رقیه اکبری

Information on the coronavirus infection 2019 (COVID-19) which can clinically range from asymptomatic infection to severe pneumonia, in transplant recipients is still low. Infections are a major cause of death in kidney transplant recipients, and kidney transplant recipients, like other organ recipients, appear to be more vulnerable to a variety of infections due to comorbidities and immunosuppressive drugs that predispose them to infection.

In this study, we reviewed 10 transplant recipients with a mean age of 50.3±11.25 years who were admitted to Ayatollah Rouhani Hospital in Babol due to COVID-19 From April 2019 to September 2019. Four patients were female and six ones were male. Fever (100%) and cough (60%) were the most common symptoms in patients. All patients used standard immunosuppressive drugs (tacrolimus, corticosteroids, mycophenolate, and cyclosporine). The mean level of oxygen saturation at the time of admission in these patients was 87.9±11.3 and in two patients with death outcomes of 57% and 95%, it was at the beginning of hospitalization. The mean leukocytes of patients at the beginning of hospitalization was10470±5784.08 per ml and the mean lymphocytes of these patients were 1081.5±516.05. In the studied patients, the mean of previous years of transplantation was 8/05±7.13 and two patients died 20 years and 5 years after their kidney transplantation. Two patients (20%), aged 57 and 50 years, died from progressive respiratory symptoms and the other eight patients recovered and were discharged from the hospital.We reported COVID-19 infection in ten kidney transplant recipients with different clinical outcomes and periods, which may be a reference for the management of COVID-19 in such patients.

It seems that more information is needed to better understand the effect of anti-transplant immunosuppressive therapy on the outcome of COVID-19 infection in kidney transplant recipients. Long-term follow-up studies and more cases are needed to clarify the diagnosis, outcome, and treatment options for COVID-19 in these patients.

Clinical reasoning is one of the important categories in medicine and teaching it in different ways can accelerate the student's ability to approach expert professional thinking. In addition, complementary trainings, along with clinical training, can promote clinical training in pandemics and situations where contact with the patient is reduced for some reason.

This is an semi-experimental, case observation study in which the case group was trained in clinical reasoning by scenario writing method, and after the test, 2 groups were compared with KF and DTI tests. The two were identical based on their basic science test scores before the study.

In this study, 60 people in two groups of case and control (30 people in each group) were compared with DTI and KF tests. The average DTI score in the case group was 151.4±15.3 and the average score in the control group was 151.8±17.2, the scores in both the case and control groups were not significant (P-value=0.922). The KF scores were 36.3±4.5 in the control group and 30.2±8.2 in the case group, and the scores in the case group were significantly higher than the control group (P-value=0.001)

The results of the study showed that short-term scenario writing training can be effective in improving the KF score and clinical reasoning, but increasing the DTI score requires more training time.

Patients with systemic lupus erythematosus (SLE) suffer from a variety of psychological problems, including depression, anxiety, and stress. This study aimed to examine the effect of mindfulness-based metacognitive skills training on depression, anxiety, stress, and sense of well-being in patients with SLE.

This randomized clinical trial with pre-test/post-test design was carried out in 60 patients with SLE attending Babol Shahid Beheshti Nephrology Clinic, 2018. They were randomly divided into two groups (n=30 per group). The experimental group received weekly sessions of mindfulness-based metacognitive skills training (1 hr/ 8 weeks), while the control group did not receive any intervention. The patients’ socio-demographic information was recorded and Depression Anxiety and Stress Scale (DASS-21) and Psychological Well-Being Scale (PWB) were administered. Descriptive and inferential statistical methods including generalized estimator equations with autoregressive correlation structure were applied in SPSS V24.

In experimental group, the mean scores for depression, anxiety, and stress significantly changed after the intervention (P=0.001). In this group, the post-intervention mean score for well-being also significantly improved (P=0.006). Compared with the experimental group, the control group was not found with any significant changes in depression, anxiety, stress, and well-being.

Mindfulness-based metacognitive skills may improve depression, anxiety, stress, and sense of well-being in patients with systemic lupus erythematosus.

Ongoing measurement of quality of life especially in patients with chronic diseases، maybe the basis of health care evaluation. This study aimed to assess and identify factors affecting quality of life in hemodialysis patients in Kermanshah city.

This is a cross sectional study carried on 98 cases of hemodialysis patients referred to two of teaching hospitals (Imam Khomeini and Imam Reza affiliated to Kermanshah University of Medical Sciences. Available sampling applied to patients who started dialysis at least three months before. Demographic data collected and SF-36 questionnaire of quality of life performed which its validity and reliability has been confirmed previously in Iran.

The physical health score decreased with increasing age (P<0. 05) and increased with increasing education level (P<0. 005). In addition، physical health in those who did not exercise any time were less than the other (P<0. 001). Overall mental health scores increased with increasing education level (P<0. 001) and increasing household income was associated with increasing mental health score (P<0. 05). The overall score of mental health for those who had always exercised was more than the others and for those who did not exercise any time was less than (P<0. 001). The overall score of mental health in people who had dialysis twice a week was the highest (P<0. 05).

Considering the impact of physical activity and socioeconomic status on patients'' quality of life accounting، these factors in order to promoting the quality of life will be effective.