Stress Management Experience of Caregivers of Thalassemia Children: A Qualitative Research

Background: Children with thalassemia do not have favorable psychological health. Today, the use of different therapeutic regimes for caregivers with thalassemia has increased life expectancy; however, these patients have other various needs and requirements such as constant professional training. The aim of the present study was to explain stress management in caregivers with thalassemia children. Materials and Methods: The method applied in this study was phenomenological qualitative research with conventional content analysis. This study was done in 2016-2017 in Shahrekord, Iran. A total of 15 participants, including 10 mothers, 1 grandmother, and 4 fathers participated purposely in this study. There were two sessions of interviews each of which lasted for 30 minutes. The content of interview was recorded and analyzed through conventional content analysis method after documentation. Results: Following content analysis, three categories were obtained: seeking for hope included two subcategories of seeking for hope and trusting in God, seeking for information included two subcategories of seeking for information from parents and seeking for information from physician and nurse, and seeking for new treatment included two subcategories of seeking for new treatment and seeking for transplant. Conclusion: This findings of the present study showed that planners and healthcare team can contribute caregivers of thalassemic children in coping with this disease using three adaptation approaches; that is, offering caregivers hope and providing them with proper information about the disease and treatments

Relationship between Iron Deficiency Anemia and Febrile Seizures

ObjectiveFebrile seizure is the most common convulsive disorder in childhood. The role of iron in metabolism of neurotransmitters and carrying oxygen to the brain suggests the possibility of a relationship between iron deficiency anemia and febrile seizures.The aim of this study was to investigate the relationship between iron deficiency anemia and febrile seizures.Materials & MethodsThis case - control study was performed on 132 cases and 88 controls, aged 9 months to 5 years, from July 2007 to June 2009 in Baqyiatallah Hospital. Patients were selected using simple random sampling. The case group included children with first febrile seizure (core temperature over 38.5˚C during  seizure) without a central nervous system infection or an acute brain insult. The control group included children suffering from a febrile illness without seizure. Iron deficiency anemia was defined with one of these laboratory indexes: 1) Hemoglobin (Hb) <10.5mg/dl 2) Plasma ferritin <12ng/dl 3) Mean corpuscular volume (MCV) <70  fl. The data collected from patients were analyzed with SPSS.13 software.ResultsLow plasma ferritin was found in 35 cases (26.5%) compared to 26 controls (29.5%), low Hb level was found in 4 cases (3%) compared to 6 controls (6.8%) and low MCV was found in 5 cases (3.8%) compared to 6 controls (6.8%).There was no significant difference in plasma ferritin , Hb level and MCV indices between the two group.ConclusionConsidering the above-mentioned results, there is no relationship between iron deficiency anemia and febrile seizures

Evaluation of the Role of Hemoperfusion on Mortality and Morbidity in Patients with Severe Coronavirus Disease 2019 (COVID- 19)

Background: Cytokine storm in severe Covid-19 disease is one of the leading causes of death in these patients. Hemoperfusion is a method used to purify the blood from toxins and inflammatory factors. The aim of this study was to evaluate the effect of hemoperfusion on mortality and morbidity in patients with severe Covid - 19 disease. Methods: This was a retrospective study which performed by reviewing the files of 30 patients with severe Covid-19 disease referred to Sina Hospital affiliated to Tehran University of Medical Sciences in 2020. Thirty patients with severe covid-19 disease and positive PCR participated in the study. All patients received routine treatment protocol for covid-19. Hemoperfusion was used for 15 patients in addition to receiving routine care. The remaining 15 patients were included in the control group. Patients in the hemoperfusion group underwent four sessions of hemoperfusion using continuous renal replacement therapy with continuous venovenous hemofiltration. Results: the ICU length of stay in the control and hemoperfusion groups was 3.40 ± 11.40 and 9.65 ± 16.33 days, respectively (P= 0.075). 8 patients died and 7 patients were discharged in the control group, but 11 patients died and 4 patients were discharged in the hemoperfusion group (P= 0.256). The respiratory rate of patients in the control and hemoperfusion groups decreased from 7.43 ± 29.40 to 4.03 ± 24.60 and from 6.11 ± 31.60 to 5.04 ± 24.46, respectively (P < 0.001). The percentage of arterial blood oxygen saturation in the control and hemoperfusion groups increased from 90.86 ± 5.61 to 93.06 30 4.30 and from 92.33 26 3.26 to 92.06 31 5.31, respectively (P= 0.456). Conclusion: Hemoperfusion could not prevent the mortality of patients and finally out of 15 patients, 11 patients died and 4 patients were discharged. Also, no significant difference was observed between the two groups in terms of arterial blood oxygen saturation

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation

بررسی ارتباط كیفیت ثبت و انجام مراقبتهای پرستاری در بخش اورژانس با میزان ازدحام

Introduction: Overcrowding in the emergency department is a major obstacle in receiving care. The present study was done with the aim of evaluating the relationship of nursing care and documentation qualities with overcrowding in emergency department. Methods: The present cross-sectional study was carried out in Alzahra Hospital, Isfahan, Iran in 2012. Data were gathered by a trained observer throughout working hours of the hospital using a standard checklist extracted from nursing textbooks. Overcrowded shifts were separated from other shifts by considering the number of patients admitted, and results were compared between the 2 situations using statistical analyses. Results: 170 patient files were evaluated regarding the quality of nursing and its documentation. According to the statistical analyses, documenting the nursing care given decreased at overcrowded times (p = 0.028), however the quality of care given did not vary (p = 0.36). Conclusion: The results of this study showed that despite the decline in quality of nursing care documentation following overcrowding in emergency department, rate and quality of care were not affected by overcrowding. مقدمه: ازدحام در بخش اورژانس به عنوان یکی از موانع اصلی در دریافت مراقبت های درمانی به شمار می رود و می تواند بازتابی از عدم تطابق عرضه و تقاضا در سیستم های بهداشتی درمانی باشد. مطالعه حاضر با هدف ارزیابی ارتباط كیفیت ثبت و انجام مراقبتهای پرستاری در بخش اورژانس با میزان ازدحام طراحی و انجام شده است. روش کار: پژوهش حاضر یك مطالعه مقطعی است که در سال 1391 در مرکز پزشکی آموزشی و درمانی الزهرا شهر اصفهان، ایران انجام گرفته است. جمع آوری اطلاعات توسط یک مشاهده گر آموزش دیده در تمام ساعات بستری بیمار با استفاده از چک لیست مراقبتی استاندارد تهیه شده از کتب پرستاری انجام گرفت. با توجه به آمار تعداد بیماران پذیرش شده به نسبت پرستاران، شیفتهای کم ازدحام و پر ازدحام تفکیک گردیده و نتایج حاصله در دو وضعیت مورد آنالیز آماری و مقایسه قرار گرفت. يافته ها: در مجموع پرونده 170 بیمار از نظر كیفیت ثبت و انجام مراقبت‌های پرستاری در زمان پرازدحام و کم ازدحام بررسی شد. طبق آنالیز آماری انجام گرفته کیفیت ثبت اقدامات پرستاری در زمان پر ازدحام در اورژانس کاهش یافته است (028/0=p). ولی کیفیت انجام مراقبتهای پرستاری از بیماران با افزایش ازدحام تغییری حاصل نکرد (36/0=p). نتيجه گيری: نتایج مطالعه حاضر نشان داد که علی رغم کاهش کیفیت ثبت خدمات پرستاری به دنبال افزایش ازدحام در بخش اورژانس، میزان و کیفیت ارائه خدمات بالینی به بیماران از شلوغی متاثر نشده بود

Quality of Nursing Care and Documentation with Overcrowding in Emergency Department

Introduction: Overcrowding in the emergency department is a major obstacle in receiving care. The present study was done with the aim of evaluating the relationship of nursing care and documentation qualities with overcrowding in emergency department. Methods: The present cross-sectional study was carried out in Alzahra Hospital, Isfahan, Iran in 2012. Data were gathered by a trained observer throughout working hours of the hospital using a standard checklist extracted from nursing textbooks. Overcrowded shifts were separated from other shifts by considering the number of patients admitted, and results were compared between the 2 situations using statistical analyses. Results: 170 patient files were evaluated regarding the quality of nursing and its documentation. According to the statistical analyses, documenting the nursing care given decreased at overcrowded times (p = 0.028), however the quality of care given did not vary (p = 0.36). Conclusion: The results of this study showed that despite the decline in quality of nursing care documentation following overcrowding in emergency department, rate and quality of care were not affected by overcrowding

Betanin purification from red beetroots and evaluation of its anti-oxidant and anti-inflammatory activity on LPS-activated microglial cells.

Microglial activation can release free radicals and various pro-inflammatory cytokines, which implicates the progress of a neurodegenerative disease. Therefore suppression of microglial activation can be an appropriate strategy for combating neurodegenerative diseases. Betanin is a red food dye that acts as free radical scavenger and can be a promising candidate for this purpose. In this study, purification of betanin from red beetroots was carried out by normal phase colum chromatography, yielding 500 mg of betanin from 100 g of red beetroot. The purified betanin was evaluated by TLC, UV-visible, HPLC, ESI-MASS, FT-IR spectroscopy. Investigation on the inhibitory effect of betanin on activated microglia was performed using primary microglial culture. The results showed that betanin significantly inhibited lipopolysaccharide induced microglial function including the production of nitric oxide free radicals, reactive oxygen species, tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6) and interleukin-1 beta (IL-1β). Moreover, betanin modulated mitochondrial membrane potential, lysosomal membrane permeabilization and adenosine triphosphate. We further investigated the interaction of betanin with TNF-α, IL-6 and Nitric oxide synthase (iNOS or NOS2) using in silico molecular docking analysis. The docking results demonstrated that betanin have significant negative binding energy against active sites of TNF-α, IL-6 and iNOS

The codification of spiritual intelligence measurement model in librarianship and medical information science students of medical universities in Iran

Introduction: According to the research mission of the librarianship and information sciences field, it is necessary to have the ability to communicate constructively between the user of the information and information in these students, and it appears more important in medical librarianship and information sciences because of the need for quick access to information for clinicians. Considering the role of spiritual intelligence in capability to establish effective and balanced communication makes it important to study this variable in librarianship and information students. One of the main factors that can affect the results of any research is conceptual model of measure variables. Accordingly, the purpose of this study was codification of spiritual intelligence measurement model. Methods: This correlational study was conducted through structural equation model, and 270 students were opted from library and medical information students of nationwide medical universities by simple random sampling and responded to the King spiritual intelligence questionnaire (2008). Initially, based on the data, the model parameters were estimated using maximum likelihood method; then, spiritual intelligence measurement model was tested by fit indices. Data analysis was performed by Smart-Partial Least Squares software. Results: Preliminary results showed that due to the positive indicators of predictive association and t-test results for spiritual intelligence parameters, the King measurement model has the acceptable fit and internal correlation of the questionnaire items was significant. Composite reliability and Cronbach's alpha of parameters indicated high reliability of spiritual intelligence model. Conclusions: The spiritual intelligence measurement model was evaluated, and results showed that the model has a good fit, so it is recommended that domestic researchers use this questionnaire to assess spiritual intelligence

The The Effect of Time-Dependence of 10 Hz Electromagnetic Field on Spatial Learning and Memory in Rats: A 10 Hz Electromagnetic Field Improves Spatial Memory

Introduction: In everyday life, electrical devices are the primary sources of extremely low-frequency electromagnetic fields (ELF-EMF), and the human body may be a great conductor of these fields. We chose alpha band power, especially at 10 Hz frequency, due to its prior beneficial role in memory. The purpose was to clarify whether there is a relationship between ELF-EMF exposure and cognitive deficits in rats, clinical signs, behavioral analysis, and the impact of ELF-EMF during different times of exposure on neuroplasticity via the expression of BDNF.Methods: Forty adult male rats were selected randomly. The rats were exposed to ELF-EMF (10 Hz, 4 mT) for 7 days and 30 days, one hour daily. The expression of BDNF proteins in the hippocampus was evaluated after sacrificing animals to assess learning and memory function. The body weight of rats in the long-term exposed group differed significantly (P&lt;0.05). The level of BDNF mRNA in the hippocampus was found by the RT-PCR method.Results: Our findings indicate that exposure to ELF-EMF affects spatial learning and memory and can improve memory, especially with long-term exposure. In addition, we discovered a significant difference in the long-term exposed group (P&lt;0.05), where radiation for 30 days resulted in a substantial rise in BDNF levels.Conclusion: After prolonged exposure, male rats spent more time and traveled a greater percentage of their distance in the target quadrant, demonstrating that long-term exposure improves spatial memory and that 10 Hz might be safe