Relationship between effort-reward imbalance, job satisfaction, and intention to leave the profession among the medical staff of Qom University of Medical Sciences

Objective: The effort–reward imbalance(ERI) model claims that work that has the characteristics of high effort and low reward has a mutual defect between input and output and this imbalance may result in sustained and long-lasting results. This study aimed to investigate the relationship between the intention to leave the profession(ILP) and ERI and job satisfaction among the medical staff in Qom Province.Methods: A descriptive-correlative study was conducted on 202 medical staff in Qom Province based on random sampling in 2018. Demographics checklist, standard ILP, job satisfaction, and Siegrist’s ERI questionnaires were used for data collection. The chisquared test, independent t-test, and one-way Analyses of Variance(ANOVA) were used to analyze data.Results: The mean age of employees was 32.04 ± 7.9 years, and 165(87.1%) of the employees were women. The results showed that the medical staff was willing to leave their profession at a moderate level(40.7 ± 10.3). There was no significant relationship between demographics and ILP. Nevertheless, a significant and inverse relationship was observed between ERI(r:0.318, P < 0.01) and ILP(r: 0.197, P < 0.01). Leave the profession(LP) had a negative correlation with the dimensions of job descriptive index(JDI) such as job, manager, coworker and wage score(P < 0.01, r:-0.147, r:-0.262, r:-0.292, r:-0.271, r:-0.396).Conclusions: According to the results, managers need to make sure that their working staff is rewarded as they deserve. According to the results, managers need to ensure that the reward factor is observed for the staff, while an ERI imbalance may contribute to ILP of the staff. On the other hand, it leads to job satisfaction.

Neuroprotective potential of traditional Ayurvedic Kadha:age-related neurological disorders:a comprehensive literature review

Despite modern medicine’s advancements,age-related neurological diseases like Alzheimer’s disease and Parkinson’s disease remain challenging due to high costs,side effects,and limited accessibility.Ayurveda,a traditional Indian medicine system,offers Kadha tea as a potential herbal option.This review explores Kadha’s components(basil(Ocimum basilicum L.),black pepper(Piper nigrum L.),Cinnamon(Cinnamomum verum J.Presl),ginger(Zingiber officinale Roscoe),and raisin(Vitis vinifera L.))and their interaction with various neurological disorders.Studies suggest Kadha exhibits anti-inflammatory,antioxidant,and antiviral properties,potentially impacting Alzheimer’s disease,Parkinson’s disease,neurotoxicity,neuroinflammation,and brain trauma.By focusing on specific disease mechanisms and Kadha’s intergrade effects,this review aims to elucidate its potential role in managing age-related neurological disorders.

Spatiotemporal analysis,hotspot mapping,and clustering of confirmed cases of COVID-19 in the initial phase of the pandemic in Qom province,Iran

Objective:To identify the incidence rate,relative risk,hotspot regions and incidence trend of COVID-19 in Qom province,northwest part of Iran in the first stage of the pandemic.Methods:The study included 1125 officially reported PCR-confirmed cases of COVID-19 from 20 February 2020 to 20 April 2020 in 90 regions in Qom city,Iran.The Bayesian hierarchical spatial model was used to model the relative risk of COVID-19 in Qom city,and the segmented regression model was used to estimate the trend of COVID-19 incidence rate.The Poisson distribution was applied for the observed number of COVID-19,and independent Gamma prior was used for inference on log-relative risk parameters of the model.Results:The total incidence rate of COVID-19 was estimated at 89.5 per 100000 persons in Qom city(95%CI:84.3,95.1).According to the results of the Bayesian hierarchical spatial model and posterior probabilities,43.33%of the regions in Qom city have relative risk greater than 1;however,only 11.11%of them were significantly greater than 1.Based on Geographic Information Systems(GIS)spatial analysis,10 spatial clusters were detected as active and emerging hotspot areas in the south and central parts of the city.The downward trend was estimated 10 days after the reporting of the first case(February 7,2020);however,the incidence rate was decreased by an average of 4.24%per day(95%CI:−10.7,−3.5).Conclusions:Spatial clusters with high incidence rates of COVID-19 in Qom city were in the south and central regions due to the high population density.The GIS could depict the spatial hotspot clusters of COVID-19 for timely surveillance and decision-making as a way to contain the disease.

Fatal case of human rabies infection: A case report

Rationale:Rabies,as an acute viral disease of the mammal’s central nervous system(CNS),with a high mortality rate,is transmitted to humans through the bite of a rabid animals,especially canine and feline.Patient concerns:An Afghan man,aged 50 years was bitten by a fox in a farm around the Qom-Tehran road,Central Iran in 2018.The patient visited the doctor after the bite,however the period between incidence and hospital visit was not established and no indication was given whether the bite site injury was thoroughly washed.The patient was neither referred to the health center for vaccination(post-exposure prophylaxis)nor an effective therapeutic measures was applied.Forty-five days post-exposure,the patient presented with symptoms such as headache,fever,tingling and burning sensation and was referred to the Centers for Disease Control and Prevention(CDC)unit of Qom Provincial Health Center.Diagnosis:Rabies infection.Interventions:Forty-five days after the animal bite,in CDC of Qom Health Center,he received rabies post-exposure prophylaxis treatment and was referred to an infectious diseases physician.Based on the history of animal bites,the patient was classified as probable case of rabies.The clinical symptoms of rabies appeared in patient after hospitalization.Outcomes:Ultimately the patient died in hospital 4 days after hospitalization(50 days after the occurrence of animal bite).After referring the patient to the CDC,the patient’s saliva(0.5-1 mL)was sampled three times every 3-6 hours and tested by PCR.Human rabies was confirmed by Department of Virology in the Pasteur Institute of Iran.Lessons:Physicians and clinicians have responsibilities to be critical in observations and take prompt actions in case of animal bites,as rabies usually develops within 7 to 14 days,and delayed intervention after the onset of symptoms,vaccine and serum injections cannot lead to the survival of the patient.

Maternal death due to severe and critical COVID-19 in Qom,Iran:A case series

Objective:To report the maternal death due to COVID-19.Methods:A total of 14 maternal deaths due to severe and critical COVID-19 who were referred to the obstetric department of Nekouie-Forghani-Hedayati Hospital,Qom,Iran from December 2019 to May 2022 were collected.The clinical manifestations and maternal and perinatal outcomes were analyzed.Results:Dexamethasone was used in 7 cases,while remdesivir was used in 5 cases.Acute respiratory distress syndrome,multiple organ failure,and sepsis were the main cause of mother death.The pregnancy in 8 cases were terminated by caesarean and only one neonatal death was reported from a mother at 13th week of gestational age,while all other fetus delivered were healthy and alive.Conclusions:COVID-19 in pregnancy is an emergency.Critical appraisal is needed to detect the other comorbidities and positive PCR test by throat swap should be performed as soon as possible.

Spatial distribution of sand flies(Diptera: Psychodidae; Larroussius group), the vectors of visceral leishmaniasis in Northwest of Iran

Objective: To determine spatial distribution of sand flies(Diptera: Psychodidae; Larroussius group), the vectors of visceral leishmaniasis in Ardabil province, Northwest of Iran.Methods: Sand flies were collected using sticky traps from the 30 selected points in Ardabil province, during May-November 2017.The MaxEnt model in GIS software was used for modeling.Results: A total of 2 794 specimens of sand flies were collected, of which 33% were Larroussius subgenus sand flies.Phlebotomus kandelakii and Phlebotomus wenyoni were the highest and lowest collected species respectively.Based on the modeling, four areas in the province were identified with more than 70% probability of the presence of Larroussius group vectors which were at risk of visceral leishmaniasis disease transmission.Conclusions: The distribution of Larroussius subgenus sand flies was observed in all parts of Ardabil.But the northern parts of the province(Germi and Bilesavar counties) as well as central part(Ardabil and Meshkinshahr counties) were of great importance in terms of the presence of Larroussius subgenus sand flies and the possibility of transmission of the visceral leishmaniasis.

Design feasibility of gamma camera without collimator based on specific arrangement of the detectors

In gamma camera and single-photon emission computerized tomography, the collimator removes most photons. Here, a gamma camera without collimator utilizes a specific arrangement of detectors. Instead of bending beams(like a lens) or directing beams(by parallel hole collimator), changes are created in detectors' field of view(FOV), so that each detector's FOV looks different from others. Simulation proved this theory, with 98 detectors(2 cm 9 1.41 cm) arranged in a zigzag manner for Monte Carlo simulation. A radioactive source with energy of140 ke V was situated on the detectors' faces. Sixty projections, each 3(0 –179) apart, were simulated by Monte Carlo N-Particle(MCNP) 4C code, rotating detectors around a radioactive point. The band containing the radioactive source is clearly visible in each projection.Counts obtained after simulation in different projections were reconstructed, and point source location emerged correctly. Simulation of gamma camera with zigzag arrangement of detectors and MCNP-4C code demonstrated that one could string the space and determine radioactive source by image reconstruction without using collimators, solely through these special detectors' distribution.

Identification of climatic and environmental factors associated with incidence of cutaneous leishmaniasis in Central Iran using satellite imagery

Objective:To determine the effect of climatic and environmental factors on the incidence of cutaneous leishmaniasis in Qom province in 2018.Methods:In this cross-sectional study,the data on cutaneous leishmaniasis incidence were collected from the Disease Control and Prevention Center in Qom province.Climatic and environmental data including Normalized Difference Vegetation Index(NDVI),Land Surface Temperature(LST),and soil moisture were extracted using satellite images.Data of altitude and sunny hours were provided based on shuttle radar topography mission digital elevation model and hemispherical viewshed algorithm,respectively.The associations of climatic and environmental variables with the incidence of the disease were analyzed by Pearson correlation method.The Arc GIS 10.3 software was used to determine the geographical distribution of these factors.Results:There were positive correlations between cutaneous leishmaniasis incidence and the two climatic factors:LST and sunny hours per day(P=0.041,P=0.016),and it had weak negative correlations with the digital elevation model(P=0.27),soil moisture(P=0.54),and NDVI(P=0.62).The time delay analysis showed that in one-,two-,and three month periods,the correlations increased with a 95%confidence interval.Accordingly,the correlation with the three-month time delay was positive and relatively strong between the cutaneous leishmaniasis incidence and LST and sunny hours(P=0.027,P=0.02);nevertheless,there were negative correlations between the cutaneous leishmaniasis incidence and the soil moisture(P=0.27)and NDVI(P=0.62).Conclusions:As Qom is located in one of the semi-arid climate zones,topography and solar energy are important factors affecting the incidence of cutaneous leishmaniasis in autumn.Therefore,appropriate disease control programs are recommended.

Letter to the Editor: Additional Recommendationsbefore Intubation of COVID-19 Patients

EVER since the first patie nt was diag no sed with co ro no virus disease 2019(COVID-19),many epidemiologic reports tried to present signs日nd symptoms of patients infected with SARS-CoV-2(Severe acute respiratory syndrome coronavirus 2).For instance,in a review article pub-lished by Jiang et al,respiratory symptoms including cough and dysp nea,are the comm on in itial fin dings in such patients after fever.[1]This Very contagious disease involves lower respiratory system and can lead to coronavirus pneumonia and rapidly progressive acute respiratory distress syndrome(ARDS),[2]and if the respiratory failure occurs,patients need intubation and protective mechanical ventilation.

Spatial distribution and infection rate of leishmaniasis vectors(Diptera: Psychodidae) in Ardabil Province, Northwest of Iran

Objective: To determine the spatial distribution and infection rate of sand flies as vectors of Leishmania parasite in Ardabil province, northwest of Iran.Methods: This was a descriptive cross-sectional study. The sand flies were collected from 30 areas in all 10 districts of Ardabil province during 2017. The specimens were caught using the sticky traps. The head and genitalia of sand flies were separated and mounted in Berlese solution for microscopic identification. The Geographical Information System ArcMap10.4.1 software was used to provide the spatial maps. Results: A total of 2 794 sand flies specimens were collected and 22 species of sand flies were identified from the two genera: Phlebotomus and Sergentomyia from Ardabil province. The highest frequency was found in Phlebotomus papatasi(23.7%) followed by Phlebotomus kandelakii(13.0%). The promastigote form of Leishmania infantum parasite has been reported from the three main vectors of visceral leishmaniasis(Phlebotomus kandelakii, Phlebotomus perfiliewi and Phlebotomus tobbi) from Ardabil province, where the spatial distribution map of these visceral leishmaniasis vectors was prepared. Some important species of sand flies such as Phlebotomus kandelakii, Phlebotomus perfiliewi and Phlebotomus tobbi were reported and identified as main and probable vectors of visceral leishmaniasis in Ardabil. Conclusions: According to the Geographic Information System based maps, the frequency of the sand flies as leishmaniasis vectors, the leishmania parasite infection rate and the prevalence of the disease in the central areas of Ardabil province are higher than in other areas in Ardabil province.

Clinical features, management and outcomes of pediatric pleural empyema: A retrospective, multicenter cross sectional study

Objectives:To evaluate clinical features,treatment strategies,and outcomes of pleural empyema for children who were treated at referral pediatric hospitals in 8 provinces of Iran.Methods:In this retrospective,multicenter cross sectional study,we retrospectively retrieved patients'data from 8 teaching hospitals during 2010 and 2017.A questionnaire was applied and filled,and all data were statistically and descriptively analyzed.Results:In total,191 children(109 males and 82 females)were included.Their mean age was 4.95 years and ranged from 11 months to 16 years.The majority of cases(45.1%)were 1-4 years old.Fever(70.3%),cough(65.6%),tachypnea(53.1%),chest pain(14.6%),and abdominal pain(12%)were the most common manifestations at admission.The mean length of admission in hospital was 16.4 d.Consequently,27 patients(14.1%)were admitted into the pediatric intensive unit because of severe illness,and 15 patients(7.9%)died.Logistic regression analysis showed that younger age(less than 12 months)and presence of underlying diseases(such as cardiovascular disease,immune deficiencies,malignancies,and neuro-developmental delay)significantly increased the mortality rate of patients with pleural empyema(P=0.004 and P=0.001,respectively).Conclusions:Pleural empyema children of younger age and with underlying diseases are at higher risks of death.In addition,guidelines for treating pleural empyema should be developed.

Relationship between clinical performance and professional self-concept in critical care nurses

Objective:To determine the relationship between clinical performance and professional self-concept in critical care nurses.Methods:This study was conducted on 308 critical care nurses.Data gathering instruments were nurses’clinical performance questionnaire(NCPQ)and nursing professional self-concept measure(NPSCM).Independent sample t-test,one-way analysis of variance(ANOVA),and Pearson correlation coefficient were used for data analyses.Results:The average age of the nurses was 33.74±7.01 years.The clinical performance score of female nurses was significantly higher than male nurses.In the domain of clinical performance,clinical judgment and clinical inquiry had the highest and lowest scores,respectively.In the nurses’professional self-concept,the highest and lowest scores were awarded to the subscales of self-confidence and staff relations,respectively.In addition,there was a significant positive correlation between self-concept and clinical performance of nurses.Conclusions:Increasing professional self-concept improves the clinical performance of critical care nurses.Professional self-concept enhancement measures are recommended to improve the clinical performance of nurses in critical care units.

Larvicidal Properties of Botanical Extracts of <i>Lawsonia inermis</i>against <i>Anopheles stephensi</i>

The aim of this study was to determine the larvicidal activity of Lawsonia inermis against Anopheles stephensi as the main malaria vector in Iran. This study was carried out from February to July 2011. Larvicidal activity of >L. inermis was studied in the range of 4 - 4000 PPM in the laboratory against early and late stages of larvae of An. stephensi. The larvae were reared in the?insectarium. The LC50 and LC90 values of the larval stages of An. stephensi were calculated by probit analysis and regression line draw using Microsoft office excel 2003 software. The highest toxic effect of L. inermis was found at 4000 PPM and the lowest at 4 PPM against larval stages I and II. The same result was found against larval stages III and IV. The LC50 and LC90 was found as 413.8 and 3366.3 respectively against larval stages I and II while against late stages found as 696.9 and 3927.7 respectively. This study suggests that L. inermis extract can be used as an alternative larvicidal compound during the IPM programs for the An. stephensi control. It is recommended to investigate the competency of other similar plants to malaria control.

Explaining the dimensions of specific competence in training specialist nurses in multiple sclerosis:a qualitative study

Background:The complexity of multiple sclerosis(MS)due to psychological,emotional,physical,family,and social dimensions complicates the care of these patients.MS patients need hospitalizations and long-term care to treat and control the progression of the disease.Therefore,the competence of caring for MS patients is one of the important issues in clinical nursing.Objective:To explain the dimensions of competence in caring for MS patients.Methods:This study is a qualitative descriptive study using conventional content analysis method.Field notes and semi-structured face-to-face interviews were conducted on 12 specialist nurses of MS and 3 MS patients from the neurology ward.Participants were selected through purposeful sampling.Data analysis was performed using the approach of Zhang and Wildemuth by continuous comparison simultaneously with data collections.Results:Data analysis led to the extraction of 2 categories with 5 subcategories.The first category is“unlearned care competence,”with the subcategories as psychological-emotional resilience,psychological skills,and excellent communication skills.The second category is“specialized technical competence,”with the subcategories as up-to-date pathological knowledge and expertise in clinical procedures.Conclusions:Identifying the competencies of nurses of MS patients is important for educating nurses to provide qualified care and improve MS patient satisfaction.Nursing managers can empower nurses in non-technical areas such as in-service psychology courses and improve professionalism in caring for MS patients by promoting communication and specific clinical skills.

A Case of Megaloblastic Anemia with Thrombocytopenia

Megaloblastic anemias are a group of hematologic disorders in which abnormal DNA synthesis causes blood and bone marrow disorders. This type of anemias occurs as a result of folic acid deficiency or impaired vitamin B12 absorption. The prevalence of this type of anemia is highly variable worldwide and megaloblastic anemia caused by lack of vitamin B12 (cyanocobalamin) is rare during pregnancy [1]. In this case report, we report follow-ups conducted for a pregnant 33-year-old woman, G2, P1, with a history of previous natural childbirth who attended Kamali Hospital due to labor pain associated with severe thrombocytopenia. Although this woman was injected 10 units of PLT and also vitamin B12 (cyanocobalamin), folic acid and corticosteroids in the course of treatment, her platelet level has not yet returned to normal levels after 6 months and she is still being treated.

Attitude of Military Students and Military Nurses toward Spirituality and Spiritual Care

Military nurses are exposed to various occupational stresses.Spirituality contributes to adaptation to critical situations and stresses.Spiritual care is an essential part of holistic care which,in recent years,has attracted the attention of health-related organizations.The aim of this study was to determine the attitude of military nurses,faculty members,and military nursing students toward spirituality and spiritual care.In a cross-sectional descriptive study,214 military nurses,faculty members,and nursing students of Baqiyatallah University of Medical Sciences in Tehran were selected according to inclusion criteria by simple sampling method and completed the spirituality and spiritual care rating scale.The mean score of attitude toward spirituality and spiritual care in clinical nurses was 69.4(standard deviation[SD]±12.6),in nursing professors 74.6(SD±6.6),and in students 67.5(SD±4/11).The majority of the research community was at a high and desirable level(between 63 and 92,which was the maximum score of the questionnaire).The results of this study showed that military nurses,faculty members,and nursing students of Baqiyatallah University of Medical Sciences in Tehran have a positive attitude toward spirituality.They tend to provide spiritual care.Therefore,it is necessary to provide a suitable platform for providing spiritual care.

Exosomes in viral infection:Effects for pathogenesis and treatment strategies

Exosomes are small vesicles that carry molecules from one cell to another.They have many features that make them interesting for research,such as their stability,low immunogenicity,size of the nanoscale,toxicity,and selective delivery.Exosomes can also interact with viruses in diverse ways.Emerging research highlights the significant role of exosomes in viral infections,particularly in the context of diseases like COVID-19,HIV,HBV and HCV.Understanding the intricate interplay between exosomes and the human immune system holds great promise for the development of effective antiviral therapies.An important aspect is gaining clarity on how exosomes influence the immune system and enhance viral infectivity through their inherent characteristics.By leveraging the innate properties of exosomes,viruses exploit the machinery involved in exosome biogenesis to set replication,facilitate the spread of infection,and eliminate immune responses.They can either help or hinder viral infection by modulating the immune system.This review summarizes the recent findings on how exosomes mediate viral infection and how they can be used for diagnosis or therapy.This could lead to new clinical applications of exosomes in disease management.

Lavender aromatherapy on anxiety and depression in patients with Acute Coronary Syndrome: a single-blind randomized clinical trial

Objective:In cardiovascular disease,a patient’s anxiety and depression can increase cardiac rehabilitation duration and recovery.Lavender aromatherapy as a non-pharmacological intervention effective in other contexts may be an efficient intervention to alleviating anxiety and depression in patients with Acute Coronary Syndrome(ACS).Methods:In this study,110 ACS patients were randomly assigned to two intervention and control groups.Inhalation of the lavender fragrance was prescribed for the intervention group and the drop of aromatic almond for the control group for 3 days.Results:The first-day anxiety and depression were significantly different in the two groups at 1 h and 9 h after the intervention.The’morning’s difference before the intervention was not significant,but it was substantial 1 h after the intervention.On the third morning of the intervention,this difference was confirmed.Conclusions:This study confirmed the effectiveness of lavender aromatherapy in reducing anxiety and depression in ACS patients.This’study’s results enable intensive care nurses to use aromatherapy with lavender oil as a non-pharmacological and cost-effective intervention to reduce their psychological tensions and increase patient satisfaction during hospitalization in the cardiac care units(CCU).

Placental pathologies and fetal outcome in pregnant women with COVID-19: A retrospective study

Objective:To describe histopathologic findings in the placentas in women with coronavirus disease 2019(COVID-19)during pregnancy.Methods:In a cross-sectional study,38 pregnant women with COVID-19 and undergoing delivery between March 2020 and January 2022,were included.The patients had positive polymerase chain reaction(PCR)test for SARS-CoV-2 infection and the placentas after delivery were sent for histopathologic evaluation based on the Amsterdam Placental Workshop Group Consensus Statement and assessed by two pathologists.Results:Our results showed that maternal vascular malperfusion was the most common and was present in 17 cases(44.7%).These features included accelerated villous maturation(36.8%)distal villous hypoplasia(5.3%),placental infarction(5.3%)and intervillous fibrin deposition(10.5%).Other pathologic findings included focal calcification(10.5%),intravillous congestion and hemorrhage(10.5%),sub-chorionic hemorrhage(5.3%),acute villitis,chronic histiocytic intervillositis and delayed villous maturation each in one case(2.6%).Twelve out of 38 cases showed no significant pathologic changes.Fetal outcomes included neonatal intensive care unit admission rate of 13.2%,dyspnea 31.6%,newborn’s anosmia 7.9%,intrauterine fetal demise 2.6%,asphyxia 2.6%and neonate COVID infection 5.3%.Conclusions:Microvasculopathy,as a sign of maternal vascular malperfusion,is a common finding in placentas from SARS-CoV-2 positive pregnant women in the present study.Further studies with larger sample sizes and comparative studies between COVID-19 positive and negative,as well as information from patient follow-up are suggested.

Phlebotomus(Adlerius) kabulensis(Diptera: Psychodidae) a new record sand fly species from Iran: Morphological and molecular aspects

Objective: To represent a new geographical record, Phlebotomus(Adlerius) kabulensis(P.kabulensis), which is suspected to be a potential vector of visceral leishmaniasis.Methods: For the first time, P.kabulensis specimens were collected using the sticky paper traps method in outdoor places in mountainous areas with vegetation coverage of three provinces in Iran.Identification of males was based on ecological, morphological, morphometric and molecular(mtDNA cytochrome b gene sequences) criteria.Generally, males have two ascoids on the 8^(th)antennal segment and one ascoid on segments 9^(th)to 15^(th), aedeagus with normal obtuseangled sub-terminal notch and coxite with 27–50 groups of hairs on the distal half of its body.Results: Morphometric measurement revealed that P.kabulensis specimens were the same as compared with seven other morphological characters in three provinces of the country but lengths of the coxite were significantly different.The PCR result of the cytochrome b(Cyt b)-mtDNA fragment shows 550-bp length, with its special nucleotide arrangement.The male and female of P.kabulensis were newly discovered members of the subgenus Adlerius from Iran.Initial DNA analysis indicated how distinct this species is.Conclusions: The results show that the P.kabulensis female will be identified by comparing with other Adlerius female groups regarding its morphometric characters and molecular sequencing.