Impact of Povidone-iodine Versus Chlorhexidine for Periurethral Cleaning Before Catheterization on Pyuria and Bacteriuria Among Emergency Department Patients

Background: We aimed to determine the effect of periurethral cleaning before catheterization using chlorhexidine and povidone-iodine on bacteriuria and pyuria. Methods: This study was a single-blind clinical trial on a sample selected by convenience sampling. Demographic and clinical questionnaires were completed, and patients were randomly divided into two groups) 36 patients each of povidone-iodine and chlorhexidine using Minimization Software based on confounding variables including age, consciousness level, triage level, nutritional status, and underlying disease. The periurethral areas were cleaned with the given antiseptics and catheterized using standard and sterile procedures. Then, specimens were taken for urinalysis and urine culture immediately, 72 hours, and five days after catheterization. Then, bacteriuria rate, pyuria rate, and the number of microorganisms were determined through examinations. Data analysis was conducted using SPSS version 19. Results: There was no statistically significant difference in the bacteriuria rate between the two groups immediately (P = 0.76), 72 hours (P = 0.22), and five days (P = 0.50) after catheterization. The positive pyuria rate was not significantly different between the two groups immediately after catheterization. However, it was significantly higher in the povidone-iodine group 72 hours (P = 0.03) and five days (P = 0.004) after catheterization. The Mann-Whitney test compared the mean number of microorganisms between the two groups at different times. This test showed no significant difference in the number of microorganisms immediately (P = 0.93), 72 hours (P = 0.43), and five days (P = 0.61) after catheterization. Conclusions: Due to the lower side effects of chlorhexidine than povidone-iodine, it is suggested that similar studies be performed in other hospital wards with more stable patients to obtain more statistically significant results.

Data Infrastructure for a Poisoning Registry with Designing Data Elements and a Minimum Data Set

Background: The prevalence of poisoning is on the rise in Iran. A poisoning registry is a key source of information about poisoning patterns used for decision-making and healthcare provision, and a minimum dataset (MDS) is a prerequisite for developing a registry. Objectives: This study aimed to design a MDS for a poisoning registry. Methods: This applied study was conducted in 2021. A poisoning MDS was developed with a four-stage process: (1) conducting a systematic review of the Web of Science, Scopus, PubMed, and EMBASE, (2) examining poisoning-related websites and online forms, (3) classification of data elements in separate meetings with three toxicology specialists, and (4) validating data elements using the two-stage Delphi technique. A researcher-made checklist was employed for this purpose. The content validity of the checklist was examined based on the opinions of five health information management and medical informatics experts with respect to the topic of the study. Its test-retest reliability was also confirmed with the recruitment of 25 experts (r = 0.8). Results: Overall, 368 data elements were identified from the articles and forms, of which 358 were confirmed via the two-stage Delphi technique and classified into administrative (n = 88) and clinical data elements (n = 270). Conclusions: The creation of a poisoning registry requires identifying the information needs of healthcare centers, and an integrated and comprehensive framework should be developed to meet these needs. To this end, a MDS contains the essential data elements that form a framework for integrated and standard data collection.

Correlation Between Anger, Sleep Quality, and Indoor Activities During COVID-19 Quarantine

Background: Coronavirus disease 2019 (COVID-19) is a life-threatening disease that has spread globally and received international concern. Iran is one of the countries severely affected by this pandemic, implementing social lockdown and restrictive strategies. According to Persian medicine, restrictions like quarantine have psychological and social consequences. Objectives: This study aimed to investigate the relationship between sleep quality and anger behaviors in Iran and compare it with Persian medicine viewpoints. Methods: In this cross-sectional study, 739 participants were interviewed in April 2020 in Shiraz, Iran. The questionnaire included the Pittsburgh Sleep Quality Index (PSQI), the Multidimensional Anger Inventory (MAI), and items on demographics, temperament, and the quarantine situation social factors. All participants completed the questionnaires willingly and were ensured of data confidentiality. Results: We found that 58.3% of the participants had low sleep quality. Females showed higher scores on anger and its related aspects (P < 0.05). In addition, people with lower education and income levels revealed higher anger scores (P < 0.05). Moreover, the mean scores of anger and its related factors were higher in participants with low sleep quality, higher sleep latency, daytime dysfunction, and experience of using sleep medications (P < 0.05). Also, after adjustment for demographics and other social factors, the mean scores of anger and all of its aspects were higher in those with a sleep disorder, use of sleep medications, and daytime dysfunction (P < 0.05). Conclusions: In conclusion, our findings illustrated that various factors, including low sleep quality, are associated with anger in individuals with the experience of home quarantine during the COVID-19 outbreak. The outcome is compatible with Persian medicine evidence.

Evaluating the Risk Factors of Development and Progression of Diabetic Retinopathy: A Review Study

: Diabetes is a chronic, underlying, and common disease worldwide that imposes an enormous burden on the health system. Diabetic retinopathy (DR) is a serious complication in the eye caused by diabetes and may lead to visual impairment and blindness. The knowledge about the risk factors of DR is critical for the prevention of disease and developing treatment options. Moreover, DR is a multifactorial disease, and many studies have demonstrated various risk factors associated with it, such as hyperglycemia, hypertension, hyperlipidemia, etc. In this review study, we survey the main risk factors of the development and progression of DR.

Correlation of Anxiety with Pregnancy Symptoms and Maternal-fetal Attachment

Background: Anxiety during pregnancy may affect maternal-fetal attachment (MFA) and the prevalence of pregnancy symptoms. Objectives: The present study aimed to assess the correlation of anxiety with pregnancy symptoms and MFA. Methods: This cross-sectional study was conducted on 220 pregnant women in the health centers of Tabriz, Iran, in 2020. Samples were selected by the cluster sampling method. Data were collected using the socio-demographic questionnaire, Pregnancy-related Anxiety Questionnaire-revised 2 (PRAQ-R2), MFA Scale (MFAS), and Pregnancy Symptoms Inventory (PSI), all of which were completed as self-administered in the second half of pregnancy. The Pearson’s correlation coefficient and adjusted general linear model were used for data analysis. Results: The results of Pearson’s correlation showed no correlation between anxiety during pregnancy and MFA among nulliparous (r = -0.003, P = 0.976) and multiparous (r = -0.003, P = 0.712) pregnant women. However, anxiety and pregnancy symptoms were significantly correlated among nulliparous (r = 0.424, P < 0.001) and multiparous (r = 0.227, P = 0.028) pregnant women. According to the general linear model, after adjusting the socio-demographic variables, a significant correlation was observed between anxiety and pregnancy symptoms (P < 0.001), while no relationship was found between anxiety and MFA (P = 0.705). Conclusions: Given the significant correlation between anxiety and pregnancy symptoms, pregnant women with anxiety symptoms need to be screened and treated by an expert psychological team if their disorder is confirmed.

BRAF V600E Positive Hairy Plasma Cell Leukemia; Are the Cytoplasmic Projections in Plasma Cells Predictive of a Particular Molecular Characterization?

Introduction: Plasma cell leukemia (PCL) is a rare and clinically aggressive form of plasma cell dyscrasia. Despite the significant role of BRAF mutation in plasma cell neoplasms, this mutation has been rarely considered in these cases. Finding evidence guiding us toward assessing the BRAF mutation in patients with plasma cell neoplasms could help make the suitable decision for targeted therapy. Case Presentation: A 79-year-old man presented with leukocytosis. Peripheral blood smear exhibited marked lymphocytosis and infiltration of about 50% abnormal lymphoid cells with slender cell-surface projections and oval shape nucleus. These findings raised the provisional diagnosis of hairy cell leukemia (HCL) or HCL variants (HCL-v). Molecular analysis confirmed the presence of BRAFV600E mutation, which was in agreement with HCL diagnosis, albeit the flow cytometric assessment of abnormal lymphocytes corroborated PCL. Conclusions: Together with the previous comprehensive analysis regarding the association of cytoplasmic projections and BRAF mutations, our findings could suggest this morphological characteristic in plasma cells (PCs) as an indication for the assessment of BRAF V600E mutation in PC dyscrasias.

Design and Implementation of a Guideline-Based Workflow Software System for Improving the Chemotherapy Process

Background: While chemotherapy is an effective modality for the treatment of patients with cancer, it is a complex, multidisciplinary, and error-prone process. Paper-based protocols are commonly applied in chemotherapy; however, they fail to eliminate the complexity of this process. Therefore, a new guideline-based workflow software (GWS) system is needed to improve the workflow and quality of chemotherapy process. Methods: Planning was initiated 11 months before the system implementation and it involved a multidisciplinary group to analyze the current chemotherapy workflow and protocols for identifying the workflow components, analyzing paper-based protocols, developing computer-based protocols, and designing of systems based on an object-oriented analysis. To implement the GWS, we applied a system based on Python programming language and SQL language. Results: The conceptual model was developed based on need assessments and chemotherapy steps. A minimum dataset was developed for the electronic health records. We established examination forms for the patient management system (PMS), as well as specific standard forms for chemotherapy ordering, prescription verification and administration templates. Finally, developed GWS system consisted of a PMS, computerized provider order entry (CPOE), prescription verification system (PVS), and nursing administration system (NAS). Conclusions: A PMS, a PVS, a NAS, and a protocol-based clinical decision support system were integrated into the CPOE system to improve the chemotherapy process. Elimination of iterations and unnecessary steps in old chemotherapy workflow, increase of patient safety, improvement of communication and coordination between healthcare providers, and use of updated evidence-based medicine in direct chemotherapy orders justify the integration of GWS in the cancer care settings.

Identifying Economic Resistance Components in COVID-19 Pandemic: The Case of Iranian Health System

Background: As economic resistance is largely defined as the capacity of an economy to improve or adapt to the effects of unexpected, exterior shocks such as COVID-19 pandemic for health systems, the purpose of this study was to identify the economic resistance components of the Iranian health system during COVID-19 pandemic. Methods: This qualitative study was conducted using the content analysis method from 2020 to 2021. The statistical population of the study consisted of health system experts who are familiar with the subject of resistance economy. Using the snowball sampling method, semi-structured interviews with 30 selected participants were done. The reliability and transparency were determined by Guba and Linkon criteria such as credibility, transferability, confirmability, and consistency, or dependability. Data were analyzed using the Clarke and Braun thematic six-step method. Results: It was found that economic growth, economic stability, justice, and economic resilience, as four main components, affected the economic resistance of the health system in COVID-19 pandemic. Each of these components encompasses a number of sub-components that can help reinforce the health system in two restorative and resilient categories. Conclusions: To the best of our knowledge, a comprehensive study with an exploratory approach was not retrieved to find the main determinants of economic resistance components in COVID-19 pandemic. The present study can greatly contribute to the available knowledge to guide the policymakers for better understanding of the system during unexpected situations and applying the most applied solutions as well. It may help the health systems particularly those who encounter unpleasant macro-trends and unplanned crises, to keep their preparedness and readiness and improve their resilience.

The Effect of the Benson Relaxation Technique on the Quality of Sleep and Working Life of Surgical Technologists in Shiraz

Background: This study evaluated the effect of the Benson relaxation method on the quality of sleep and working life of surgical technologists. Methods: This randomized controlled trial was done on 180 surgical technologists who worked in 9 hospitals in Shiraz. Before the beginning of the intervention, participants were randomly assigned to either experimental or control conditions (simple randomization). The experimental group listened to an audiotape of the Benson relaxation technique twenty minutes periods, two times a day for four weeks, while the control group did not receive any intervention at all. The Pittsburgh sleep quality index and Walton quality of working life (QWL) questionnaires were used to measure the sleep quality and working life of surgical technologists, respectively. Results: Independent t-tests indicated that after the intervention, there were significant improvements regarding the total mean scores of quality of sleep (Mean (SD) Intervention = 2.88 (1.36), Mean (SD) Control = 15.1 (3.41), P < 0.001), and working life (Mean (SD) Intervention = 133.78 (9.22), Mean (SD) Control = 62.18 (19.68, P < 0.001) and their domains in the intervention group compared to the control group. Conclusions: Our findings are an important contribution to the previous research regarding the Benson relaxation technique as a non-drug, economical method. The current results can help health professionals for determine which psychological techniques are needed to be emphasized for promoting sleep quality and quality of working life in surgical technologists.

A Comparison of Demirjian and Cameriere Methods in Estimating Age and Development of a Modified Cameriere Method

Background: In recent years, age estimation in forensic medicine has become so important. Teeth are used to estimate age as valuable indicators. Objectives: This study aimed to compare Cameriere and Demirjian methods in estimating chronological age (Age) in an Iranian population and to develop a modified Cameriere method. Methods: In this cross-sectional study, we investigated a total of 486 panoramic radiographs of individuals aged 5 - 15 years adopted from two craniofacial radiology centers in Babol, northern Iran, in 2019. The dental age of subjects was assessed by Demirjian (DAge) and Cameriere (CAge) methods and compared with their chronological age. Also, a formula was designed based on the Cameriere method for our studied population, and the results of the original and modified Cameriere (MCAge) methods were compared. Results: The mean ± SD of Age (10.38 ± 2.30) had a significant difference with DAge (10.67 ± 2.33) and CAge (9.77 ± 2.01) (P < 0.001). The modified Cameriere formula was more accurate than Cameriere one, and MCAge was 10.38 ± 2.12, indicating no significant difference with Age (P = 0.993). Conclusions: According to our results, both Demirjian and Cameriere methods were not reliable for age estimation in the Iranian population. However, the modified Cameriere formula had a very high accuracy in estimating the age of the studied population.