A COVID-19 pregnant patient with thrombotic thrombocytopenic purpura: a case report

Background: Pregnancy seems to increase the risk of thrombotic thrombocytopenic purpura (TTP) relapses and make the TTP more severe in any of the pregnancy trimesters, or even during the postpartum period. Case presentation: This study highlights details of treating a COVID-19 pregnant patient who survived. This 21-year addicted White woman was admitted at her 29th week and delivered a stillbirth. She was transferred to another hospital after showing signs of TTP, which was caused by a viral infection. Conclusion: This viral infection caused fever and dyspnea, and the patient was tested positive for COVID-19 infection. A chest computed tomography scan showed diffuse multiple bilateral consolidations and interlobar septal thickening. She stayed at the Intensive Care Unit for 20 days and treated with plasmapheresis. As far as we know, this is the first report of a TTP pregnant patient with COVID-19 infection. © 2021, The Author(s)

Surgical management of patients with von Willebrand disease: summary of 2 systematic reviews of the literature

von Willebrand disease (VWD) is the most common inherited bleeding disorder. The management of patients with VWD who are undergoing surgeries is crucial to prevent bleeding complications. We systematically summarized the evidence on the management of patients with VWD who are undergoing major and minor surgeries to support the development of practice guidelines. We searched Medline and EMBASE from inception through October 2019 for randomized clinical trials (RCTs), comparative observational studies, and case series that compared maintaining factor VIII (FVIII) levels or von Willebrand factor (VWF) levels at >0.50 IU/mL for at least 3 days in patients undergoing major surgery, and those with options for perioperative management of patients undergoing minor surgery. Two authors screened and abstracted data and assessed the risk of bias. We conducted meta-analyses when possible. We evaluated the certainty of the evidence using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. We included 7 case series for major surgeries and 2 RCTs and 12 case series for minor surgeries. Very-low-certainty evidence showed that maintaining FVIII levels or VWF levels of >0.50 IU/mL for at least 3 consecutive days showed excellent hemostatic efficacy (as labeled by the researchers) after 74% to 100% of major surgeries. Low- to very-low-certainty evidence showed that prescribing tranexamic acid and increasing VWF levels to 0.50 IU/mL resulted in fewer bleeding complications after minor procedures compared with increasing VWF levels to 0.50 IU/mL alone. Given the low-quality evidence for guiding management decisions, a shared-decision model leading to individualized therapy plans will be important in patients with VWD who are undergoing surgical and invasive procedures

Sedative and analgesic effects of propofol�ketamine versus propofol�fentanyl for emergency department procedures

Background: To manage and reduce painful procedures in the emergency wards, procedural sedation as well as analgesia can be used. Propofol combinations are the most common short-acting intravenous sedative drugs in the field of emergency medicine. Objectives: This research aimed to compare the effectiveness, safety, and complications of intravenous infusion of ketofol with fentofol in painful emergency procedures. Methods: This study was a randomized, double-blind clinical trial. Sampling was simple and used random assignment; 196 participants were randomly assigned to two groups of 98 patients each. In each group, injection was done with fentanyl�propofol or ketamine�propofol. For data gathering, pre-procedure, and procedure, modified Aldrete�s scoring checklist was used. In order to determine the levels of sedation, we used the Ramsay Sedation Scale. Data analysis was performed via SPSS Version 20 using statistical tests such as mean ± standard division, t-test, chi-square test, and analysis of variance. Results: Among the participants in this study, shoulder procedure was performed more than other procedures (56.6). The mean of recovery time was significantly different in the two groups (ketofol: 5.65 ± 0.35 vs fentofol: 9.33 ± 0.78); the recovery time in group B (fentofol) was longer than that in group A (ketofol) (p = 0.001). Drug complications were statistically significant in the two groups, and complications by ketofol were less than those by fentofol (p = 0.001). �Hypotension and bradycardia� were observed with fentofol and �tachycardia� was observed with ketofol. The performance of these two drugs was not the same when subject to various procedures. Conclusion: Results of this study revealed that ketofol provided better analgesia and sedation, faster recovery time, lesser complications and adverse events, and reduced bradycardia and hypotension. © The Author(s) 2020

Correlation between Anger and Job Motivation among Psychiatric Nurses in Kashan Psychiatric Hospital

Abstract Aims: In general, nurses who work in department of psychiatric are in fact interacting with emotional disorders of patients once providing their care services. higher levels of job motivation and satisfaction can markedly foster service improvement. The aim of this study was to evaluate the correlation between anger and job motivation in nurses of a psychiatric hospital. Instrument & Methods: In this cross-sectional descriptive research in 2014, all 50 psychiatry nurses working at Kargarnejad Hospital of Kashan City, Iran, were entirely studied. A demographical questionnaire, the Anger Multiple Scale and the Job Motivation Scale were used for data gathering. Data were analyzed by SPSS 19 software using Pearson correlation coefficient. Findings: The mean score of anger was 3.01±0.36 and of job motivation was 1.70±0.86. There was a significant relationship between job motivation and the number of family members and conditions of employment of nurses (p=0.001). There was a significant inverse relationship between scores of anger and job motivation of psychiatry nurses of the hospital (r=-0.712; p=0.001). Conclusion: There is a relationship between anger and job motivation in nurses of Kashan Psychiatric hospital

angizesh

مدارس و معلمان نقشی فرهنگی در رشد و توسعه علمی دانش آموزان و کسب پیشرفت های آموزشی آن ها بر عهدهدارند. از آن جمله می توان به انگیزش اشاره کرد که به صورت تمایل ذاتی و درونی برای رفتار و یادگیری است و توسطمحیط پیرامون تشویق و حمایت م یشود و یا بالعکس بر اثر بی توجهی، تضعیف م یگردد در پی آن عملکرد یا علاقهبه ادامه یا ترک تحصیل رخ می دهد. از این رو هدف پژوهش حاضر بررسی نقش واسطه ای انگیزش خود تعیین گری وعملکرد تحصیلی در رابطه ارتباط معلم – دانش آموز و تصمیم به ادامه یا ترک تحصیل است. روش پژوهش حاضر از نوعهمبستگی و جامعه آماری شامل کلیه دانش آموزان دختر و پسر پایه ی سوم راهنمایی و اول دبیرستان مناطق شهریشهرستان شهرکرد بود که در سال تحصیلی 93 - 1392 مشغول به تحصیل بودند. نمونه این پژوهش 400 نفر بودند کهبه روش خوشه ای چند مرحله ای انتخاب شدند.ابزار پژوهش عبارت بود از پرسشنامه خود تنظیمی تحصیلی ) ،)ASRQمقیاس سنجش عملکرد تحصیلی مورد انتظار) AP (، پرسشنامه) QTI (، مقیاس ترک تحصیل الرند و همکاران) 1997 ( وپرسش نامه خود گزارشی از ترک تحصیل. یافته های پژوهش نشان داد که انگیزش خود تعیین گری و عملکرد تحصیلیمی تواند در رابطه بین ارتباط معلم – دانش آموز و تصمیم به ادامه و ترک تحصیل نقش واسطه ای داشته باشد) 01/0   نتایج نشان داد که با بهبود روابط معلم دانش آموز ضمن افزایش انگیزش و بهبود عملکرد دانش آموز می توان تصمیم بهترک تحصیل را در دان شآموزان کاهش داد

Prevalence and risk factors for developing traumatic childbirth in Iran

Aim: Traumatic childbirth is among the important factors that make childbirth an unpleasant experience and has psychological negative effects on women. This study aimed to determine the prevalence and risk factors associated with traumatic childbirth. Subject and methods: In this cross-sectional study, 400 women were interviewed in the first 48 h after childbirth in Torbate-heydariyeh (eastern Iran) in 2015. Traumatic childbirth was determined based on DSM-V-A criteria. Statistical analysis of the data was done through chi-square and logistic regression. Results: The prevalence of traumatic childbirth was 48.3 (N = 193). Logistic regression showed variables such as place of residence, type of delivery, pregnancy complications, bleeding during pregnancy, rupture of grade 3 or 4 during delivery, and emergency cesarean section were significantly correlated with traumatic childbirth (p <0.001). Conclusion: Considering the high prevalence of traumatic childbirth, it is recommended that its associated risk factors be identified so that negative psychological consequences for the mother can be prevented. © 2016, Springer-Verlag Berlin Heidelberg

The effect of cognitive-behavioural and solution-focused counselling on prevention of postpartum depression in nulliparous pregnant women

Objective: The aim of this study was to evaluate the effect of cognitive-behavioural approach and solution-focused counselling on prevention of postpartum depression in nulliparous pregnant women. Background: Maternity blues is a common disorder and postpartum depression is a serious disorder. Therefore, the use of preventive measures and timely intervention is of particular importance. Methods: In this randomised clinical trial, 85 nulliparous pregnant women at 30–35 weeks were randomly divided into three groups: cognitive-behavioural counselling (n = 25), solution-focused counselling (n = 25) and control (n = 35). Counselling meetings were held on a weekly basis. The cognitive-behavioural group received four sessions of counselling and the solution-focused group received three sessions of counselling. The control group received only routine pregnancy healthcare services. Maternity blues and postpartum depression were, respectively, measured on postpartum days 5 and 15 through the Austin Inventory and Edinburgh Postnatal Depression Scale. The mean scores of the three groups were compared using one-way ANOVA. Results: The results of this study showed that the maternity blues mean scores of the three groups of cognitive-behavioural counselling, solution-focused counselling and control groups were 6.1 ± 4.6, 4.2 ± 3.6 and 6.7 ± 4.9, respectively, and the difference between the scores was significant. The mean scores of postnatal depression on the 15th postpartum day in the three groups were 6.7 ± 5.3, 4.4 ± 4.4 and 10.4 ± 5.9, respectively. The results showed that cognitive-behavioural and solution-focused counselling significantly reduced the maternity blues and postpartum depression scores compared with the control group and no difference was observed between the scores of these two counselling methods. The odds ratio of being depressed in women with maternity blues was 7.6 (95 CI: 2.1–27.5). Conclusion: Integration of solution-focused and cognitive-behavioural counselling programmes in prenatal care can be effective for improving the mental health of pregnant women. © 2016 Society for Reproductive and Infant Psychology