parvin sarbakhsh

Adequate physical activity is essential to healthy aging. This study aimed to examine the construct validity of the Persian version of the Physical Activity Scale for the Elderly (PASE) among community-dwelling adults, which would be used as a screening tool at the Neyshabur longitudinal study on the aging (NELSA) Center.

This cross-sectional study was conducted in Neyshabur, Iran, as a pilot phase at the NELSA center between May and January 2019. The sampling method was a stratified random method. For explanatory factor analysis (EFA) and confirmatory factor analysis (CFA), 300 and 650 community-dwelling adults aged 50 and older were selected, respectively. EFA was used with the principal component extraction method, and Varimax rotation and CFA were performed with the maximum likelihood estimation method.

Of the 950 participants, 445 (46.8%) were male, and 505 (53.2%) were female. The mean age of participants was 63 ± 8.6 years. The mean physical activity score was 89.7 ± 70.7. According to the percentage of variance explained in EFA, all five extracted factors explained 62.7% of the total variance. The results of CFA showed that all item-scale relationships were significant (P < 0.05), except for household activity (Q8) and leisure time activity (Q2) (P > 0.05). The values of the fit indices showed that the model fits well with the data.

The EFA and CFA confirmed the construct validity of the Persian version of PASE. This questionnaire is suitable for measuring the physical activity level of older Persian adults.

Understanding the complex interplay of faculty members’ personality traits is essential for optimizing teaching and learning environments. To this end, this study investigated and prioritized the impact of personality dimensions (personal, scientific, and professional) related to the teaching of faculty members on the learning of students.

The current study was conducted with a practical purpose using a meta-synthesis coding method, specifically theme analysis. This method discovers new and fundamental topics and metaphors by providing a systematic approach for researchers through the combination of different studies, expands the current knowledge, and provides a comprehensive view of the issues.

Out of a total 114 articles , number of 85 codes, 10 concepts and 3 components were identified concerning the personality dimensions of university professors. Based on the findings, the codes of “teaching skills”, “research skills”, “interactive ability”, and “individual ability” were the most frequent components of the personality dimensions of faculty members.

According to the findings, universities should pay special attention to academic mastery, eloquence, and interest in teaching when recruiting faculty members. Additionally, it is important to plan and organize teaching empowerment workshops for them. This leads to more satisfaction among students and improves the quality of teaching and learning. Therefore, the findings of this study can be used in the policymaking of ministries and universities when recruiting faculty members.

Diagnostic thinking and clinical competence are the two main domains of efficient nursing care. This study assessed the association between diagnostic thinking and clinical competence among emergency nurses.

The present correlation study was conducted in 2020 on 113 nurses working in emergency departments in a northwestern province of Iran over two consecutive years. A stratified random sampling method was used for recruiting nurses. Data was gathered via a demographic questionnaire, the Diagnostic Thinking Inventory, and the Nurse Competence Scale and analyzed using the SPSS 18 software. Pearson's correlation assessed the association between the nurses' diagnostic thinking and clinical competence at a significance level of 0.05.

According to the findings, the nurses’ diagnostic thinking abilities were poor (154.15 ±15.73, range of 150-155), while their clinical competence was good (61.62±18.97, range of 51-75). Significant correlations emerged between thinking flexibility, work role (r=0.22, p=0.017), and memory structure. In addition, thinking flexibility was significantly associated with work role (r=0.22, P=0.017), and memory structure was correlated with teaching-coaching function (r=0.22, P=0.015), diagnostic functions (r=0.25, P=0.006), management of situations (r=0.45, P=0.0001), therapeutic interventions (r=0.42, P=0.0001), regimens (r=0.18, P=0.056), and work role (r=0.4, P=0.0001).

Amplifying thinking procedures and using diagnostic thinking patterns enhance emergency nurses' practice, performance, and clinical competence and promote nursing care. Lecturers and planners must employ modern educational methods to increase nurses' thinking skills and clinical competence.

Adverse events of COVID-19 Vaccination in children are somewhat unknown, and limited population-based studies have been carried out in this age group. This study aims to determine the short-term Sinopharm and Soberana (PastoCoVac) vaccination adverse events in 5- to 12-year-old children. This study is an observational study with a control group. The cluster sampling method by considering health care centers and mass vaccination centers of Tabriz as clusters were used to recruit the study samples with a ratio of 2:1 for the vaccinated and unvaccinated groups, respectively. Information was collected by telephone calls and interviews with their parents. Data were analyzed by using a mixed-effect logistic regression model. In this study, 577 (63.2%) vaccinated and 336 (36.8%) unvaccinated children were investigated. Results demonstrated that the most frequent complication among vaccinated children was injection site pain (399 (69.2%, CI 95%: 65.2% to 72.9%)). The most frequently reported systemic adverse events among vaccinated versus unvaccinated children were fever (9.0% vs. 3.6% (0.003)), fatigue (5.5% vs. 0.9% (0.002)), and headache (2.9% vs. 0.6% (0.032)). No serious adverse events including myocarditis, multisystem inflammatory syndrome (MIS), and hospitalization were reported. The odds of having any symptoms in the vaccinated group adjusted for confounders were significantly higher than in the control group (adjusted OR=4.71, CI 95%: (3.04, 7.26), p-value<.001). According to the results, it can be concluded that Sinopharm and PastoCoVac vaccines did not have serious side effects. Also, it seems that some of the reported adverse events in other studies are overestimated due to the lack of a control group.

Emergency department nurses should be trained people with high knowledge, skills, innovativeness, and ablity to judge and make decisions in critical clinical situations. This study aims to determine clinical reasoning level and its relationship with innovation in nurses working in the emergency departments of hospitals in Tabriz, Iran.

In this descriptive-correlational study conducted in autumn 2021, 170 nurses working in all emergency departments of hospitals in Tabriz city were included by stratified random sampling method. Data were collected using Liou et al.’s clinical reasoning scale and the Hurt-Joseph-Cook innovativeness Scale. The data analysis was done using Pearson correlation test, t-test, ANOVA, and linear regression analysis in SPSS software, version 26.

The mean age of participants was 34.54±6.97; most of them were female (56.5%) and married (69.4%) with permament employment (56.5%). The mean scores of clinical reasoning and innovation were 60.91±7.079 (Ranged 15-75), and 102.11±10.26 (Ranged 20-140), respectively. The results showed a significant relationship between clinical reasoning and innovation (P<0.001). After adjusting the effects of confounding variables, for every one unit increase in clinical reasoning score, the innovation score increased by 0.35 units.

There is a significant relationship between clinical reasoning and innovation in emergency department nurses. Nursing professors should provide the ground for learning and strengthening these two important concepts in nursing students.

 Percutaneous Coronary Intervention (PCI) is a fundamental procedure for coronary artery disease management, yet the risk of adverse events such periprocedural myocardial injury (PMI) persists. This double-blind, randomized clinical trial aims to assess the efficacy of empagliflozin in preventing myocardial injury during PCI procedure.

 A total of 90 patients were randomly assigned to two groups A and B; Group A as the intervention group received empagliflozin 25 mg 24 hours before and empagliflozin 10 mg 1-2 hours before coronary intervention and group Bas the control group received placebo at similar intervals. The primary outcome involved comparing baseline, 8-hour, and 24-hour cTnI and baseline and 24-hour hs-CRP levels after PCI in both groups to measure the incidence of periprocedural myocardial injury (PMI) and anti-inflammatory effects of empagliflozin.

 Baseline cTnI levels with P=0.955, 8 hours after PCI with P=0.469, and 24 hours after the intervention with P=0.980 were not statistically different in the two groups. Baseline levels of hs-CRP in both intervention and control groups were not statistically significantly different (P=0.982). Also, there was no statistically significant difference in hs-CRP levels 24 hours after PCI in two groups (P=0.198). Finally, the results showed that MACEs did not occur in any of the groups.

 The results of this trial could not express the advantages of acute pretreatment with empagliflozin in preventing PCI-related myocardial injury.

 Pentoxifylline has anti-inflammatory effects in end stage renal disease (ESRD) patients and may play an important role in reducing inflammatory factors and improving quality of life (QoL) in hemodialysis (HD) patients.

 In this randomized placebo-controlled trial 88 chronic hemodialysis patients were divided into two groups with equal numbers. Intervention group received tablet pentoxifylline 400 milligrams and control group received the matching placebo, daily for 3 months. At baseline and after 3 months, inflammatory factors including serum levels of tumor necrosis factor-alpha (TNF-a) and C-reactive protein (CRP) were measured. Also, the Medical Outcome Study 36-Item Short-Form Health Survey (SF-36) quality of life (QoL) questionnaire was completed by each patient at the beginning and end of the study.

 Significant reduction in serum levels of TNF-a, CRP as well as substantial improvement of all dimensions of QoL were observed in intervention group after 3 months of pentoxifylline treatment (P = 0.04; P <0.001, P <0.05 respectively). Between groups comparison showed marked reduction in inflammatory markers including TNF-a and CRP in recipients of pentoxifylline than control group at the end of the study (P = 0.003 for both). In addition to dimensions of physical component score (PCS), mental component score (MCS) and overall score of QoL showed significant improvement in the pentoxifylline group compared to the placebo group at month 3 of the study (P = 0.003; P = 0.027, P = 0.002 respectively).

 Use of pentoxifylline in HD patients illustrated positive effects on inflammation and health-related QoL.

 High power laser therapy (HPLT) seems to be a new modality to possibly manage rotator cuff tendinitis.The purpose of this study was to investigate the effects of HPLT on clinical and sonographic findings in people with chronic rotator cuff tendinitis.

 Thirty-two people suffering from rotator cuff tendinitis participated in this study. The patients  were  randomly assigned to the control group (n=16) that received routine physiotherapy including Transcutaneous electrical nerve stimulation (TENS), ultrasound, hot pack, exercise consisting range of motion, pendulum, strengthening, and stability exercises, or the treatment group (n=16) that received routine physiotherapy and HPLT in the painful area of the shoulder (12 sessions) Clinical and functional findings including pain, shoulder range of motion, shoulder disability, and sub-acromial liquid were measured using the visual analog scale, goniometry, questionnaire, and sonography, respectively before and after treatment.

 Pain, active and passive range of motion, shoulder disability and sub-acromial fluid accumulation were significantly different in both groups and improved, but no difference was reported in the thickness of the rotator cuff tendon, especially the supraspinatus tendon. The improvement was more significant (pain reduction and sub-acromial liquid, increase in range of motion and level of function) in the treatment group than in the control group (P <0.05).

 HPLT combined with the routine physiotherapy improve the clinical as well as sonography findings including supraspinatus tendon thickness and accumulation of sub-acromial fluid in people with rotator cuff tendinitis compared with those in the control group.

Frailty syndrome significantly impacts the health of older adults, and sleep quality is likely a pertinent clinical factor. Therefore, this study aims to investigate the relationship between sleep quality and sleep duration with frailty syndrome in the older adults of Naqadeh City.

This cross-sectional study enrolled 347 older adults aged 60 years and above in Naqadeh city in 2020 using 2-stage sampling (first, stratified, and then simple random sampling. Data collection tools included demographic questionnaires, the Edmonton Frail Scale, and the Pittsburgh Sleep Quality Index. Statistical analysis was performed using SPSS25 software.

The study revealed that 30.3% of older adults were frail. Furthermore, a statistically significant correlation was observed between sleep quality and duration with older adults' frailty (r=0.635, p<0.001 and r=-0.170, p<0.001, respectively). Additionally, all frailty domains exhibited a significant relationship with sleep quality, with the most notable associations found in mood, medication use, and cognition domains (r = 0.487, r = 0.397, r = 0.381, respectively).

Probably, the quality and duration of sleep affect the frailty syndrome, so it is necessary to design and implement effective interventions to improve the quality of sleep and ultimately reduce the frailty of older adults, especially in the domains of cognition and mood.

Evaluation of the alignment of the trunk and lower limbs in people with forward head posture (FHP)assumes critical importance due to biomechanical connection. The present study aimed to assess the reliability of trunk, pelvis, and lower limb posture assessment in people with FHP by the photogrammetric method.

This observational study was conducted on 60 male and female participants, 32 with FHP and 28 without FHP, from students of Tabriz University of Medical Sciences. The mean age of participants was 23.30±2.66 years. A craniovertebral angle of 48 degrees or less is known as FHP. To evaluate intratester reliability, postural evaluation was repeated one week apart by the first examiner and one hour apart by the second examiner to assess intertester reliability. The measured angles included vertical and lateral alignment of the body, vertical alignment of the trunk and lower limbs, the horizontal alignment of the pelvis, as well as the angle of the hip and ankle joints.

The results of the intraclass correlation coefficient based on Munro's scale demonstrated that in the FHP group, the vertical straight angle of the body had the lowest (0.73), and the hip joint angle had the highest intertester reliability coefficient (0.96). Considering intertester reliability in the FHP group, the lower limb alignment was the lowest (0.88), and the hip joint angle had the highest reliability coefficient (0.97).

The evaluation of trunk and lower limb posture in people with FHP by photogrammetry can be used as a quantitative method with high reliability

Stroke, as the primary and most critical cerebrovascular condition, is known as a leading cause of disability and mortality. Timely and appropriate care plays an important role in reducing death and associated complications. The purpose of this research is to assess the knowledge and adherence of emergency nurses to tissue plasminogen activator guidelines for patients with stroke.

Methods & Materials:

In this descriptive study, a random quota sampling method was employed to select participants. A total of 170 emergency department nurses in Tabriz hospitals in 2023 self-administered knowledge and adherence scales. Data were analyzed using SPSS version 26, employing t-test, one-way ANOVA and Pearson’s correlation coefficient.

The mean (SD) age of the nurses was 34.24±6.57 years, with a majority (101 nurses, 59.4%) having completed courses on the process and activation of Code-724. The mean scores for nurses' knowledge and adherence to tissue plasminogen activator guidelines were 52.67±10.37 (range score: 0-100) and 68.14±5.18 (range score: 15-75), respectively. A positive yet weak relationship was observed between nurses' knowledge and adherence to the guidelines (r=0.263, P=0.332). No significant association was found between nurses' socio-demographic characteristics and their knowledge and adherence scores (P>0.05).

The findings revealed suboptimal scores in nurses' knowledge and adherence to tissue plasminogen activator guidelines for stroke patients. Given the importance of adequate knowledge for adherence to guidelines, it is suggested to implement essential training and supervision measures for nurses.

Acknowledging the considerable influence of undernutrition on health outcomes and HRQOL, this study sought to appraise the nutritional risk status of elderly patients with cardiovascular diseases (CVD) through the utilization of the Nutritional Risk Screening (NRS). Additionally, the investigation aimed to evaluate the correlation between NRS status and HRQOL within the context of patients referred to a cardiac hospital in Tabriz, Iran.

This cross-sectional study was conducted in Tabriz, Iran. The participants were selected randomly from patients referring to Shahid Madani Heart Hospital, a comprehensive university hospital during July to December 2018. A linear regression was used for control of confounding variables (age, gender, education level, marital status, and income levels) and predict the relationship between nutrition risk status and HQRL.

Of the 200 patients with CVD participated in this study, 68 (34%) of participants had normal nutrition status, 108 (54%) were at risk for undernutrition, and 24 (12%) had undernutrition. A total of 24 aging patients with undernutrition, 13 (54%) were divorced or widowed. 86% of patients with diabetes were at risk for undernutrition and 13.9% had undernutrition. There were statistically significant relationship between undernutrition and HRQOL dimensions, age, gender, and marital status.

The study revealed a correlation between elevated undernutrition scores in patients and factors such as older age, female gender, and marital status of being divorced or widowed. Furthermore, the results imply that a notable elevation in the risk score for undernutrition in patients is significantly linked to impaired HRQOL among elderly individuals with CVD.

 Although most countries have long used female staff for prehospital emergency medical services (EMS), this is quite a recent development for the Iranian health system. It is hence necessary to analyze the perspectives of its recipients about the feasibility of assigning female staff to prehospital EMS to improve this service and compare it with other countries. This study aimed to design and evaluate the psychometric properties of a scale for assessing the feasibility of using female staff in prehospital EMS.

This was a methodological study. The literature was reviewed to develop items for the scale. The scale's content validity index (CVI) was then evaluated based on expert opinions, and its face validity was examined by eliciting comments from the target group and experts. Following that, 456 EMS recipients from East Azerbaijan Province, Iran, completed the electronic version of the scale. Finally, the construct validity and reliability of this scale were determined using exploratory factor analysis (EFA) and internal consistency (Cronbach's alpha), respectively.  

 The findings confirmed the scale's high content validity and internal consistency, as well as its acceptable face validity. The EFA findings also revealed three factors, all of which were based on primary domains: the need for engagement (17 items), groundwork (14 items), and staffing (9 items).

 The study's findings suggested that the intended scale's design and psychometric properties were appropriate for Iranian culture. Therefore, it can be used to examine public opinion before, during, and after the inclusion of female personnel in prehospital EMS.

Using personal protective equipment, including masks, is one of the most important ways to prevent coronavirus disease 2019 (COVID-19). The aim of this study was to estimate the prevalence and pattern of mask use and its association with COVID-19-related morbidity and mortality in different areas of Tabriz, Iran.

In this population-based study, 6,600 pedestrians were selected by multi-stage proportional sampling method in nine areas of Tabriz in 2021. The data was collected using the observation method. For each participant, we recorded gender, approximate age, mask usage, type of mask, and correct or incorrect use. The data of COVID-19-related morbidity and mortality for six months (from 21 March 2021 to 22 September 2021) were obtained from the Integrated Syndromic Surveillance System (ISSS).

The overall prevalence of facial mask use was 56.8% (95% CI: 55.56 – 57.95). Out of 3,421 men, 1,599 (46.7%; 95% CI: 45.1-48.4) and out of 3,179 women, 2,147 (67.5%; 95% CI: 65.9-69.2) were used face mask (P<0.001). The correlations between mask use and morbidity (r=0.375, P=0.320) and mortality (r=0.219, P=0.571) rates were not statistically significant.

The percentage of using face masks in Tabriz was relatively low, especially among males and young people. Also, there was no significant relationship between COVID-19 morbidity and mortality and mask use.

Practical Implications:

The results of the present study showed that the percentage of mask use in men and the youth was relatively low. In times of disease epidemics, it is necessary to create the necessary sensitivity in these groups and to carry out the necessary training and interventions to increase the use of masks and protective measures.

 Pattern recognition of pedestrians’ traffic behavior can enhance the management efficiency of interested groups by targeting access to them and facilitating planning via more specific surveys. This study aimed to evaluate the pedestrians’ traffic behavior pattern by fuzzy clustering algorithm and assess the factors related to higher-risk traffic behavior of pedestrians.

Study Design: 

This study is a secondary methodological study based on the data from a cross-sectional study.

 The fuzzy c-means (FCM), as a machine learning clustering method, was conducted to identify the pattern of traffic behaviors by collecting data from 600 pedestrians in Urmia, Iran via “the Pedestrian Behavior Questionnaire” (PBQ) and using 5 domains of PBQ. Multiple logistic regression was fitted to identify risk factors of traffic behaviors.

 Results revealed two clusters consisting of lower-risk and higher-risk behaviors. The majority of pedestrians (64.33%) were in the lower-risk cluster. Subjects≤33 years old (Odds ratio [OR]=1.92, P<0.001), subjects with≤6 years of education (OR=1.74, P=0.010), males (OR=1.90, P=0.001), unmarried pedestrians (OR=3.61, P=0.007), and users of public transportation (OR=2.01, P=0.002) were more likely to have higher-risk traffic behavior.

We identified traffic behavior patterns of Urmia pedestrians with lower-risk and higher-risk behaviors via FCM. The findings from this study would be helpful for policymakers to promote safety measures and train pedestrians.

The aim of the study is to evaluate the effect of metformin in complication improvement of hospitalized patients with COVID-19.

This was a randomized clinical trial that involved 189 patients with confirmed COVID-19 infection. Patients in the intervention group received metformin-500 mg twice daily. Patients who received metformin before admission were excluded from the control group. Patients who were discharged before taking at least 2000 mg of metformin were excluded from the study. Primary outcomes were vital signs, need for ICU admission, need for intubation, and mortality.

Data showed that patients with diabetes with previous metformin in their regimen had lower percentages of ICU admission and death in comparison with patients without diabetes (11.3% vs. 26.1% (P = 0.014) and 4.9% vs. 23.9% (P ≤ 0.001), respectively). Admission time characteristics were the same for both groups except for diabetes and hyperlipidemia, which were significantly different between the two groups. Observations of naproxen consumption on endpoints, duration of hospitalization, and the levels of spO2 did not show any significant differences between the intervention and the control group. The adjusted OR for intubation in the intervention group versus the control group was 0.21 [95% CI, 0.04-0.99 (P = 0.047)].

In this trial, metformin consumption had no effect on mortality and ICU admission rates in non-diabetic patients. However, metformin improved COVID-19 complications in diabetic patients who had been receiving metformin prior to COVID-19 infection, and it significantly lowered the intubation rates.

Substance abuse has significant health impacts on families and society as a whole. We aimed to provide detailed prevalence estimates of substance abuse among the Azar Cohort Study respondents in Tabriz, Iran.

Data on 15 006 participants of Azar Cohort Study were analyzed. The variables included tobacco smoking, alcohol use, drug abuse, and socio-demographic characteristics. The prevalence of substance abuse (with a 95% confidence interval) was calculated using the direct standardization method.

Overall, 9.3% and 6.2% of the participants were regular and heavy cigarette smokers, respectively. Also, 1.9% and 2.1% of participants reported a history of using illicit drugs and alcohol, respectively. Substance abuse was more prevalent among males than females. Substance abuse varied significantly with age and socioeconomic variables.

We identified specific demographic and socioeconomic groups with a higher prevalence of all studied behaviors. Such high-risk groups should be targeted when designing substance abuse prevention programs.

Effective clinical care and identifying susceptibility to COVID-19-related mortality requires rapid recognition of risk factors and their relations with disease outcomes. This study aimed to cluster and identify various subgroups of COVID-19 patients and examine the relationship between these subgroups and the causes of death.

This retrospective study assessed the risk factors contributing to COVID-19 patients’ death (n = 128) by evaluating deceased patients’ demographic, clinical, and laboratory features and clustering various subgroups of individuals to investigate any correlation.

The mean age of deceived patients was 69.7 years, and the majority of them were male (65.6%). The levels of blood urea nitrogen, creatinine, alkaline phosphatase, erythrocyte sedimentation rate, lactate dehydrogenase, and C-reactive protein were high at admission and increased during the hospitalization. Shortness of breath (68%) and cough (62.5%) were the most common symptoms, and hypertension (50.8%) was the most common comorbidity among deceased patients. The clustering quality based on the underlying disease and symptoms was not acceptable. However, clustering based on vital signs showed significant differences in body temperature, pulse rate, respiratory rate and oxygen saturation (P<0.001). Furthermore, disseminated intravascular coagulation (DIC) was significantly higher in patients with weaker vital signs than those with better vital signs (15.36% vs. 0.0% P = 0.002).

Older age, male sex, hypertension, and high inflammatory markers might be the risk factors for COVID-19-related mortality. Furthermore, considering that patients with poor vital signs were susceptible to develop DIC, prevention of these consequences might be helpful in COVID-19 management.

We evaluated the Persian version of the pediatric constipation score-parent report (PCS) validity and reliability.

Functional constipation in children results in physical and psychological problems. Therefore, it is necessary to utilize a questionnaire to assess the health-related quality of life in children with chronic constipation.

First, our team translated the English version of the questionnaire into the Persian language. Second, the psychometric properties of the Persian version were collected in 149 children with functional constipation referred to a pediatrics hospital by an expert team. We assessed content validity (CV) through the CV index (CVI) and CV ratio (CVR). The construct validity was evaluated by exploratory factor analysis, and reproducibility was tested based on test-retest reliability using the intra-class correlation coefficient (ICC). Internal consistency was calculatedusing Cronbach's α. we also evaluated the ceiling or floor.

Results showed acceptable CVI in relevancy, clarity, and simplicity, acceptable CVR for all items, moderate internalconsistency (Cronbach's alpha=0.548), and almost perfect reproducibility (ICC=0.93). No ceiling or floor effect was seen.

The Persian version of PCS showed good validity and reliability in children with functional constipation in Iran. Therefore, we can use it in clinical and research domains in Persian-speaking countries.

Insulin resistance has been suggested as one of the known metabolic disorders during cachexia. This study hypothesized that cachexia in cancer patients might be related to insulin resistance as early as cachexia development.

This study was performed on 46 patients with metastatic gastrointestinal cancer. Anthropometric characteristics and biochemical markers were assessed at baseline, second and third month. Insulin resistance was assessed using the homeostasis model assessment-estimated insulin resistance (HOMA IR) method. SFQ-36 questions were used to assess the patients' quality of life at baseline, second and third months.

Anthropometric characteristic was significantly associated between pre-cachectic and non-pre-cachectic patients in third month. Cholesterol (P-value = 0.93), albumin (P-value: 0.82), and serum creatinine (P-value = 0.88) in pre-cachectic patients decreased over three months. There was an increasing trend of insulin resistance between pre-cachectic and non-pre-cachectic patients in third month. Cholesterol had an upward trend with a significant relation in cachectic patients [(P-value = 0.00), (P-value = 0.03), (P-value = 0.01)]. We detected a decreasing trend of insulin resistance between cachectic and non-cachectic patients from second to third month (P-value = 0.04). SFQ evaluation had no significant relation with cachectic status.

Previous studies showed that the use of NSAIDs, progesterone’s, corticosteroids, COX-2 inhibitors, anabolic agents and drugs targeting inflammatory cytokines may be beneficial for improving of symptoms of cachexia. Significant relation between anthropometric variables with pre-cachexia and cachectic conditions was concluded. Patients' outcome and its relation with insulin resistance demonstrated a significant relation between the cachectic and non-cachectic patients in the third month. We also detected the increased serum cholesterol level in cachectic patients, moreover, higher cholesterol levels in expired cachectic patients than in the living.

Varicella-Zoster virus (VZV) is the causative agent of herpes zoster, or "shingles." Most cases of acute herpes zoster are self-limiting, although the pain can cause significant suffering, and experience postherpetic neuralgia (PHN), particularly in older adults. Early treatment of herpetic neuralgia in the subacute phase may prevent PHN progression. This study aimed to evaluate the efficacy of memantine in the treatment of subacute neuropathic herpes zoster. 

This randomized clinical trial was performed on sixteen patients aged 18-75 years with subacute herpetic neuralgia. Patients were randomly assigned to the intervention or control group according to the inclusion and exclusion criteria (8 in each group). The duration of the study was eight weeks. Patients in the memantine group received Gabapentin 300 mg per day and memantine 5 mg twice a day. Then, after one week, the memantine dose was tapered up to 10 mg twice a day. In the control group, patients received only Gabapentin from the first week to the end of the study. DN4 questionnaire is used to measure the severity of nerve pain. The patients of both control and intervention groups completed the questionnaire before starting the treatment and it was done again after the end of the treatment period (8 weeks).

The results showed improvement in pain in patients who received Memantine along with Gabapentin in comparison with Gabapentin alone (P =0.001). Moreover, the DN4 questionnaire score evaluation indicated a significant difference only for the intervention group's Q1 variable in within-group analysis (P =0.031).

Co-administration of memantine with Gabapentin reduced the severity of subacute neuropathic herpes. In addition, memantine is expected to be a viable option for treating and relieving subacute and chronic nerve pain in patients.

 Neonatal respiratory distress syndrome (NRDS) affects approximately up to 7% of all term newborns. This study aimed to assess the efficacy and safety of investigational beractant (BeraksurfTM, Tekzima Company) in comparison with poractant alfa (Curosurf®, Chiesi Pharmaceuticals) as surfactant replacement therapy in NRDS.

 This trial was a randomized, controlled, single-blind, phase III study of two natural surfactants which was conducted in NICU of Alzahra hospital in Tabriz for 8 months. 220 infants were enrolled in 2 groups to receive either 100 mg/kg BeraksurfTM or 200 mg/kg Curosurf® as an initial dose endotracheally. Additional doses were given if needed. Infants’ gestational age, birth weight, discharge weight and other demographic information were recorded. Efficacy outcomes were changes in fraction of inspired oxygen (FiO2) and the number of infants who reached FiO2 less than 0.3 (treatment success rate) which were compared between both groups with analysis of covariance (ANCOVA).

 The results showed that the treatment success rate was 92% and 72% in BeraksurfTM and Curosurf® groups, respectively (P-value< 0.001). In addition, no difference was observed in the efficacy of these two treatments in terms of binary outcomes and incidence of complications such as mortality.

 The result analysis of current study implies BeraksurfTM has same beneficial impact on clinical management of RDS as Curosurf® among infants below 32 weeks. However, larger studies are needed to evaluate further efficacy and safety outcomes of this surfactant in comparison with the reference products in other subgroups.

In recent decades, significant increases in the prevalence of obesity in developing and developed countries suggest that obesity is a complex health problem. Environmental factors such as lack of physical activity, excessive TV watching and sedentary lifestyle, consumption of high-calorie foods and side effects of various drugs can cause overweight and obesity. Obesity is associated with severe health problems such as diabetes, hypertension, hyperlipidemia, asthma, arthritis and decreased life expectancy. Obesity includes profound effects on people's mental health. This study assessed relationships between anthropometric indices and perceived stress levels in working women.

After ethics committee approval from Iran University of Medical Sciences, Tehran, Iran, 395 healthy women between 20 and 50 years old participated in the study. Women who worked at Iran University of Medical Sciences completed questionnaires including general information and assessment of the participants’ statuses of eating behaviors. Anthropometric variables, including height, weight, body fat percentage and waist and hip circumferences, were measured and body mass index and waist-to-hip ratio were calculated. Then, each participant completed questionnaires of perceived stress, 24-h food recall and physical activity.                                                                                                                                                                      

Anthropometric indices (weight, height, body mass index, waist circumference and hip circumference) were reported lower in people who ate breakfast than those who did not. Waist-to-hip ratio was lower in those with a slower eating speed than those of the fast group (p = 0.034). Weight, body mass index and body fat percentage were significantly higher in those eating during screen watch. No significant relationships were reported between the eating behaviors (speed rate, breakfast or not eating breakfast and eating with or without screen watch) and perceived stress levels. Anthropometric indices increased with increasing food intakes (p < 0.001) and decreasing physical activities, while no relationships were reported between dietary intakes and physical activities with perceived stress levels.

Dietary behaviors and physical activities affect anthropometric indices, while perceived stress levels do not affect dietary behaviors or anthropometric indices.

 
Many nurses are uncertain when making clinical decisions, and this can lead to burnout and professional dissatisfaction. However, no study has addressed facilitators of uncertainty in clinical decision-making among Iranian nurses.
 
This study aimed to explore Iranian nurses' experiences of facilitators of uncertainty in decision-making.
 
This qualitative content analysis study was conducted from June to December 2020. Participants were 17 nurses with bachelor's or higher degrees who were purposively recruited from three hospitals affiliated with Tabriz University of Medical Sciences. Data were collected through semi-structured interviews and analyzed through a content analysis method.
 
Participants' experiences were categorized into three main categories, namely, an unconfident nurse, complex situations, and unclear guidelines and policies. Each category included three to four subcategories.
 
Nurses may experience uncertainty in clinical decision-making when confronted with ambiguous clinical situations or lack sufficient decision-making skills. Nurse leaders are suggested to develop educational programs and support interventions to promote nurses' decision-making skills and help them manage ambiguous situations.

It is of utmost importance to identify populations with the elevated risk for Covid-19 and the factors influencing its outcomes. The present study aimed to investigate the factors affecting mortality and length of stay (LOS) in the hospitals of East Azerbaijan Province, Iran, during a 15 months period of this pandemic. Study design: A retrospective study.

This retrospective study was conducted by using data on ISSS (integrated syndromic surveillance system) on the patients admitted to the hospitals from February 21, 2020, to April 11, 2021. The association of variable of interest on death and LOS was investigated via multiple logistic regression and multiple linear regression.

In total, 24,293 inpatients with the mean age of 53.99±19.37 years old were included in this study. About 15% of patients lost their lives. The mean age of the deceased patients was 69.02±14.64 years old and significantly higher than the recovered ones (p<0.001). Aging, male gender and having chronic diseases were correlated with the patient mortality. In addition,   aging and having chronic diseases were associated with higher LOS in hospitals.

The older patients were at a higher risk of mortality and even prolonged hospitalization. In addition, patients’ underlying diseases could cause a severe form of COVID-19 and these individuals were more likely to lose their lives and stay in hospitals for a longer time due to COVID-19.