Understanding Factors Contributing to Nurses’ Intention to Care for COVID-19 Patients Using the Theory of Planned Behavior

Background: Globally, the nursing community has lost several colleagues during the Coronavirus Disease 2019 (COVID-19) battle. One of the negative consequences of the disease is the pressure on healthcare services and demands that exceed the system's capacity to provide sufficient resources. Similarly, the experiences of care providers might trigger emotional and physical stress, which could affect the healthcare system's readiness to manage infectious outbreaks. This study was aimed at investigating nurses’ intention to care for COVID-19 patients and determining factors contributing to their intentions to care at the Ministry of Health facilities in Saudi Arabia. Methods: This descriptive cross-sectional survey design was used to recruit 336 nurses working in Al Madinah Ministry of Health hospitals where COVID-19 patients received medical and nursing care. The instrument was created following the framework of the Theory of Planned Behavior. Results: Nurses’ intention to care for COVID-19 patients was significantly correlated with their education level, nationality, knowledge about COVID-19, and nurses’ exposure during their earlier education for emerging infectious diseases. Factors related to social pressure from friends, colleagues, and workplace administration support needed improvement. Examining the model fits through multiple regression revealed that the combination of six subscales – “attitude, subjective norms, perceived behavioral control, behavioral beliefs, normative beliefs, and control beliefs” – accounted for a significant (89%) variability of intention to care, R2 = 0.892, adjusted R2 = 0.793, F (6-329) = 201, p ≤ 0.000. Conclusion: Providing nursing education is the main predictor of higher nurses' intention to care for COVID-19 patients, it is imperative that nursing education courses should continue investing in enhancing nurses' capabilities in caring for COVID-19 patients.

Expression of Cyclin D1 in Oral Squamous Cell Carcinoma

Background: Cyclin D1 expression regulates normal cell cycle. Its deregulation or overexpression may cause disruption in the normal cell cycle control and lead to cancer progression. In this study, we aimed to study the expression of cyclin D1 in oral squamous cell carcinoma (OSCC) and find its association with the different grades of oral tumors, if any. Methods: This cross-sectional study included 40 formalin-fixed paraffin-embedded tissue blocks specimens of OSCC with variable grades. The expression of cyclin D1 was evaluated through immunohistochemical (IHC) staining. Results: There were 9 female and 31 male samples, with a male-to-female ratio of 3.4:1. The age ranged between 25 and 90 years with an average age of 65.5 years. Twenty-five (62.5%) samples were diagnosed as well-differentiated squamous cell carcinoma (WDSCC) and fifteen (37.5%) as poorly differentiated squamous cell carcinoma (PDSCC). No cases of moderately differentiated squamous carcinoma were included in the study. The expression of cyclin D1 was detected in the cases of WDSCC and a lesser expression was seen in the PDSCC with a P-value of 0.0003, OR 1581 and 95% CI (29.8239 to 83810.7113). Conclusion: Cyclin D1 is expressed in OSCC and stronger expression was detected in WDSCC.

The Effect of Intravenous Metoclopramide on Pain, Nausea, Discomfort, and Ease of Insertion of Nasogastric Tube in Emergency Department: A Double-blind Randomized Clinical Trial

Background: Placement of nasogastric tube (NGT) is a routine procedure in the emergency departments, which can be uncomfortable, painful, and cause nausea. The aim of this study was to investigate the effect of intravenous metoclopramide on the ease of NGT insertion, as well as reduction of patients’ pain, nausea, and discomfort during NGT insertion in the emergency department. Methods: In this randomized, double-blind, placebo-controlled trial, 80 patients referred to Imam Khomeini Hospital, Mazandaran Province, Iran were enrolled. Data were collected from December 2015 to March 2016. Participants were selected via convenience sampling and randomly divided into two equal groups (placebo and intervention groups). In metoclopramide and placebo groups, 10 mg of metoclopramide and 10 mg of normal saline solution were administered, respectively. All of the NGT was inserted 15–20 mins after the intravenous infusion. Patient-reported pain, discomfort, and nausea were evaluated using visual analogue scale (VAS), at four time points including before (T0), immediately (T1), 30 min after (T2), and 1 hr after the NGT placement (T3). The ease of NGT insertion was evaluated as easy, moderate, and difficult to pass. Results: None of the patients had pain, nausea, and discomfort in T0. Additionally, for those who received intravenous metoclopramide, pain intensity significantly decreased compared with the placebo group in T1 (37.7 vs 55.0), T2 (26.2 vs 41.7), and T3 (20.5 vs 33.7), respectively (P < 0.001). Nausea intensity decreased significantly over time among patients in the intervention group compared with the placebo group in T1 (32.7 vs 43.2), T2 (19.5 vs 31.2), and T3 (9.0 vs 21.7), respectively (P < 0.001). The intensity of patients’ discomfort decreased significantly among patients in the intervention group compared with the placebo group in T1 (39.5 vs 54.0), T2 (28.7 vs 40.2), and T3 (26.2 vs 39.6), respectively (P < 0.001). Patients in the intervention group had easier placement of NGT compared with the placebo group (Easy: 40.0% vs 0.0%, Moderate: 45.0% vs 62.5%, and Difficult: 15.0% vs 37.5%; P < 0.001). Conclusion: Based on the results of the present study, it seems that intravenous metoclopramide can be used as a promising modality for improving the ease of NGT placement and reducing patients’ pain, nausea, and discomfort during NGT insertion in the emergency department.

Comparison of Pocket Pulse Oximeter and Standard Pulse Oximeter With ABG Analysis in Critically Ill Patients

Background: Pulse oximetry (SpO2) is a standard monitoring device in patients presenting to EMDs and intensive care units (ICUs). Pocket pulse oximeters (PPOs) are used widely in wards, EMDs, and small hospitals/clinics. These inexpensive PPOs also guide therapeutic interventions. Few studies have evaluated the accuracy of SpO2 in patients presenting to critical care areas vis-à-vis devices like PPO and standard pulse oximeter (SPO). This study becomes extremely relevant in view of the ongoing crisis of the COVID-19 pandemic wherein SpO2 monitoring is very important in hospitals, quarantine centers, small clinics, or even at home. Methods: Patients presenting to critical areas who underwent arterial blood gases (ABG) analysis on the recommendation of the treating physician between November 2016 and October 2018 were included in this study. Along with the ABG analysis, a simultaneous assessment of SpO2 was done with a single PPO and SPO and all values were noted. Statistical analysis was done using the SPSS v.21.0 for Windows. Results: The study included 300 patients. We compared the O2 saturations of ABG, SPO, and PPO with respect to sex, different age groups, and at different levels of ABG pCO2, HCO3, and pH in all patients. All parameters were compared using the Pearson’s correlation test; the results showed that ABG O2 saturations were closer to the SPO than the PPO but the differences were not statistically significant as the Pearson’s correlation values for all parameters were >0.8. We also compared the parameters by Bland Altman Plot and all observations were outside 95% CI (confidence interval), which means that there was a good agreement between O2 saturations by all three methods, that is, ABG, SPO, and PPO; however, ABG O2 saturations were closer to SPO than PPO but this difference was not statistically significant. Hence, we conclude that the PPO is a useful tool for reliable monitoring of O2 saturations. Conclusion: This study highlights that inexpensive and noninvasive PPO can be used as a standard monitoring device with reliability in critically ill patients presenting to EMDs, ICUs, and small hospitals/clinics, quarantine centers, and even at home.

Practice and Perception of Radiographers on the Positioning Techniques of Erect Lateral Cervical Spine Radiography in Non-trauma Adult Patients

Background: The visualization of the lower cervical spine (C-spine), including the C7-T1 junction on lateral radiograph is a challenge due to the overlapping of the shoulder girdle. Therefore, the radiographers have adapted different positioning strategies to overcome this challenge. This study explores the current practice and perception of radiographers on positioning techniques of erect lateral cervical spine radiography in non-trauma adult patients. Methods: This prospective study was conducted with a self-administered, structured questionnaire distributed among 50 radiographers working in four selected hospitals in Sri Lanka. Results: The radiographers used weight-bearing and non-weight-bearing positioning techniques for the erect lateral C-spine radiography. Most of them employed the standing breath-holding technique for image acquisition with or without exertion. While 54% of the radiographers utilized two water-filled cans during the weight-bearing technique, 82% used holding arms back with the shoulders down and pulling as low as possible in the non-weight-bearing technique. In addition, 88% of the radiographers believed that the weight-bearing position could increase the visibility of the C-spine. Almost all the radiographers (100%) stated that correct positioning instruction could improve the visibility of the C-spine. Conclusion: Radiographers have mainly used two positioning techniques of weight-bearing and non-weight-bearing for erect lateral C-spine radiography for non-trauma adult patients. In addition, most radiographers had a positive attitude toward the weight-bearing technique in the evaluation of lateral C-spine. These results highlight the importance of conducting studies to evaluate the effectiveness of the weight-bearing technique in erect lateral C-spine radiography.

Effects of Curcumin on Iron Overload in Rats

Background: Iron overload, common in patients with hematological disorders, is a key target in drug development. This study investigated the effects of curcumin on iron overload in rats. Methods: Forty male Wistar rats weighing 139.78 ± 11.95 gm (Mean ± SD) were divided into three equal groups: (i) controls; (ii) iron overload group that received six doses of iron dextran 1000 mg/kg–1 by intraperitoneal injections (i.p.); and (iii) iron overload curcumin group that received six doses of curcumin (1000 mg/kg BW by i.p.). In addition to six doses of iron dextran 1000 mg/kg–1 by i.p., we studied the effects of curcumin on liver function enzymes (alanine aminotransferase [ALT] and aspartate aminotransferase [AST]); antioxidant enzymes (malondialdehyde [MDA], total oxidant status [TOS], total antioxidant status [TAS]); hematological parameters (hemoglobin [Hb], hematocrit [Hct], red blood cells [RBC], white blood cells [WBC], mean corpus volume [MCV], mean corpuscular hemoglobin [MCH], mean corpuscular hemoglobin concentration [MCHC]); and iron parameters (serum iron profile, transferrin, total iron-binding capacity [TIBC], ferritin, and transferrin saturation [TS%]). Results: Curcumin caused a significant decrease in the Hct and Hb concentrations in Group III (P < 0.05). It also significantly reduced the serum levels of ALT (52.45 ± 4.51 vs 89.58 ± 4.65 U/L) and AST (148.03 ± 6.47 vs 265.27 ± 13.02 U/L) at the end of the study (P < 0.05). The TIBC, transferrin levels, and TS significantly decreased when the rats were administered curcumin serum iron (P < 0.05). The TAS level significantly increased in Group III in comparison to Group I (the control group) (P < 0.05). At the end of the study, curcumin significantly reduced the serum levels of TOS (12.03 ± 2.8 vs 16.95 ± 5.05 mmol H2O2/L) while the TAS (1.98 ± 0.42 vs 1.06 ± 0.33 mmol Trolox equiv./L) was increased. Conclusion: The findings of the present study suggest the therapeutic potential of curcumin against iron overload.

Editorial – A Brief Guide to Author Self-promotion

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Metal Complexes and Their Potential Therapeutic Role Against COVID-19: Recent Developments in Drug Designing

COVID-19 is a global pandemic caused by severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2). Being associated with high mortality rates, this pandemic has forced several countries worldwide to impose complete lockdowns to limit the spread of infection. Despite the development of various vaccines, there is still an urgent need to design novel treatments backed with safety data for fighting SARS-CoV-2 and its various mutants. Currently, scientists are putting their strenuous efforts into finding the best treatment option for COVID-19. In this regard, metal complexes being active antiviral agents and immunity enhancers have great potential against SARS-CoV-2. Herein, metal complexes' therapeutic role and significance against treating SARS-CoV-2 or any of its target proteins are discussed.

Knowledge of ICU Nurses Regarding the Ongoing Nursing Assessment of ICU Patients in Khartoum City, 2020

Background: An ongoing nursing assessment is the most significant point in the nursing process to be executed in the beginning of every shift which can be accomplished by using different approaches. It needs to be conducted accurately to guide professional nurses’ decision-making ability to further provide holistic nursing care to patients in the intensive care units (ICUs). This study was aimed to assess the ICU nurses’ knowledge regarding ongoing nursing assessment of ICU patients. Methods: This descriptive cross-sectional hospital-based study was conducted in Khartoum city, and included 86 out of the 135 participants working in the critical care units of the main governmental hospitals in Khartoum city. Data were collected using a structured self-administered questionnaire after being tested for validity and then analyzed using mean, standard deviation, and correlation. Data were then presented as frequencies and percentages. Results: The study participants were aged between 20 and 40 years with a female to male ratio of 3:1, and varied levels of experience. Overall, 71.7% of the studied participants scored good on the standardized knowledge classification tool used, with few areas of knowledge gap, impacted by increased experience. Moreover, 36% of the participants used the ABCDE approach for ongoing nursing assessment, followed by the head-to-toe assessment approach (21%). Conclusion: The nurses’ knowledge regarding ongoing nursing assessment was good with a few areas of weakness raising the need for continuous educational and training programs.

Knowledge and Awareness of Diabetic Retinopathy among Diabetic Sudanese Patients, Khartoum State, Sudan, 2018

Background: The level of awareness of diabetic retinopathy is considered an important factor for early diagnosis and management of diabetic retinopathy. This study aimed to assess the level of awareness of diabetic retinopathy among patients with diabetes mellitus in Khartoum, Sudan. Methods: This cross-sectional study was conducted among diabetic patients attending Zeenam and Abdullah Khalil Diabetic Centers between June and September 2018. A convenience sample of diabetic patients was used. Information on the sociodemographic characteristics of the patients, patients’ knowledge, compliance with available treatments, and routine eye examinations was collected using a semi-structured questionnaire. Patients were also asked about the barriers that may interfere with a regular eye examination. Results: A total of 200 patients were enrolled and 94 (47%) of them were female; 13% of the respondents were diagnosed with diabetic retinopathy, 31.5% were hypertensive, and 13.5% had hyperlipidemia. Additionally, 88.5% of the patients were aware that DM can affect their eyes and 87% had never been diagnosed with diabetic retinopathy. Although around 83% thought that diabetic retinopathy could lead to blindness, only 35.5% of them had undergone fundus examination by ophthalmologists. Moreover, 39% of the participants had irregular diabetes follow-up and 43% monthly follow-up. Only 31% went for regular eye check-up; however, their compliance with routine retinal assessment was poor, with a total of 72.5% of participants assuming that they have good vision and need not get their eyes checked up regularly. The chief factor that was related to increased awareness of diabetic retinopathy in the study was the level of education. Conclusion: Although a large proportion of diabetic patients in Khartoum are aware that diabetes mellitus can affect their eyes, regular retinal assessment of patients was poor, thus hindering early diagnosis and management.