, and a census was conducted in the quantitative part. A comprehensive clinical competency test was designed in this research using the Delphi technique and was conducted with 18 students. Then, clinical skills evaluation was performed by descriptive-analytical statistical tests and evaluator's observation using the CIPP model.

RESULTS

The comprehensive clinical competencies test of the surgical technology students was designed in four sections: content, evaluation method, test conditions, and the criteria for passing the comprehensive test. The results in the implementation stage showed that the operating room technology students had a range of excellent to weak performances in exhibiting basic skills at different levels.

CONCLUSIONS

The results of the present study showed that the comprehensive test, designed based on the Delphi technique of experts, and using the CIPP model can be a good criterion for the evaluation of the operating room technology students before entering the clerkship.

Environmental tobacco smoke exposure during pregnancy affects complications and birth outcomes in women with and without asthma

Background

It is known that environmental tobacco smoke (ETS) has adverse effects on pregnancy and birth outcomes. We aimed to assess the impact of ETS in pregnant women with and without asthma.

Methods

A cohort study was conducted from August 2014 to June 2015 enrolling 1603 pregnant women during their 2nd trimester. Data on tobacco exposure were collected at first visit and women were followed through pregnancy till postpartum.

Results

Of the 1603 women, 231 reported passive smoking, 223 non-asthmatics and 8 asthmatics. Women exposed to ETS during pregnancy were more likely to have an infant admitted to the pediatric ward (10.8% vs. 6.5%, p = 0.026) and to have low one- and five-minute Apgar scores (1 min: 6.1% vs. 2.6%, p = 0.011; 5 min: 2.2% vs. 0.7%, p = 0.039). Complications of pregnancy were also elevated in women exposed to ETS (53.7% vs. 42.3%, p = 0.002). Asthma had no additional effect beyond the impact of ETS except for cesarean sections that were more frequent in women with asthma exposed to ETS.

Conclusions

Due to the small number of women with asthma exposed to ETS, combined effects of asthma and ETS were only found for cesarean sections. Still counseling of pregnant women about adverse effects of ETS should consider women’s asthma as an additional reason to avoid ETS.

Prioritizing the health education needs based on community participation: AHP method

INTRODUCTION

The identification of health education needs through the community results in targeted services and health promotion. Prioritizing these needs, in addition to identifying the desired health system based on the needs of the community, is required for the optimal allocation of resources. Therefore, this study was conducted with the aim prioritizing the health educational needs of Sabzevar-Iran community.

MATERIALS AND METHODS

This study was a two-step mix study. In the first stage, the qualitative method of the main themes of health educational needs of Sabzevar society was determined. Then, the questionnaire was prepared by a paired scale (36 questions) and quantitative method was used to prioritize the main themes with Analytic Hierarchy Process (AHP) software. The random sampling method was used in this study and data analysis was performed using Expert Choice software using AHP method.

RESULTS

Social problems with 0.206, contagious diseases with 0.205, nutrition with 0.161, and public health with 0.132 were in the first to fourth grades of health educational needs in Sabzevar city and environmental health, health management, noncontagion diseases, elderly, and occupational health were in the fifth to ninth grades. The consistency index in this study was 0.08, although the adjustment index is <0.1 good and acceptable.

CONCLUSION

Social problems are the first priority of Sabzevar society, which require appropriate training.

The Effect of Consuming Mineral Water and Piped Water on Blood Pressure and Lipid Profiles of Hypertensive Men

Background: Hypertension is the third risk factor for the cardiovascular diseases. This study investigated the effects of mineral water from Damavand spring on the blood pressure and serum lipid profiles in men with hypertension. Methods: In this study 41 hypertensive men were randomly assigned to Damavand mineral water (DM) and Tehran water groups (TW). The DM and TW received 1.5-liter bottle of mineral water of Damavand spring and Tehran piped water bottled, respectively. The participants' blood pressure, serum triglyceride (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDLc), and high-density lipoprotein cholesterol (HDLc) were measured at the beginning and end of the study. Total hardness of water was measured by titration with EDTA. Results: The results showed that the mean systolic and diastolic blood pressures decreased in both groups at the end of the study compared to the baseline (P < 0.05), but the difference was not significant. Serum TC and LDLc significantly in the case group at the end of week 8 compared to the baseline (P < 0.05) and this reduction was significant (P < 0.05). Moreover, no significant differences were observed between the two groups with regard to the mean changes of TG and HDLc (P > 0.05). Conclusions: The findings showed that the daily consumption of 1.5 liters of premium mineral water of Damavand springs decreased the systolic and diastolic blood pressure, total cholesterol, and LDLc levels.

Prospective cohort study of pregnancy complications and birth outcomes in women with asthma

Background

Asthma is the most common potentially serious medical complication in pregnancy. The purpose of this study was to determine the association between maternal asthma and a spectrum of adverse neonatal and maternal outcomes.

Methods

Events during pregnancy and birth outcome were evaluated in 34 asthmatic as well as 1569 non-asthmatic pregnant women who were enrolled in a prospective cohort study undertaken at the antenatal clinics of Mobini Hospital in Iran. The women were interviewed and classified according to clinical severity and asthma control as per GINA guidelines. Information on asthma symptoms was collected by a questionnaire as well as by spirometry and physical examination. All subjects were followed until delivery, and postpartum charts were reviewed to assess neonatal and maternal outcomes. Eosinophil cells counts were obtained and total IgE was measured by ELISA. Results were assessed by multivariate logistic regression adjusting for maternal age and parity, and for birth outcomes, for gestational diabetes, and hypertension/pre-eclampsia.

Results

The well-known relationship between family history of asthma and asthma in pregnancy was again supported (p < 0.001). Women with asthma had more bleeding events 3 weeks or more before delivery (OR 3.30, 95% CI 1.41–7.26), more often placenta problems (OR 6.86, 95% CI 1.42–33.02), and gestational diabetes mellitus (OR 3.82, 95% CI 1.06–13.75). No significant differences between asthmatic and non-asthmatic mothers regarding duration of gestation, birthweight, low Apgar scores, or neonatal respiratory difficulties were found. Total IgE antibody levels and eosinophil counts did not differ by asthma control and severity.

Conclusions

Asthma in pregnancy poses some risk for pregnancy complications and adverse perinatal outcomes. Managing asthma effectively throughout pregnancy could benefit women and their babies and help to reduce the health burden associated with asthma during pregnancy.

Status of antioxidant and homocysteine-lowering vitamins related to cardiovascular diseases in hemodialysis patients

Background and aim

Cardiovascular disease is the major cause of mortality in hemodialysis patients. Oxidative stress and hyperhomocysteinemia may contribute to an increased risk of CVD. Therefore, we assessed the status of antioxidant and homocysteine-lowering vitamins related to cardiovascular disease in hemodialysis patients at Vasei hospital in Sabzevar.

Methods

In this cross-sectional study, we enrolled 75 hemodialysis patients by using census method at Vasei Hospital in Sabzevar (Iran) in 2014. After measuring height and body weight, food intake was assessed by a 24-hour dietary recall questionnaire for at least two days (a non-dialysis and dialysis day), and food frequency was recorded with Nutritionist IV software. Data were analyzed by SPSS version 16, using descriptive statistical tests, one sample t-test and independent samples t-test and p<0.05 was considered statistically significant.

Results

This study was carried out on 75 patients. Mean age and BMI of patients were 49.95±17.22 years and 20.04±3.38 kg/m², respectively. Intake of all vitamins with the exception of vitamin B12 in hemodialysis patients studied, were less than the recommended dietary allowance (RDA) (p<0.05).

Conclusion

According to the survey, consumption of antioxidants and B-vitamins related to cardiovascular disease was less than RDA in hemodialysis patients.

Study of fruit and vegetable intake in breast cancer patients in the city of Sabzevar

Introduction

Diet is one of the most important modifiable risk factors for prevention and control of chronic diseases, including breast cancer. This study aimed to determine the fruit and vegetable intake in women with cancer breast in Sabzevar.

Methods

This cross-sectional study was conducted on 125 women with breast cancer in Sabzevar in 2011. Census sampling was done on volunteers in a visiting home and suspected women referred to the mammography, ultrasound, and radiology clinic in the Sabzevar center for breast cancer. Demographic and semi quantitative food questionnaires of 160 foods were completed for each of the patients by trained interviewers. Data were analyzed using the software Nutritionist IV. Descriptive statistics, one-sample t-test, and Chi-square test were used, employing the SPSS version 16.

Results

In this study, 125 women were assessed with breast cancer. The highest risk with breast cancer was 35.5% in women 40 to 49 years old. The results of this study showed that patients with breast cancer had minimum daily recommended intake (3.06 ± 2.3 serving of fruits and 2.09 ± 1.81 serving of vegetables in days). One sample t-test showed that the mean intake of fruits and vegetables was not a significant deference with daily recommended intake (p>0.05). The chi-square test showed that patients with minimum daily recommended intake of fruits and vegetables were at high risk for breast cancer in comparison with those who received the highest amount (p=0.001).

Conclusion

This study supports evidence that high vegetable and fruit intake is associated with lower breast cancer risk.

The association between serum C-reactive protein and macronutrients and antioxidants intake in hemodialysis patients

Background:Despite the high levels of inflammation in hemodialysis patients and the effects of diet on systemic inflammation, such as the development of atherosclerosis and cardiovascular disease, few studies have evaluated the relationship of macronutrients and antioxidants intake with serum C-reactive protein (CRP). Therefore, this study assessed the relationship between serum high sensitivity CRP (hs-CRP) with macronutrients and antioxidants intake and serum albumin. Methods:This cross-sectional study used census sampling to select 75 hemodialysis patients (35 men and 40 women) who attended the hemodialysis department of Vaseie Hospital of Sabzevar, Iran. After obtaining the written consent, all the patients were interviewed and dietary data was collected by using a semi-quantitative food frequency questionnaire including 160 food items. Diet analysis was performed with Nutritionist IV. Before being connected to the dialysis machine, 5 cc fasting blood samples were obtained from all participants and serum hs-CRP and albumin levels were measured. All the statistical analyses were conducted with SPSS -for Windows, version 16.0. Results:The patients' mean body mass index was 20.09 ± 3.27 kg/ m2. The participants' intake of antioxidants and all macronutrients, except for carbohydrates and proteins, was less than the standard levels. Moreover, the hs-CRP had significant inverse relationships with serum albumin (P=0.0001) and vitamin E and C intakes but was not significant. Also, a significant relationship was observed between hs-CRP levels and the intake of energy (P=0.002) and protein (P=0.0001). Conclusion:Our findings indicated hs-CRP levels of hemodialysis patients to have significant inverse relationships with serum albumin and vitamin E and C intakes but was not significant. Also, a significant relationship was observed between hs-CRP levels and the intake of energy and protein.