Iranian Red Crescent Medical Journal
Year:2021 | Volume:23 | Issue:5|Papers Count:12

Background: Autologous stem cell transplantation (ASCT) is currently a gold standard treatment for eligible multiple myeloma (MM) patients. The recommended dose of CD34+ hematopoietic progenitor cells (HPCs) for adequate engraftment is above 2 × 106 cells/kg. Objectives: This study aimed to evaluate the relationship between the number of CD34+ HPCs and the survival in MM patients who underwent ASCT in the Hematology Department of Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey. Methods: The statistical population of this consisted of 200 MM patients who underwent ASCT within 2009-2019. The clinical characteristics of the patients, disease status pre-SCT, number of infused CD34+ cells, neutrophil, and platelet engraftment days were recorded. The patients were divided into two groups, based on whether the re-infused CD34+ HPCs dose was < 5 × 106 cells/kg (Group 1) or ≥ 5 × 106 cells/kg (Group 2). The groups were compared in terms of engraftment and overall survival (OS) times. Results: A total of 200 patients were included in our study. Group 1 (n=125) included patients with < 5 × 106 cells/kg CD34+ HPC re-infusion, and Group 2 (n=75) consisted of patients with ≥ 5 × 106cells/kg CD34+ HPC re-infusion. The patients’ median age scores in Group 1 and Group 2 were 57 (25-71) and 56 (33-72) years, respectively. The median follow-up period was 33 months (6-130). The median OS of all patients was 71 months (95% confidence interval, 59. 1-82. 9). The median neutrophil and platelet engraftment times were similar between the groups (P=0. 4 and P=0. 4, respectively). In both groups, the median OS time was 71 months (P=0. 8), which was similar. Conclusion: The greater number of CD34+ HPCs re-infusion for ASCT after high dose melphalan chemotherapy in MM patients did not affect platelet and neutrophil engraftment time and OS; therefore, this amount of reinfusion was not required.

Background: Peripheral neuropathy is one of the major complications of type II diabetes mellitus. Lower limb proprioceptive impairments due to neuropathy can lead to balance disorders in these patients. Objectives: The present study aimed to investigate postural stability and neuropathic changes following ankle proprioceptive training in type II diabetic patients with moderate neuropathy. Methods: The present study was conducted on 24 type II diabetic patients with moderate neuropathy (9 females and 15 males) aged 40-65 years (with a mean age of 57. 25 years). The treatment consisted of ankle proprioceptive training by the balance board and rocker for 10 consecutive days. Balance indices, including Overall Stability Index (OSI), Anterior-Posterior Stability Index (APSI), and Medial-Lateral Stability Index (MLSI), were measured with Biodex system before and after the treatment, as well as two weeks after treatment in two conditions: condition1: Eyes open, head straight, without using trunk, pelvis, thigh, and knee constrained orthosis. Condition 2: Eyes closed, head back (hyperextension), with using trunk, pelvis, thigh, and knee constrained orthosis. Plate-based Biodex stability was fixed at levels 6 and 8 for condition1 and level 8 for condition 2. The severity of neuropathy was assessed using Valk and Michigan questionnaires, as well as light touch sensation. The analysis of variance with repeated measure was used to evaluate alterations in the stability of patients. Furthermore, the correlation of neuropathic changes and stability parameters were assessed by the Pearson correlation coefficients. Results: Significant improvements were observed in OSI in all tests of condition 1 (Biodex Balance System (BBS) at level 8 (P=0. 001) and level 6 (P=0. 017), as well as test conditions 2 (level 8; P=0. 004). After the treatment, at stability level 8, a significant improvement in the mean values of postural sways in the Anterior-Posterior (AP) direction demonstrated that the ankle strategy was improved in the patients. After the treatment, the scores of the Valk (P=0. 02) and Michigan (P=0. 001) questionnaires were significantly decreased. After two weeks of follow-up, the observed improvement was maintained in the mean values of balance indices (OSI, APSI) and neuropathy due to treatment. Conclusion: As evidenced by the obtained results, 10 sessions of targeted ankle proprioceptive training improved stability, neuropathy, and light touch sensation of the foot in type II diabetic patients with moderate neuropathy. Foot somatosensory information is one of the most important causes of balance alterations in these patients.

Background: Transient Ischemic Attack (TIA) (1) is a neurological dysfunction of transient cerebrovascular ischemia, which is more common in clinical practice. The risk of further progression to ischemic stroke after a higher TIA can be used as a strong early warning signal of cerebral infarction. Objectives: To explore the correlation between stromal cell-derived factor 1 (SDF-1) and the prognosis of TIA. Methods: A number of 65 patients with TIA were collected, the ABCD2 clinical risk prediction score was implemented, relevant tests and nuclear magnetic resonance imaging (MRI) were performed, and the SDF-1 was recorded in serum levels. End-point events were selected in patients after cerebral infarction in the short term. The statistical analysis method was used to evaluate TIA short-term development for the occurrence of cerebral infarction after risk, the severity of serum level of SDF-1, and infarction. Results: Based on the results, the high-risk group, middle-risk group, and low-risk group had statistically significant differences in serum SDF-1 levels (F=3. 820; P<0. 05). Correlation analysis demonstrated that ABCD2 score was positively correlated with serum SDF-1 (r=0. 349; P<0. 05). End-point events were included in the occurrence group and not included in the non-occurrence group. The SDF-1 level of the occurrence group was significantly higher than that of the non-occurrence group. Based on the cranial MRI results as the gold standard, the areas under the curve of the receiver operating characteristic curve (ROC) drawn based on the SDF-1, ABCD2 score, SDF-1 combined with the ABCD2 score, and the occurrence of end-point events were obtained at 0. 717, 0. 697, and 0. 762, respectively. The sensitivity and specificity of SDF-1 were reported as 77. 8% and 68. 1%, respectively. The sensitivity and specificity of the ABCD2 score were 83. 3% and 48. 9%, respectively. The sensitivity and specificity of SDF-1 combined with the ABCD2 score were 72. 2% and 76. 6%, respectively. Conclusion: As evidenced by the obtained results, SDF-1 is associated with ABCD2 score risk classification. Patients with high levels of SDF-1 combined with the ABCD2 score have a higher risk of cerebral infarction. Elevated SDF-1 levels may indicate that TIA patients have a poor short-term prognosis and have a certain predictive value for the diagnosis of the risk of ischemic stroke in the short term.

Context: Social networks can perform a peculiar role in people's communication in the case of crisis and disaster. These media are interactive, digital, or mobile-based tools. Accordingly, the present study aimed to assess the role of social media in earthquakes. Evidence Acquisition: In this current systematic review, a query was conducted on such databases as Embase, Web of Science, Scopus, and Cochrane for articles in English language, based on the required criteria from 2000 to 2019 regarding the role of social media in disaster. As a result, 13, 924 studies were retrieved, among which 3, 963 were deleted due to duplication. Finally, among 244 selected articles, 19 full-text articles were analyzed. Results: In the present research, 19 studies were thoroughly reviewed. The findings were assigned to four main categories (identification, notification, requests, as well as storage and retrieval of information) with 12 sub-topics. Most of the main topics and subsets were as follows: medical and food needs, information about the accident, as well as medical and relief services, efforts to save lives, the amount of damage, problems and limitations, post-crisis measures, such as keeping calm, reducing anxiety, avoiding high-risk areas, asking for financial assistance, as well as using the information to provide relief and map the affected areas and evacuation centers. Conclusion: Considering the behavior of people in different geographical locations in the earthquake crisis, it seems that the case study of how to use social media in disaster management carries profound implications for modeling and localizing the cases in related disaster management institutions of many different countries, such as Iran.

Background: Newborn screening tests for detecting numerous congenital diseases that may cause disability or death were performed first in 2006 in Turkey. Newborn screenings for Phenylketonuria and congenital hypothyroidism have increased in recent years due to the emergence of new diseases. It is essential for healthcare personnel and families to carry out these screening programs in a timely, accurate, and efficient manner. Informing families, particularly mothers, about these screening tests will help more newborn babies benefit from these tests. Objectives: This study aimed to explore mothers’ views about newborn screening programs in Turkey. Methods: This descriptive and cross-sectional study included 112 volunteer mothers and was conducted at Zekai Tahir Burak Hospital, Ankara, Turkey, from December 2018 to January 2019. Results: Although mothers in Turkey were to some extent informed about the screening tests, they did not have sufficient information regarding the objective of these tests. Moreover, the majority of mothers expressed a positive opinion about the tests and stated that they would have these tests done even if they had to pay for them. Conclusion: Based on the obtained results, although mothers in turkey were not sufficiently knowledgeable about screening tests and their objectives, they expressed positive views about these tests. Therefore, it is recommended that families should be informed about newborn screening tests through mass media, educational environments (pregnancy schools), and screening test centers. Therefore, it is important to organize in-service training for midwives and nurses to raise their awareness in this regard.

This study investigated the effects of lyophilized mare milk, human milk, and cow colostrum on both human lung cancer cell line called A549, and healthy lung cell line called MRC5. Mare milk, human milk, and cow colostrum varieties were applied to 6 replicates in both cell lines with lyophilized milk concentrations ranging from 50-3200 ppm. The cell viability was monitored by optic microscopy and determined by the MTT test. ANOVA and Duncan's multiple range tests were used to analyze data. The results of this study indicated that the most effective milk type on reducing the A549 lung cancer cell line was human milk, followed by mare milk; however, cow colostrum showed little effect. It was observed that human milk and mare milk had anti-proliferative effects on lung cancer cell line at concentrations which were non-toxic to healthy lung cell line.

Background: Simulation studies present an important statistical tool to investigate the performance, properties, and adequacy of statistical models in pre-specified situations. The proportional hazards model of survival analysis is one of the most important statistical models in medical studies. The present study aimed to investigate the underlying one-month parametric survival model of road traffic accident (RTA) victims in a Level 1 Trauma Center in Iran using parametric and semi-parametric survival analysis models from the viewpoint of post-crash care-provider in 2017. Methods: This retrospective cohort study (restudy) was conducted at Level-I Trauma Center of Shiraz, Iran, from January to December 2017. The parametric survival modeling was employed to inspect the multiplicative effect of all covariates on the hazard considering the fact that certain covariates acting on survival may take a non-homogenous risk pattern that can lead to the violation of proportional hazards assumption in Cox proportional hazards. Distributions of choice were Exponential, Weibull, and Lognormal. Parameters were estimated using the Akaike Information Criterion for each of the fitted models. Results: Survival analysis was conducted on 8, 621 individuals for whom the length of stay (observation period) was between 1 and 89 days. In total, 141 death occurred during this time. The log-rank test revealed inequality of survival functions across various categories of age, injury mechanism, injured body region, injury severity score, and nosocomial infections. Although the risk level in the Cox model is almost the same as that in the results of the parametric models, the Weibull model in the multivariate analysis yields better results, according to the Akaike criterion. Conclusion: In multivariate analysis, parametric models were more efficient than other models. Some results were similar in both parametric and semi-parametric models. In general, parametric models and among them the Weibull model was more efficient than other models.

Background: Reports, mostly from high-income countries, have shown a wide range of symptoms, clinical profiles, and outcomes for patients diagnosed with COVID-19. However, little is known about these issues in developing countries. Objectives: This research used medical records in 15 hospitals in Tehran, the capital city of Iran, to assess predictors of in-hospital mortality in patients diagnosed with COVID-19. Methods: The required information was extracted from patients' medical records, including age, gender, laboratory data (complete blood count, serum electrolytes, and liver, renal, and muscle injury tests) at admission, and the outcome of in-hospital mortality (yes/no) of 4, 542 adult patients with confirmed COVID-19. This research used logistic regression to assess the predictors for mortality (measured as adjusted odds ratio [aOR]) and Chi-square automatic interaction detector to classify high-risk patients in different age groups as a decision tree model. Two models were developed through a machine learning approach. Results: Overall, 822 (18. 09%) cases passed away in the hospital. Mortality risk was increased from 4. 33% in patients aged 18-40 years old to 40. 96% in those aged 80+ years old. After adjusting for covariates, age (aOR 1. 62 to 7. 05 vs. those aged 18-40 years old), high aspartate transaminase (aOR 1. 64 to 3. 21), high alkaline phosphatase (aOR=2. 17), low sodium (aOR=1. 31), high sodium level (aOR=5. 05), high potassium (aOR=2. 41), low calcium (aOR=2. 31), high creatine phosphokinase (aOR=2. 21 to 2. 24), and high creatinine (aOR=3. 43) were significantly associated with in-hospital mortality. Conclusion: Based on the results of our study, the mortality rate was high among in-hospital patients, particularly among older age and those who had liver and renal dysfunctions, muscle injury, and electrolyte imbalance at admission. Triage and special care for these high-risk patients can improve in-hospital outcomes.

Background: Nursing care activities in the context of infectious epidemics, such as COVID-19, can lead to high levels of stress in nurses. Objectives: This study aimed to investigate the relationship between the occupational stress and adequacy of hospital support measures among nurses with the experience of caring for patients with infectious and non-infectious diseases during the COVID-19 outbreak. Methods: This descriptive-analytical and cross-sectional study was conducted on nurses caring for patients with COVID-19 in Imam Reza Hospital Complex in Mashhad, Iran. The sample size was determined at 194 nurses who were selected through random sampling. The data were collected using a standard questionnaire and analyzed through a structural equation modeling approach using Smart PLS software (version 2. 0). Moreover, descriptive and inferential statistics were employed for data analysis. Results: The results of the correlation analysis showed a negative and significant relationship between occupational stress and adequacy of hospital support measures (P<0. 001). Furthermore, the mean occupational stress scores of the nurses with the experience of working in infectious and non-infectious diseases wards were 63. 96 and 65. 34, respectively. Additionally, there was no difference between the mean values of occupational stress of nurses with the experience of working in non-infectious and infectious diseases wards. Moreover, the effects of the control variables of the work shift (morning, evening, or night) and work experience (years) were not significant in this study. Conclusion: The COVID-19 epidemic caused many nurses to work in new and sometimes stressful environments and conditions. Proper work shifts, improvement of interpersonal communication, and provision of ongoing supportive measures can be effective in reducing occupational stress.

Background: The abdominal draw-in maneuver (ADIM) has been suggested to enhance core stability through the improvement of lumbopelvic stability. Although the effect of ADIM and core muscle activation on some biomechanical parameters has been studied, the effect of exercising a few minutes of this maneuver on balance test results has not been established yet. Objectives: This study aimed to determine the effect of exercising a few minutes of ADIM on balance test results. Methods: This study included 18 apparently healthy participants in the age range of 18-60 years. The participants performed a fall risk test using the Biodex balance system. Afterward, the participants were instructed to perform the abdominal drawing-in maneuver. The fall risk test was repeated while the participants were performing this maneuver. The results were compared with the data obtained from participants at the beginning of the study using paired t-test. Data were analyzed according to the participants’ BMI (more or less than 25 kg/m2) or abdominal circumference (more or less than 100 cm) to reveal the effect of doing ADIM on balance scores in these subgroups. Results: Based on the obtained results, a significant improvement was observed in the means of balance scores after the participants performed the ADIM. Further analysis revealed a significant improvement in the means of balance scores of individuals with abdominal circumference more than 100 cm or BMI more than 25kg/m2 (P˂ 0. 05). Conclusion: The short-term impairment of postural control can be dangerous, especially for elderly individuals with abdominal obesity in risky situations, such as mass gatherings. Therefore, it is recommended that individuals with a high risk of falling should be instructed to practice ADIM correctly.

Background: Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has a variety of symptoms and laboratory and radiologic features whose identification can help diagnose and manage patients with COVID-19 more effectively. Objectives: This study aimed to describe the epidemiological, clinical, and laboratory features of patients with COVID-19, compare clinical features of patients in the intensive care unit (ICU) with those of non-ICU admitted patients, and define mortality risk factors for this disease. Methods: This cross-sectional study was carried out on 781 COVID-19 patients hospitalized in Rasool Akram Medical Complex, Tehran, Iran, from February to May 2020. Patients’ epidemiological, demographic, clinical, laboratory findings were collected. Routine blood tests included complete blood count, coagulation profile, and serum biochemical tests. Confirmed infection was defined as positive reverse transcription-polymerase chain reaction (RT-PCR) to SARS-CoV-2 in their nasopharyngeal specimens or typical clinical, laboratory, and imaging findings of COVID-19 infection altogether. All data were analyzed using SPSS software (version 21). Results: In this study, the majority of patients were male (n=470, 60. 2%) and the remainder were female. The median age of the patients was 64 years. Hypertension (31. 8%) and tuberculosis (1. 4%) were the most common and the least common underlying condition among the patients, respectively. Moreover, cough and seizure were the most common (75. 7%) and the least common (2. 4%) symptoms in patients. The history of diabetes mellitus, the presence of dyspnea, loss of taste, and the occurrence of seizure were associated with a higher risk of ICU admission. On the other hand, advanced age, positive PCR, presence of dyspnea, myalgia, loss of taste, and elevated liver enzymes, and lactate dehydrogenase (LDH) were associated with a higher risk of mortality. Based on the results, smoking had a preventive effect on mortality (OR=0. 292, P=0. 048); however, it had no significant effect on ICU admission. Conclusion: According to the obtained results, positive PCR and initial symptoms of dyspnea and myalgia were associated with increased odds of mortality by two times. In addition, elevated alanine aminotransferase and lactate dehydrogenase were associated with a higher rate of mortality. ICU admission was the main variable to increase the odds of mortality. Eventually, smoking might play a protective role against COVID-19 mortality.

Background: The illness caused by the novel coronavirus is an emerging disease, and for this reason, the international community is encountered with its unknown nature, such as clinical features, treatments, and long-term complications. Experience suggests that humans are affected by the psychological and social effects of epidemics and pandemics of infectious diseases. Accordingly, it is a new experience to care for patients with this disease that has to be more explored. Objectives: The present study aimed to detect the challenges with which nurses are faced in the process of caring for patients with coronavirus disease 2019 (COVID-19) in Iran using a qualitative method. Methods: This qualitative study utilized in-depth semi-structured interviews with 19 key informants selected via targeted sampling. The obtained data were analyzed by thematic analysis to identify the challenges to which the nurses have encountered in the process of caring for patients with COVID-19 in Iran. Results: Challenges of the nurses in the caring process for patients with COVID-19 are listed in five categories of stress and psychological issues, equipment-related challenges, increased events of errors, medication and treatment problems, and hospital management. It should be mentioned that at the same time, 35 other subcategories were also identified in this study. Conclusion: Since nurses are at the forefront in fighting the COVID-19, there must be plans to increase their preparedness. Deficiencies in health systems, including equipment, medicine, and personal protective gear should also be addressed so that nurses can better respond to these incidents. Psychological and mental support is a key component of the nurses’ appropriate response; therefore, along with nurses' responses, individuals, groups, and family psychological supports should be facilitated to increase performance and effectiveness in response to COVID-19.