Catastrophic Candida prosthetic valve endocarditis and COVID-19 comorbidity: A rare case

Background and Purpose: Coronavirus disease 2019 (COVID-19) and Candida prostatic valve endocarditis present various clinical manifestations which may overlap;hence, discrimination between them is extremely difficult.Case report: The case was a 66-year-old man with a past medical history of mitral and aortic valves replacement one year before COVID-19 co-infection. He was admitted with fever (for 7 days), shortness of breath, cough, seizure, lethargy,headache, and 85% oxygen saturation. Transesophageal echocardiography revealed multiple large-sized, highly mobile masses on both sides of the mechanical mitral valve highly suggestive of vegetation. Chest computed tomography scanning showed simulating scattered COVID-19 peripheral ground-glass opacities confirmed by reverse-transcription polymerase chain reaction. The set of blood cultures yieldedyeast colonies that were identified as Candida tropicalis. The patient died of septic shock shortly after receiving antifungal therapy.Conclusion: This case emphasized the importance of early diagnosis andimplementation of antifungal treatment, particularly in patients with prosthetic cardiacvalves, to reduce their unfavorable outcomes in COVID-19 patient

The Survey of Hospitals Managers’ Attitude about Patient Complaints Investigating System in Hospitals Affiliated to Mashhad University of Medical Sciences

Introduction: According to the importance of managers’ role in improving quality of health services, we performed this study to survey hospital managers attitude about patient complaints investigating system in hospitals affiliated to Mashhad university of Medical sciences in 2015. Materials and Methods: This descriptive cross-sectional study was performed in 12 hospitals affiliated to Mashhad University of Medical Sciences. One questionnaire that we had confirmed the reliability and validity of that was used to assess hospitals managers’ attitude about patient complaints investigating system. Study population was all hospital managers in all levels. We studied them as census. Finally 130 completed questionnaires were analyzed with SPSS Version 16. Results:20% of managers assessed the current status of patient complaints investigating system as improper. 35% of manager expressed not using information that derived from patients’ complaint as most defect in patient complaints investigating system. 60% of managers believed that the most impact of reinforcement patient complaints investigating system is improvement of services quality and system validity. Finally 56% of managers expressed staff dissatisfaction is the great reason for patient complaints. Conclusion: According to the findings and relatively positive attitude of managers, it is necessary to organize a team for improving and revising patient complaints investigating system in each hospital. Also managers’ attention to staff satisfaction and their educational needs is important for reducing patient complaints

Prosthetic valve endocarditis caused by multidrug-resistant Candida albicans in a patient with myelodysplasia syndrome: A case report and literature review

Background and Purpose: Candida endocarditis is an infrequent disease with a high mortality rate, which commonly occurs in immunosuppressed patients with cardiac valve replacement. We reported a 70-year-old woman diagnosed with Candida prosthetic valve endocarditis (PVE). This study also involved a review of all published cases of Candida PVE from 1970. Case report: Herein, we reported a 70-year-old woman with the history of severe mitral stenosis and myelodysplasia syndrome. She underwent mitral valve replacement for two times. The blood cultures were positive, and phenotypic identification of the isolates at the species level was performed based on microscopic and macroscopic characteristics. In the second prosthetic valve replacement, huge fungal white and creamy vegetation was observed which was identified as Candida albicans based on the conventional and molecular methods. Despite the administration of antifungal treatments, the patient passed away probably due to the multidrug-resistant Candida PVE. Conclusion: As PVE is a late consequence of prosthetic valve replacement, extended follow-up visits, early diagnosis, repeating valve replacement surgeries, and timely selective antifungal treatments are warranted. Keywords: Amphotericin B, Antifungal resistant, Azoles, Candida endocarditis, Multi-drug resistant, Myelodysplasia syndrome, Prosthetic valve replacemen

The Relationship between Matrons' Knowledge, Attitude, and Performance in Clinical Governance Domain and Mashhad Hospitals Fulfillment of Clinical Governance: 2013

Introduction: Clinical Governance (CG) is a systematic approach to the maintaining and improving the quality of provided services for patients in the health system. With regards to the implementation of clinical governance in hospitals affiliated to Mashhad University of Medical Sciences and the role of matrons in ensuring quality care, little is known about the relationship between matrons’ participation in this plan and hospital success in clinical governance fulfillment. Materials and Methods:This cross-sectional, analytic-descriptive study was conducted to investigate the relationship between matrons’ knowledge, attitude, and performance in clinical governance and Mashhad hospitals' fulfillment of clinical governance. A researcher-made questionnaire was used for data collection on matrons’ knowledge, attitude, and performance. The standard checklist of the health ministry and observation were used to assess hospital clinical governance fulfillment. Data was analyzed at the hospital level by SPSS16. Results: The mean scores of matrons' knowledge, attitude, and performance were above average. Matrons' attitude towards clinical governance achieved the highest mark (4.46). There was no significant correlation between matrons' knowledge/attitude/performance and hospital scores for clinical governance fulfillment (P>0.05). Conclusion: While the levels of matrons' knowledge, attitude, and performance were satisfactory, there is still a need for improving matrons' knowledge. Absence of any statistically significant relationship between matrons' knowledge, attitude, performance and hospitals scores for clinical governance fulfillment may be due to the study small sample size

Evidence-Based Medicine: Studying the Attitude of Medical Residents in Mashhad

Introduction: Evidence-Based Medicine (EBM) means ensuring that the right patient has received the appropriate treatment and it strives to form a common scientific language for all doctors. It uses the combination of the best available knowledge (evidence) and clinical experience beside the patient values. This study was designed to investigate the attitude of medical residents of Mashhad University of Medical Sciences towards EBM. Materials and Methods: In this cross sectional study a self-designed questionnaire was used for data collection. The study was performed in the autumn of 2012 in Mashhad University of Medical Sciences, Mashhad, Iran. The study aimed at investigating the attitude of medical residents towards EBM and evaluating its use in medical practice. Questionnaires’ data were analyzed by the SPSS Version 13. Results: 49 (52.1%) residents were familiar with the concept of EBM whereas 45 (47.9%) were not. The rate of familiarity with EBM concepts was (26.5%) in the surgical fields and (73.5%) in the non-surgical ones, showing a meaningful difference (p=0.014). There was a significant correlation between the field of study and knowledge about the concepts of EBM, whereas a greater number of non surgical residents were familiar with its concept in comparison to surgical residents (73.5% vs. 26.5%, p=0.014). Conclusion: The concepts of EBM are familiar to (82%) of medical residents of Mashhad and regarding the increasing importance of this science, upgrading EBM concepts in a timely and accurate planning is highly recommended

Medical Waste Management in the second largest City of Iran (Mashhad) with Three-Million Inhabitants

Introduction: One of the first and important steps to improve medical waste management is awareness and monitoring of the quality and quantity of medical waste. The aim of this study was to determine the present status of waste generation and the process of waste management in hospitals. Materials and Methods:This cross sectional study was performed in ten university hospitals in Mashhad. A standard questionnaire was prepared according to the National Health instructions and completed by the project team members who were environmental health experts.  Results: The total waste which was generated in the studied hospitals was 7683 kg/day. The study showed total waste generation in selected hospitals as (61.85%) general medical waste, (34.90%) infectious waste and (3.25%) sharp waste. The average generation rate for total, general, infectious and sharp waste was (2.6, 1.5, 1.01) and (0.08) kg/bed/day, respectively. Mean scores of the different steps of waste management process with respect to National Health instructions were as follows: waste segregation (64%), waste storage (67%), waste transportation (76 %) and waste treatment 63%. There was no significant difference between the average rate of waste generation per bed in public and specialized hospitals (P=0.34). Conclusion: High rate of infectious waste shows the need for establishing executive rules and standards for medical waste management. Medical managers should update their knowledge and further educating their staff; implying careful and constant monitoring of waste management