Insights into Background of Microbial Aggregations (Acinetobacter baumannii): A Century of Challenges

: In recent years, Acinetobacter baumannii has attracted the research community’s attention since they are turned into the leading cause of both community- and hospital-acquired infections. The emergence of MDR-Acinetobacter baumannii strains threatens hospitalized patients since antibiotics fail to withdraw the bacterial infectious agents. Despite its worldwide distribution, health settings fail to combat limitations in therapeutic regions against Acinetobacter baumannii. The capability of biofilm formation in Acinetobacter baumannii strengthens their virulence and also survival. Understanding the fundamental virulence mechanisms beyond the microbial aggregations leads to exploring alternative drug targets such as signaling molecules and Quorum sensing systems to block bacterial communication and antimicrobial resistance. The significance of examining the biofilm's structural details and the relationship between Quorum sensing networks and related signaling molecules has been explicitly highlighted. Accordingly, this review study aimed to explain the general biofilm structure, the mechanisms beyond biofilm formation, quorum sensing system, and the generation of signaling molecules in Acinetobacter baumannii.

Single-Port Laparoscopic Appendectomy Performing by Emergency Operation: An Intervention Study in Vietnam

Background: Appendectomy is one of the most commonly performed surgical procedures of the abdominal area. One of the recent innovations is single-port laparoscopic surgery (SPLS), which can insert multiple ports through a proprietary device with multiple channels. An incision is sited in the umbilicus to result in no visible scar. Objectives: The study aimed to evaluate the results of the treatment of acute appendicitis by applying single-port laparoscopic surgery. Methods: A clinical single-port laparoscopic appendectomy intervention of 122 patients, with the absence of a control group, was carried out by a sole surgeon at the Hue University of Medicine and Pharmacy Hospital, Hue, Vietnam, from August 2013 to December 2017. Research parameters included clinical history, physical examination, laboratory test, ultrasound imaging, intraoperative characteristics, and surgical outcomes. Results: We included 122 patients (64 males and 58 females) who met the inclusion criteria. The mean age was 31.28 ± 13.51 years (range, 16 - 73 years). The average BMI was 20.4 ± 1.39 kg/m2. All patients had abdominal pain, and the average duration of symptoms was 17.39 ± 5.41 hours (range, 6 - 31 hours). Five patients had a history of abdominal surgery. The mean diameter of appendicitis in ultrasound was 8.8 mm (range, 6 - 15 mm). Moreover, 89.3% of patients had an increase in white blood cells. The difficult location of appendicitis was 1.6% under the liver and 20.5% in the retrocecal region. In addition, 18.0% of retroperitoneal appendicitis and 6.6% of appendicitis were under cecalserosa. The mean operative time was 40.19 ± 14.67 mins (range, 23 - 150 min). Two cases (1.6%) required additional trocar insertion. Three cases (2.5%) had wound infection and no other complications. The median hospital stay was 3.64 ± 1.72 days (range, 2 - 13 days). Conclusions: Single port laparoscopic surgery is the safe and effective treatment of acute appendicitis. This technique may be feasible for acute appendicitis with a difficult location.

Drug Abuse Prevalence Among 10th - 12th-Grade Students of Kerman, Iran in 2017 - 2018 Academic Year

Background: It is generally accepted that due to various reasons, the age of drug abuse prevalence continues to decline, which imposes numerous personal and social dysfunctions. Objectives: This study aimed to assess the prevalence of drug abuse among adolescents in Kerman, Iran. Methods: This cross-sectional study was conducted on 2,000 10th - 12th-grade students in the academic year of 2017 - 2018 selected by random cluster sampling. Data collection tools included demographic characteristics checklist and alcohol smoking and substance involvement screening test (ASSIST). Data were analyzed using chi-square test. Results: The results showed that the highest prevalence of substance abuse among students was related to tobacco, alcohol, and sedatives. It was also demonstrated that the use of cigarettes, sedatives, cannabis, and amphetamine was significantly higher among male subjects compared to female participants (P < 0.05). Moreover, 16.4, 12.9, and 5.1% of the tobacco, alcohol, and sedative users required low interventions, respectively, whereas 1.5, 0.8, and 0.4% of them required high interventions, respectively. Conclusion: According to the results of the study, there was higher drug abuse prevalence in male students compared to female students. As such, it seems that consumption of alcohol, tobacco, and narcotics in adolescents requires serious intervention.

Association of Safety Climate and Chronic Multidimensional Occupational Fatigue in Nurses of Shahrekord Hospitals

Background: Nursing is associated with many stressful situations that can cause problems such as fatigue, reduced quantity and quality of patient care, as well as physical and mental illness. Safety climate is one of the most important indicators of safety management performance that evaluates employees' attitudes toward safety issues. Objectives: This study aimed to investigate the association between safety climate and occupational fatigue in nurses. Methods: This descriptive-analytical study was performed on nurses working in hospitals affiliated with Shahrekord University of Medical Sciences in 2018. We selected 216 nurses by a proportional quota sampling method. A demographic questionnaire, the nurses' safety climate questionnaire designed by the USA, and the occupational fatigue questionnaire designed by Sweden were used to collect information. The validity and reliability of the questionnaires were confirmed. Statistical tests for two independent samples, analysis of variance, Mann-Whitney, Kruskal-Wallis, and multiple regression analysis were used to analyze the data by SPSS version 21 software. Results: The results showed that the mean scores of occupational fatigue and safety climate were 72.23 ± 7.75 and 3.46 ± 0.305, respectively, and 72.23% of nurses reported occupational fatigue. There was no significant relationship between safety climate and the education level, gender, and job satisfaction (P < 0.05). Also, there was no significant relationship between occupational fatigue and job satisfaction and education (P < 0.05), but there was a significant relationship between job satisfaction and gender, age, and marital status (P < 0.05). Having a second job by nurses increased their occupational fatigue by 19%. The effect of safety climate on occupational fatigue was about -0.09. Conclusions: The findings of this study showed that demographic variables have significant effects on occupational fatigue, and increasing the safety climate can reduce employees’ occupational fatigue.

The Flap Based on the Subscapular Artery: A Cross-sectional Study

Background: The lateral thoracic-lumbar-scapular region is an ideal source to supply flaps. The study towards improving the method of taking flaps towards conserving a part of the muscle needs to clarify the ratio of branching forms of the arteries in the muscle. Objectives: This study was done to describe the typical anatomy, the anatomical and size variations of subscapular and circumflex scapular vessels, the branching and distribution of vascular pedicle supplying latissimus dorsi muscle flap, and serratus anterior muscle flap of circumflex scapular vessels. Methods: We conducted a cross-sectional study on 24 corpses of adults of both genders. The flap vessels were revealed through two stages of surgery, including the axillary region and the lumbar-scapular region. We classified the collected information and recognized typical and transformed forms based on statistical data. Results: The subscapular artery was separated by the axillary artery, the general origin of the circumflex scapular artery, and the thoracodorsal artery. Subscapular vessels were found in 40/42 cases, accounting for 95.2%, and the length and diameter were 3.04 ± 0.51 cm and 2.85 ± 0.46mm, respectively. The circumflex scapular artery, which had originated from the subscapular artery, was found in 40/42 cases. It also showed origin from subscapular artery with 2/42 cases. The length of the circumflex scapular artery was 3.14 ± 0.70 cm, and its diameter was 2.46 ± 0.48 mm. Terminal branches of the circumflex scapular artery were very variable. Almost all branching forms of the artery in the latissimus dorsi muscle were external branches, but they might be present or not in internal and recurrent branches. Conclusions: The vascular pedicle’s distribution, size, and presence were influenced by the subscapular artery supply flaps. Due to the diverse blood supply from the flaps’ vessels, the surgeon can use the flaps based on the subscapular artery in many forms. These flaps could be used as a seamless vascular flap or a free flap in orthopedic surgery.

Naphthalene Poisoning During a Decade: A Retrospective Clinical Study

: In this study, we investigated the naphthalene poisoning cases using the archived medical records of patients who were referred to Loghman-Hakim Hospital in Tehran, Iran, from 2008 to 2018. In the 52 studied cases, the highest prevalence was observed in the age groups of below five years and 20 - 25 years. Eighteen (34%) patients had no symptoms, and in others, gastrointestinal problems were the most common complaints. None of the patients needed intubation, and no one was admitted to the intensive care unit. Hemolysis was observed only in one patient with a background of G6PD deficiency. The average length of hospital stay was one day, and all patients improved without any complications. In general, naphthalene poisoning is not highly prevalent in Iran and usually does not cause severe morbidity and mortality. However, it is an available substance and can cause serious complications, especially in children. Therefore, it is necessary to investigate the clinical characteristics of these patients to improve the quality of health care.

Presentation of a Model for the Distribution of Emergency First Aid During Pre-hospital Triage with a Practical Example

Background: The proper triage of patients, supply chain management, and proper location, delivery, and distribution of health facilities and services in times of crises and disasters have always been challenging issues playing an important role in reducing damages and increasing the level of patient care during emergencies. Objectives: This study was conducted to design a model for allocating emergency first aid in pre-hospital triage. Methods: The model presented in this study is a two-level mathematical model using nonlinear programming to introduce a new location for the establishment and activation of distribution centers in the supply chain and distribution of pre-hospital health-oriented services during crises. This proposed hybrid model seeks to strike a balance between the concepts of efficiency, cost, and dispersion. By expanding the insurance coverage of health services, the number of services provided in the times of crises and triage of injured patients also increases, leading to the delivery of more profits and improvement in the effectiveness of medical services in the shortest possible time. Results: This model helps to select suitable candidate locations for the triage of patients and increases its performance. Therefore, the appropriateness of each place is measured according to the criteria set for them. This model considers different parameters for selecting places for the distribution and allocation of emergency services, including the efficiency of the centers selected for the triage of patients, the cost of the inventory system for providing primary services, the dispersion of selected triage centers, demands for sick and injured patients, the possibility of constructing additional distribution centers (e.g., field hospitals), and strategies to avoid the imposition of additional costs. Conclusions: This study showed that by maximizing the dispersion of desirable facilities, such as distribution centers, the demand coverage of different regions is appropriately improved. In other words, the health service distributor, as one of the important parts of the supply chain, helps service providers better meet the needs of injured patients during emergencies.

Chimeric Antigen Receptor T-Cell Therapy: An Overview of the Changing Face of Cancer Immunotherapy

: Chimeric antigen receptor (CAR) T-cell therapy has emerged as the revolutionary cancer treatment method in recent years due to the heartwarming clinical outcomes in several types of hematologic malignancies. Since 2017, the US Food and Drug Administration has approved four CAR T-cell products, including tisagenlecleucel [for B-cell acute lymphoblastic leukemia and diffuse large B-cell lymphoma (DLBCL)], axicabtagene ciloleucel (for DLBCL), brexucabtagene autoleucel (for mantle cell lymphoma), and lisocabtagene maraleucel (for DLBCL). The efficacy optimization and toxicity management methods of CAR T-cell therapy are among the most investigated fields of cancer immunotherapy. Furthermore, the favorable outcomes achieved by the aforementioned CAR T-cell products in hematologic malignancies have encouraged researchers to bring successful outcomes to solid tumor patients. This study aimed to highlight the outstanding characteristics and the manufacturing process of CAR T-cells and discuss the key lane leading to their clinically approved products.