Hospital Practices and Research
Volume:9 Issue: 1, Winter 2024

Some neutrophils are shown to be able to release structures consisting of DNA strands associated with histones, decorated with about 20 proteins. These structures are called Neutrophil Extracellular Traps (NETs). NETosis is the process by which the formation of neutrophil extracellular traps eventually leads to cell death. Indeed, NETosis is a cell death process that is unique from other common types of cell death. Two kinds of NETosis have been identified, vital NETosis and suicidal NETosis. Vital NETosis, unlike suicidal NETosis, occurs a few minutes after neutrophil stimulation. Suicidal NETosis can be dependent on or independent of NADPH oxidase. NADPH-independent NETosis can be induced by calcium ionophores. As long as NETs are set up properly, they play an important role in fighting infections. However, if not properly adjusted, tissue damage and inflammation increase. Furthermore, NETs are involved in some autoimmune diseases.

The coronavirus Disease 2019 (COVID-19) pandemic emerged in December 2019, resulting in a high number of deaths worldwide. There is a need to investigate how this condition affected people with different diseases, particularly atopy. This study aimed to compare clinical symptoms, laboratory test results, radiological manifestations, and clinical outcomes between hospitalized COVID-19 patients with and without atopy. This single-center cross-sectional study with matched controls was conducted on 106 (out of 334) COVID-19 patients hospitalized in Baqiyatallah Hospital, Tehran, Iran, from March 24 to April 24, 2020. Among them, there were 40 and 66 cases with and without atopy, respectively. The non-atopic patients were also matched with the atopic patients in terms of age, gender, Body Mass Index (BMI), and the prevalence of comorbidities, particularly hypertension and diabetes. Patients' clinical characteristics, laboratory findings, and radiological features, recorded upon their admission, and the outcomes were then compared between both study groups. Compared with the non-atopic group, weakness, myalgia, and chills were more frequent in the patients affected with atopy (P <0.05), and neutrophil count, Erythrocyte Sedimentation Rate (ESR), C-Reactive Protein (CRP), bilateral lung involvement, bilateral pneumonia, and Ground-Glass Opacity (GGO) were among the laboratory test results and radiological manifestations that were observed significantly less in atopic patients (P <0.05). No significant difference was further detected regarding the COVID-19 outcomes in both study groups (P >0.05). This study showed that atopic conditions were capable of increasing the frequency of some COVID-19 clinical symptoms and reducing the severity of COVID-19 with regard to laboratory findings and radiological features on admission. In addition, atopy was not correlated with COVID-19 outcomes in atopic patients.

Different studies have shown that despite the expanding number of antifungal drugs, the death rate caused by Candida species has increased during the recent decades due to drug resistance occurrence. The present study aims to identify molecular structure and evaluate drug susceptibility in Candida species isolated from bronchoalveolar lavage fluid in patients diagnosed with hematological malignancies. In this cross-sectional study, 54 clinical specimens were taken from the bronchoalveolar lavage of patients. The suspected colonies were investigated by microscopic examination and subsequent passages were evaluated according to standard operating procedures and specification of the type of colony color prescribed by CHROMagar to isolate the yeast. The sequencing method (ITS1, ITS4) was used to approve Candida species. Finally, susceptibility test was carried out according to M27S-3 and M38-A2 micro-dilution methods. Among 54 samples investigated with culture and PCR methods, 33 Candida species were identified in patients with hematological malignancies. Candida albicans (75.7%) was the most common fungal isolate. Results of drug susceptibility tests showed that the isolated C. albicans (n = 2), C. glabrata (n = 1), and C. tropicalis (n = 1) from patients with hematological malignancies were resistant to fluconazole. The present study showed that the prevalence of C. albicans was higher than other fungal species among patients with hematological malignancies. Candida species are more susceptible to voriconazole, amphotericin B and Caspofungin. Therefore, identification of candida species along with their antifungal susceptibility pattern can help clinicians to better treat patients.

Device-Associated Infections (DAIs) pose significant challenges in healthcare settings, leading to increased morbidity, mortality, and healthcare costs. Understanding the impact of the COVID-19 pandemic on DAIs and device utilization rates is crucial for optimizing infection control practices and enhancing patient safety. This study aims to elucidate the shifts in infection rates, specifically CAUTI, VAP, and CLABSI in a tertiary care centre before and after the onset of the global pandemic. In this retrospective study, we analysed trends in DAIs and device utilization rates before (October 2019 - March 2020) and after (August 2021 - January 2022) the COVID-19 pandemic. Data on urinary catheter days, central line days, ventilator days, and rates of Catheter-Associated Urinary Tract Infection (CAUTI), Central Line-Associated Bloodstream Infection (CLABSI), and Ventilator-Associated Pneumonia (VAP) were collected from medical records. According to the findings of the present study, fluctuations in CAUTI, CLABSI, and VAP rates pre- and post-pandemic, with no significant difference in infection rates between the two periods (P >0.05) were observed. There was a notable increase in urinary catheter days post-pandemic, accompanied by reductions in ventilator days and central line days. The urinary catheter utilization ratio substantially increased post-pandemic, while ventilator and central line utilization ratios showed slight declines. This study highlights the dynamic nature of DAIs and device utilization rates in the wake of the COVID-19 pandemic. Implementing evidence-based protocols and continuing research in infection control practices are essential for optimizing healthcare delivery and enhancing patient safety in the post-pandemic era.

Nursing is stressful, especially for female nurses, due to workload and emotional labor. These stressors can contribute to negative emotional states, including meta-worry, irritable mood, and difficulties processing emotions effectively. The purpose of the present study was to investigate the effectiveness of Acceptance and Commitment Therapy (ACT) in reducing meta-worry, irritability, and improving emotional processing in anxious female nurses. A quasi-experimental pre-test, post-test control group design was employed.  The target population comprised all female nurses at Imam Khomeini Hospital, Ahvaz, Iran, experiencing anxiety in 2023. A convenience sample of 30 nurses was randomly assigned to either the ACT intervention group (n = 15) or the control group (n = 15). The intervention group received an eight-week ACT program each lasting for 90 minutes. Anxiety-related outcomes were assessed using the Meta-worry Questionnaire, The Irritability Questionnaire, and The Emotional Processing Scale. Data were analyzed using ANCOVA with SPSS-25 software. Prior to the intervention, no statistically significant differences were identified between the control and experimental groups on measures of meta-worry, irritable mood, and emotional experience processing. Following the ACT intervention, the experimental group demonstrated significant improvements (P <0.001) compared to the control group. Specifically, ACT led to a decrease in meta-worry scores and positive changes in both irritable mood and emotional experience processing among anxious female nurses. The findings demonstrated that ACT positively improved meta-worry, irritable mood, and emotional experience processing among the participants. These results suggest that ACT may be a valuable intervention for reducing anxiety-related symptoms and improving emotional well-being in female nurses experiencing anxiety.

Acute kidney injury appears to be both the cause and the result of developing chronic kidney disease. "Acute on chronic kidney disease" refers to acute kidney injury that develops in the presence of pre-existing chronic kidney disease. This study aimed to gain a better understanding of the disease's incidence and outcomes in a rural area. A retrospective analysis was conducted to identify individuals with acute or chronic kidney disease who had acute dialysis at Sakon Nakhon Hospital in Thailand between January 2021 and December 2022. The patient's demographics, clinical symptoms, laboratory values, and outcomes were documented. There were 82 patients with acute kidney injury requiring dialysis, of which 35 (42.7%) had acute on chronic kidney disease. The mean age was 61.6 ± 13.46 years, with 48.6% being male. Diabetes was the most frequent primary cause and comorbid condition (60%). The majority of indication for acute dialysis (57.1%) was volume overload. Sepsis (37.1%), and urinary tract obstruction (25.7%) were the leading causes of acute renal function decline. There was a significant difference in risk variables between non-survivors and survivors, including shock (P <0.00001), mechanical ventilation use (P = 0.0017), and Intensive Care Unit (ICU) admission (P = 0.0005). Significant mortality-related risk factors identified by logistic regression analysis were shock [OR 159.00, 95%CI 6.86-3683.71; P = 0.002], mechanical ventilation usage [OR 30.79, 95%CI 1.59-597.71; P = 0.024], and ICU admission [OR 43.00, 95%CI 2.18-847.42; P = 0.013]. Acute on chronic kidney disease increased not just in-hospital mortality and morbidity, but also the risk of chronic kidney disease onset and progression.

Numerous factors involve in the incidence of addiction including social, economic and psychological stress. The present study aimed at studying the effectiveness of cognitive-behavioral stress management on irrational beliefs and resilience of drug addicts. In an experimental study, 20 addicts who were in the camp were randomly assigned into two groups of experimental (10 individuals) and control (10 individuals). The experimental group were being treated with cognitive-behavioral stress management for ten 90-minute sessions, and the control group did not receive any treatment. All participants in the study, at the beginning and the end of the treatment and two months after treatment filled out the irrational beliefs and resiliency questionnaire. Analysis of covariance and multivariate analysis of covariance (MANCOVA) was used to analyze the collected data. The findings of analysis of covariance between two groups in the post-test was significant in ten aspects of irrational beliefs including the need to recognize and protect others (F = 4.09), high expectations of themselves (F = 16.84), tend to blame (F = 17.03), reaction to frustration (F = 11.88), emotional irresponsibility (F = 10.97), excessive preoccupation (F = 10.97), avoiding the issues (F = 8.48), dependency (F = 12.45), despair to change (F = 8.94), and perfectionism (F = 15.56) in the one present level. In addition, the results of analysis of covariance of second hypothesis showed that resilience (F = 22.61) in the experimental group had a significant difference with the control group. Also, the obtained results were significant at the 0.01 level. Therefore, according to the above-mentioned finding, cognitive-behavioral stress management training is effective in reducing irrational beliefs and increasing the resilience of addicts. According to the lower average scores of the experimental group in the post-test stage in the dimensions of irrational beliefs, it can be concluded that stress management training in a cognitive-behavioral way reduces the irrational beliefs of addicts. Also, according to the higher average scores of the experimental group in the post-test stage in resilience, it can be concluded that cognitive-behavioral stress management training is effective in increasing the resilience of addicts.

Infertility is a significant psychosocial stressor associated with adverse mental health outcomes. Given the intricate link between mental health and self-concept, enhancing self-concept may be crucial for improving overall well-being among infertile women. The present study aimed to enhance self-concept in infertile women through Mindfulness-Based Cognitive Therapy (MBCT). This study employed a quasi-experimental design with a three-wave (pre-test, post-test, 45-day follow-up) assessment and two groups: experimental and control. To conduct the research, 40 infertile women referring to the Isfahan Infertility and Infertility Center in 2023 were selected conveniently based on inclusion and exclusion criteria and were randomly assigned to the experimental (n = 20) and control (n = 20) groups. The participants completed the Beck Self-Concept Test in three stages of pre-test, post-test, and follow-up. The experimental group participated in an eight-week MBCT intervention, consisting of one 90-minute session per week. The control group received no intervention during this period. Data were subjected to repeated-measures analysis of variance (ANOVA) using SPSS-24. The findings indicated that MBCT significantly improved self-concept in infertile women in the social skills dimension (P <0.01). The significant improvement in self-concept, particularly in the social skills dimension, suggests that MBCT can be a helpful intervention for this population. Infertility-related social isolation and diminished self-concept may be ameliorated through MBCT. This study demonstrates that MBCT can enhance social interaction skills in infertile women, thereby positively influencing their overall self-concept. These results support MBCT as a beneficial approach for enhancing the mental health of women facing infertility.