Relationships between dimensions of fatigue and psychological distress among public hospital nurses

Background: Fatigue and psychological distress are fairly common among nursing personnel,but their relationship is not clearly understood.Methods: In this cross-sectional study, we investigated the relationships between dimensions of fatigue and psychological distress among 699 public hospital nurses in Iran. The Multidimensional Fatigue Inventory (MFI–20) and General Health Questionnaire (GHQ–12)were used for evaluation of fatigue and psychological distress, respectively.Results: The total fatigue score of the MFI–20 was 52.5 (SD = 11.8). The general fatigue (mean± SD = 13.2±3.1) and reduced motivation (mean ± SD = 9.2±2.7) were the fatigue dimensions with the highest and lowest mean scores, respectively. The percentage of psychological distress(e.g., those nurses scored above the cut-off point [GHQ–12 ≥ 4]) was 29.1%. Stepwise multiple linear regression analysis indicated that general (P<0.001), physical (P<0.001) and mental(P<0.001) aspects of fatigue were significantly related to the psychological distress, so that the scores of these fatigue dimensions were significantly higher for those nurses with a higher level of psychological distress (above the cut-off point) than those with a lower level of psychological distress (below the cut-off point).Conclusion: The results emphasize the need for multi-component interventions aimed at decreasing both mental and physical fatigue, and consequently reducing the psychological distress among this group of healthcare professionals

Association between Immunofluorescence Pattern and Mucosal Involvement in Patients with Bullous Pemphigoid

Bullous pemphigoid is an acquired autoimmune subepidermal blistering disease which is associated with mucocutaneous lesions. The type and amount of autoantibody deposition may have a role in mucosal lesions. We studied the association between mucosal involvement and direct immunofluorescence pattern in cutaneous lesions of patients with bullous pemphigoid. In this retrospective analytical cross-sectional study, we studied the demographic data, clinical presentations, and immunopathological findings of 69 patients with bullous pemphigoid admitted to our hospital 2008-2016. Patients were allocated into two groups on the basis of the mucosal involvement, and direct immunofluorescence patterns were evaluated. The data were analyzed using SPSS version18. The mean age of patients was 70.9±14.97 (mean ± Standard Deviation) years old. In our study, 56.5% of patients were women. All patients showed deposition of IgG and C3 in the dermoepidermal junction, with different severity. Patients with mucosal involvement (40.6% of cases) had a more prominent deposition of IgG, IgA, and C3 at the dermoepidermal junction compared with patients without mucosal involvement, which represented a statistically significant difference (P&lt;0.05). Logistic regression analysis showed that lower age, IgA, and C3 deposition (P&lt;0.05) were associated with mucosal involvement. Deposition of IgA and C3 (in addition to IgG) at the dermoepidermal junction seems to be a marker of mucosal involvement in patients with bullous pemphigoid. Attention to direct immunofluorescence pattern in patients with bullous pemphigoid may be helpful in prediction of mucosal involvement in these patients. </p

Association between Immunofluorescence Pattern and Mucosal Involvement in Patients with Bullous Pemphigoid

Bullous pemphigoid is an acquired autoimmune subepidermal blistering disease which is associated with mucocutaneous lesions. The type and amount of autoantibody deposition may have a role in mucosal lesions. We studied the association between mucosal involvement and direct immunofluorescence pattern in cutaneous lesions of patients with bullous pemphigoid. In this retrospective analytical cross-sectional study, we studied the demographic data, clinical presentations, and immunopathological findings of 69 patients with bullous pemphigoid admitted to our hospital 2008-2016. Patients were allocated into two groups on the basis of the mucosal involvement, and direct immunofluorescence patterns were evaluated. The data were analyzed using SPSS version18. The mean age of patients was 70.9±14.97 (mean ± Standard Deviation) years old. In our study, 56.5% of patients were women. All patients showed deposition of IgG and C3 in the dermoepidermal junction, with different severity. Patients with mucosal involvement (40.6% of cases) had a more prominent deposition of IgG, IgA, and C3 at the dermoepidermal junction compared with patients without mucosal involvement, which represented a statistically significant difference (P&lt;0.05). Logistic regression analysis showed that lower age, IgA, and C3 deposition (P&lt;0.05) were associated with mucosal involvement. Deposition of IgA and C3 (in addition to IgG) at the dermoepidermal junction seems to be a marker of mucosal involvement in patients with bullous pemphigoid. Attention to direct immunofluorescence pattern in patients with bullous pemphigoid may be helpful in prediction of mucosal involvement in these patients. </p

Instant Gratification and Overtreating to Be Safe: Perceptions of U.S. Intensive Care Unit Pharmacists and Residents on Antimicrobial Stewardship

Antimicrobial stewardship programs have been associated with numerous impacts on medical practice including reductions in costs, antimicrobial resistance, and adverse events. While antimicrobial stewardship is now considered an essential element of medical practice, the understandings of the value of antimicrobial stewardship among medical practitioners vary. Additionally, non-physician practitioners are regularly left out of antimicrobial stewardship interventions targeting antimicrobial decision-making. Here, we contribute the perspective from resident physicians and specialists in pharmacy regarding their involvement in antimicrobial prescribing. Notably, our semi-structured interviews with 10 residents and pharmacy specialists described their limited autonomy in the clinical setting. However, the participants regularly worked alongside primary antimicrobial decision-makers and described feeling pressure to overtreat to be safe. The clear rationales and motivations associated with antimicrobial prescribing have a noticeable impact on physicians in training and non-physician practitioners, and as such, we argue that antimicrobial stewardship interventions targeting primary antimicrobial decision-makers are missing an opportunity to address the breadth of antimicrobial prescribing culture. By looking at the perspectives and rationales of physicians in training and non-physician practitioners, we can see evidence that the act of antimicrobial prescribing is impacted by individuals on all levels of the hierarchies present in medical practice

Anetoderma with positive Darier’s sign

Anetoderma describes a localized laxity of the skin due to dermal elastolysis. It can be either primary or secondary to an inflammatory dermatosis. Rarely secondary anetoderma has been associated with mastocytosis. We report a 16-year-old man, with multiple pouch like lesions (anetoderma) mostly on the face, neck and upper trunk which had positive Darier`s sign. Anetodermic lesions developed two years ago without preceding urticaria pigmentosa lesions. In skin biopsy perivascular mast cell and eosinophil infiltrations were observed

Diphallus: Report on Six Cases and Review of the Literature

Background: Diphallus is an extremely rare anomaly. Numerous associated genitourinary, gastrointestinal and other anomalies have been described with diphallus. These patients need several investigations, and finally surgical intervention. Cases Presentation: In this report we discuss six patients with diphallus which evaluated retrospectively. Five patients had complete diphallia, and one had bifid diphallus. Meatus was normal in 3, hypospadiac in 2, and epispadiac in one patient. The most common associated anomaly was bifid scrotum (5 cases), and other common anomalies consisted of bladder duplication (3 cases), imperforate anus (2 cases), and hypospadias (2 cases). Phalloplasty was performed for all but one. Conclusion: All the patients with urethral duplication have to be evaluated carefully because of the high incidence of other systemic anomalies

Erythema gyratum repense like eruption in bullous pemphigoid: A case report

Bullous pemphigoid (BP) is an autoimmune disease characterized by presence of bullous eruption on the trunk and extremities especially flexural aspects of the limbs. This disease usually occurs in the elderly. The initial presentation of BP is variable. An urticarial or erythematous rash may precede the appearance of the blister formation and can be associated with itch or pruritus. We presented 87 year old bedridden man diagnosed with BP who initially presented with erythema gyratum repens like eruption before blister formation. This case report discusses the presentation of figurate erythema in non-bullous phase of BP for clinicians