Iranian Red Crescent Medical Journal
Volume:25 Issue: 6, Jun 2023

Context:

 Nutritional management of Covid-19 (Coronavirus Disease 2019) patients can serve as a tool to strengthen the patient's immune system and provide sufficient physiological resources to maintain vital functions during the fight between the virus and the body.
This review aimed to highlight available recommendations for the nutritional management of Covid-19 patients based on previous treatments used in similar diseases.

Evidence Acquisition: 

For this narrative review, a comprehensive search was performed in three databases, including PubMed, Scopus, and Web of Science databases from January 2020 to 7th December 2021, in the English language. The articles that focused on nutrition, diet, food, immunity, and coronavirus were searched. The titles and abstracts of all imported articles were screened. Only systematic and narrative reviews, commentary, opinion, prospective, and original articles, which related to the study question, were included. Studies which investigated the role of nutrition in the prevention of Covid-19 were excluded.

Due to the unique nature of Covid-19 and the role of nutrition in immunity and prognosis of Covid-19, the nutritional needs of patients with Covid-19 differ from others. Accordingly, the provision of these specific nutrient requirements and paying attention to the use of effective food supplements when adjusting the diet plan of patients with Covid-19 can be effective in improving patients' conditions. Therefore, more studies in this field can be helpful.

The first case of COVID-19 infection in Turkey was reported on March 11th, 2020, and declared a pandemic by the World Health Organization (WHO) in March 2020, introducing new regulations to national health systems. Some patients with non-COVID-19 presentations may have been adversely affected by this pandemic.

The present study aimed to investigate the effect of COVID-19 on patients with Fournier's gangrene during the pandemic and the impact of the COVID-19 pandemic on the clinical management and patient outcomes for Fournier's gangrene.

This retrospective cross-sectional study was conducted between March 2018 and March 2022 at the General Surgery Department of Trakya University. Patients were stratified into pre-pandemic and pandemic groups based on the date of March 11th, 2020, when the first Covid-19 case was reported in Turkey. Data collection and retrospective analysis were completed for all patients who were operated on for Fournier's gangrene originating from the perianal region. Demographic characteristics, predisposing factors, as well as laboratory and clinical results of the patients treated during the pandemic, were compared with the patients treated before the pandemic.

A total of 43 patients were included in the study (pre-pandemic: 24, pandemic: 19). There was a statistically significant difference between the pre-pandemic and pandemic groups in terms of the median length of hospital stay (7 vs. 16 days, p<0.001) and the median number of debridement (4 vs. 2, p=0.002).

In the presence of life-threatening surgical pathologies, such as Fournier's gangrene, the number of admissions did not decrease despite the pandemic. Precautions taken to reduce the risk of transmission in pandemic conditions and more aggressive surgical applications can reduce the number of debridement procedures and shorten the length of hospital stay. Subsequently, this is associated with similar treatment outcomes, lower morbidity, and reduced treatment costs.

Context: 

Long non-coding RNA (lncRNA) is a novel set of non-coding RNAs (ncRNA), over 200 nucleotides in length, accounting for the regulation of genes and chromosome structure. There are a few articles, mostly focusing on changes in the expression profile of DANCR. However, this review tried to collect documents to discuss the molecular mechanisms of this lncRNA in different cellular signaling pathways, considering microRNAs, to obtain a better understanding of its mode of action.

Evidence Acquisition: 

Differentiation antagonizing non-protein coding RNA (DANCR) is a cancer-associated lncRNA whose dysregulation, mostly upregulation, has been reported in almost all cancers, particularly in stages of invasion, migration, and progression. The regulatory mechanism of DANCR is mostly working as competitive endogenous RNAs (ceRNAs), leading to the hypothesis that lncRNA DANCR has oncogenic functions in malignancies. LncRNA DANCR harbors a number of MicroRNA Response Elements (MREs) for various microRNAs involved in different pathways, which are responsible for turning the situation toward supremacy for the dissemination of cancerous cells and ultimately metastasis, such as PI3K/Akt, TGF-β, Wnt, JAK-STAT, EMT, and DNA damages. In fact, lncRNA DANCR could potentially sequester microRNAs from their targeted mRNAs, which share the same MREs as DANCR.

This review article provides proper evidence, of why the aberrant expression of DANCR pathophysiologically turns the circumstances toward supremacy for the progression, migration, and invasion of cancerous cells, and proposes this lncRNA as a potent and extremely promising prognostic marker for the early detection of tumor progression and metastasis, as well as a therapeutic target for controlling the progression of several human malignancies.

Thromboangiitis obliterans (TAO) is a vasculopathy involving small and intermediate vessels of extremities with various medical and surgical treatment strategies.

This cohort study aimed to compare the outcomes of medical and surgical interventions in patients with TAO.

Patients with a definite diagnosis of TAO were enrolled in the study and evaluated on the first day, as well as three and six months follow-up visits. A total of 70 patients with TAO were followed for 30 months. Improvements in the primary complaints (claudication of calves and soles, rest pain, paresthesia, thrombophlebitis migrans, gangrene, scars, Raynaud's phenomenon) were compared between the groups.

In terms of gender, 98.6% of participants were male. The mean age of the patients was 43.24 ±9.8 years. Based on the results, 37 sympathectomy surgery, 11 amputation surgery, 15 bypass surgery, and 12 medical therapies with ILOPROST were considered for the patients (Medical treatment as combination therapy in patients with severe symptoms). The final results demonstrated that primary complaints were significantly improved in patients who underwent bypass surgery than in others.

As evidenced by the obtained results, patients in our study significantly benefited more from bypass surgery than sympathectomy and pharmacotherapy.

Although blood is donated rather than purchased, collecting, storing, and testing it for viral markers is expensive. During the Cost of Blood Consensus Conference (COBCON), activity-based costing (ABC) was proposed as a standard way to figure out the cost of preparing a unit of blood.

The ABC can be used by any organization that pays for blood or blood products. It was used to determine how much each unit of allogeneic blood costs in Iran, considering the limited blood sources and the importance of cost evaluation studies.

This cross-sectional, descriptive-analytical study was conducted at Shiraz Blood Transfusion Organization in 2020-2021 (Shiraz, Iran). We used the ABC method to determine how much each unit of allogeneic blood costs in Iran. In this study, activity centers were divided into high-level, intermediate, and final activity centers. The resources of each activity center were made up of human resources, consumables, buildings, equipment, and energy.

Direct and indirect costs of producing blood were separately investigated in the studied sub-units. The final estimated cost of preparing one blood unit was almost 13 million IRR (≈308 USD). According to our findings, indirect costs comprised a significant portion (86.45%) of the cost of producing a unit of blood, while direct costs accounted for only 13.55%.

As evidenced by the obtained results, the cost of one blood unit was far more than the national average estimated by the Iran Blood Transfusion Organization. There is a need for additional research on the cost of other blood products and indirect cost reduction strategies.

Mesenchymal tumors are part of a heterogeneous group of neoplasms.

The present study investigated the clinicopathological properties and surgical outcomes of patients with gastric mesenchymal tumors who underwent surgical treatment.

This study included all cases who underwent surgical treatment for mesenchymal tumors in Başakşehir Çam and Sakura City Hospital, Turkey, between August 2020 and August 2022. The demographic data and clinical properties of the patients, operative details, postoperative assessments, pathological specifications of the tumor, and immunohistochemical analysis results were evaluated.

The study included 14 patients, 57% of whom were male. Patients had a mean age of 59.7±9.3 years. The most frequent American Society of Anesthesiologists (ASA) score was ASA 2 in 10 (72%) patients, and the mean hemoglobin level was 12±1.9 g/dl. All patients underwent wedge resection, 5 (35.7%) by a minimally invasive method. The mean duration of operation was 98.9±29.4 min. There were no intraoperative complications, conversions, or postoperative mortalities, and the mean duration of hospital stay was 6.2±3.2 days. One patient made an unplanned re-admission to the hospital due to inadequate oral intake. As an adjuvant treatment, three patients were prescribed imatinib. The tumor location was most frequently the corpus in 5 (36%) patients, and the mean tumor diameter was 62±35.2 mm. Stromal tumors were the most common histological type in 10 (72%) patients, and the other histological types were leiomyoma in 3 (21%) and pancreatoblastoma in 1 (7%) patient. The median and maximum Ki-67 index were 3 and 80, respectively, and the median and maximum mitotic index were 3 and 18, respectively. The number of dissected lymph nodes was nine in one patient and five in another. The surgical margin was positive in one patient, and no patient had a perforated tumor.

Among the different types of mesenchymal tumors of the gastrointestinal system, which are rare, stromal tumors are the most common histological type. Gastric mesenchymal tumors can be safely treated with wedge resection, an approach that is associated with low postoperative morbidity and mortality.

Programmed Death-Ligand 1 (PD-L1) is a cell membrane protein found on the surface of cancer cells, immune system cells in the tumor microenvironment, and various healthy tissues. Moreover, it plays a key role in suppressing the immune system.

We aim to explain the presence of PD-L1 in Head-Neck Squamosus Cell Carcinomas (HNSCC) and premalign lesions by immunohistochemical method.

Our retrospective study included 22 patients with HNSCC (15(68.1%) Oral cavity and 7(31.9%) Oropharynx), 20 patients with oral lichen planus, and 14 patients with normal oral cavity mucosa. In the evaluation of PD-L1 antibodies applied immunohistochemically in patients with HNSCC, the percentage of tumor cells showing membranous staining with PD-L1 antibodies was calculated.

The mean age of HNSCC patients participating in the study was 52.24 ± 11.7 years, the mean age of oral lichen planus patients was 34.10 ± 9.8 years, and the control patients' mean age was 31.42 ± 10.6 years. The rate of PD-L1 staining of tumor cells of HNSCC patients was significantly higher than the control group (P=0.001).

The importance of PD-L1 expression in HNSCC and precancerous lesions of the oral cavity is remarkable, and the values may be related to the pathophysiology of these diseases.

The intraoperative rehydration technique known as the effect of Goal-Directed Fluid Therapy (GDFT), which is guided by the dynamic monitoring of volume responsiveness, has received a lot of attention recently. According to a meta-analysis by Bene, GDFT can maintain intraoperative hemodynamic stability, which lowers the incidence of postoperative complications and reduces stay at the intensive care unit.

This study aimed to determine how GDFT affected elderly patients who underwent combined lingual and cervical radical surgery after an operation for postoperative cognitive dysfunction (POCD).

This interventional study was conducted between December 2021 and December 2022 in a medical center affiliated with Fujian Medical University on people undergoing radical neck and tongue surgery for tongue cancer. The samples (n=36) were selected using an availability sampling method and randomly divided into conventional fluid therapy (the Non-GDFT, n=18) and GDFT (n=18) groups. The Non-GDFT group was hydrated normally during anesthesia. A continuous infusion of 8 mL/(kg/h) of compounded sodium chloride was administered to the GDFT group to maintain basal hydration volume during the operation. Before and following surgery, Montreal Cognitive Assessment Scale scores were completed, arterial blood lactate values and bilateral cerebral oxygen saturation levels were measured at various times following the stabilization of anesthesia, and the levels of interleukin 6 (IL-6) and S100 protein in venous blood were calculated.

The Non-GDFT group had a higher incidence of POCD than the GDFT group, the GDFT group had significantly lower levels of IL-6 and S100 than the Non-GDFT group, the GDFT group had significantly lower levels of serum lactate than the Non-GDFT group. The GDFT group experienced significantly lower rates of intraoperative hypotensive and intraoperative low rSO2 events than the Non-GDFT group, and this difference was statistically significant (P<0.05).

Assuring the balance of cerebral oxygen supply and demand, lowering the production of inflammatory mediators, and successfully reducing the incidence of POCD are all possible benefits of GDFT.

During the crisis of communicable diseases, nurses play an important role in controlling the disease and treating patients; therefore, the obstacles and challenges facing these medical personnel should be reduced.

The main goal of the present study was to evaluate the challenges faced by nurses during the Coronavirus Disease 2019 (COVID-19) pandemic.

This qualitative study was conducted using the content analysis approach in 2021-22 in the city ABC. The participants in this study were 30 people who were selected from 10 different hospitals and included nursing managers (n=10), supervisors (n=10), and nurses (n=10). Sampling was done purposefully and continued until the information saturation point. Semi-structured in-depth interview was used individually based on the interview guideline to collect data.

The results showed that the challenges faced by nurses during the COVID-19 pandemic included 452 codes and 12 subcategories, which after the final classification of the data, 4 main challenge categories were obtained, which included human challenges (33 subcategories), financial challenges (15 subcategories), communication challenges (8 subcategories), and organizational challenges (27 subcategories).

Based on the results of the present study, it can be concluded that the challenges faced by nurses during the COVID-19 pandemic included human, financial, communication, and organizational obstacles. Recognizing the challenges can help formulate road maps and strategies for improving disaster preparedness and management in hospitals.

The COVID-19 pandemic created an unprecedented challenge for intensive care units (ICUs) compared to other clinical wards. In addition, it caused stressful conditions due to the increased mortality rates in these wards.

Since the identification of these challenges can serve as a road map for managers in future planning against crises, the present study aimed to identify the challenges of ICU caregiving during the COVID-19 pandemic.

This qualitative study used conventional content analysis and was conducted using unstructured deep interviews with an open question and several co-constructive questions in 2023. A total of 23 ward heads, head nurses, nurses of ICU wards, nursing managers, and supervisors of six teaching hospitals affiliated with Isfahan University of Medical Sciences and Yazd Universities of Medical Sciences were included in the study through a purposive sampling method. Data analysis was performed with MAXQDA10 using qualitative content analysis with a conventional approach.

The challenges of ICUs in the COVID-19 pandemic were identified and categorized into six main categories and 14 sub-categories. The main categories included: inefficient management of resources, weaknesses in organization, challenges to laws and regulations/policies, structural challenges, weaknesses in educational processes, and mental challenges.

The findings of this study showed that it is possible to provide quality services to patients by identifying the challenges affecting the management and provision of nursing services and taking appropriate measures to improve the quality of nursing services in the intended wards.