Hospital Practices and Research

Abstract Background: Multiple Sclerosis (MS) is the most common demyelinating inflammatory disease of the central nervous system. Rituximab is an anti-CD20 monoclonal antibody used as a primary drug for MS; however, it can cause injection and post-consumption side effects.
Objectives: This study aimed to determine the side effects of rituximab in patients with Multiple Sclerosis.
Methods: This descriptive-analytical study focused on MS patients who had received Rituximab and regularly visited Isfahan Multiple Sclerosis clinics in 2021. These patients had received at least two doses of Rituximab (1000 mg), and their symptoms and examinations were documented during face-to-face visits using checklists. The data were analyzed using SPSS version 22.
Results: In this study, 150 patients with MS participated. The number of attacks (more than one) before and after using Rituximab was 22% and 4.7%, respectively. The mean EDSS score among them before and after Rituximab was 3.53 ± 1.30 and 3.66 ± 1.51. 68.7% of the patients showed infusion side effects, such as a sore throat and dyspnea. Moreover, post-consumption side effects included muscle spasm, weight gain, arthralgia, and edema of the extremities.
Conclusion: The mean EDSS score before and after using Rituximab showed a slight increase, indicating no significant effects on improving dysfunctions, but the attack rate was reduced.

Abstract Background: The novel coronavirus has been found to have neurological manifestations, and cerebrospinal fluid (CSF) analysis could be helpful in the differential diagnosis of critically ill patients with neurological symptoms and act as a prognostic factor in these patients.
Objectives: In this study, we assessed the CSF of patients with COVID-19 who presented with encephalopathy to elucidate any common characteristics.
Methods: This cross-sectional study included 36 patients with positive COVID-19 PCR who presented with encephalopathy and were hospitalized. We evaluated RT-PCR, total cell counts, LDH, protein, and glucose levels of CSF samples. Clinical manifestations, neurological complaints, and outcomes (death or survival) were extracted from patients' files.
Results: A total of 36 patients underwent lumbar puncture and CSF analysis. RT-PCR for SARS-CoV-2 RNA was negative in all thirty-six cases. Fever was present in 29 (80.6%) patients, shortness of breath in 23 (63.9%), and cough in 14 (38.9%) as primary clinical manifestations. Seizures were reported in 12 (33.3%) patients as a neurological presentation. The mortality rate was 7 (19.4%) in our cases. Abnormalities in WBC count were found in 6 (16.6%) of CSF samples. The remaining patients had normal CSF results, indicating no specific pattern of CSF markers.
Conclusion: Our study did not reveal any usual patterns in CSF analysis. Moreover, we were unable to detect SARS-CoV-2 RNA in CSF samples definitively. These findings suggest that the indirect mechanisms of SARS-CoV-2 may play a significant role in the neurological manifestations associated with COVID-19.

Abstract Background: Iatrogenic dural tear is a relatively common complication in lumbar spine surgery; however, little information exists about the frequency of this condition and its complications in our country.
Objectives: This study aimed to assess the frequency of dural tear and its complications in lumbar spine surgery.
Methods: This cross-sectional descriptive study was conducted on 884 patients who underwent lumbar spine surgery and were referred to Kashani and Alzahra hospitals from 2020 to 2021. Information including age, gender, type of surgery, duration of surgery, duration of hospitalization, number of hospitalizations, need for a second surgery, number of previous surgeries, complications of surgery, involved vertebrae, and underlying diseases were extracted from the checklist.
Results: Among 884 patients who underwent lumbar spine surgery, iatrogenic dural tear was observed in 62 patients (7%). Fever, headache, and wound site complications were observed in 8 (12.9%), 22 (35.5%), and 4 patients (6.5%), respectively. Moreover, the duration of surgery in the total group and the dural tear group was 195 ± 76.2 and 204.13 ± 71.69 minutes, respectively. The duration of hospitalization in the total group and the dural tear group was 3.10 ± 1.3 and 4.08 ± 2.68 days, respectively. Laminectomy was performed in 24.09% and 24.2% of patients in these two groups, respectively.
Conclusion: According to the findings of this study, the frequency of dural tear was 7%, which may be affected by several factors, including age, duration of surgery and hospitalization, underlying disease, smoking, and history of previous surgery.

Abstract Background: The outbreak of COVID-19 has put more pressure on the medical staff.
Objectives: The current study was performed to determine the role of emotional exhaustion on self-compassion in nurses via the mediation of empathy during the outbreak of COVID-19.
Methods: The present study was a descriptive and analytical study conducted on 150 nurses working in Al-Zahra and Kashani hospitals in Isfahan, Iran in 2021. The data were collected by three standard questionnaires of Emotional exhaustion (Chen), Self-compassion (Neff), and Empathy (Davis) and were analyzed in SPSS version 24 and LISREL8 software.
Results: The results of the study revealed that the three variables of self-compassion, empathy and emotional exhaustion are not significantly different according to the demographic characteristics of nurses (P>0.05). There was a direct and significant relationship between empathy and emotional exhaustion (P<0.05). Ultimately, the proposed model has a good fit and in the direct and indirect relationships of the model, the role of empathy as a mediator between emotional exhaustion and self-compassion is confirmed.
Conclusion: In line with the obtained results, it is suggested that considering the spread of a deadly infectious disease, appropriate educational measures and strategies should be implemented to promote or boost the spirit of empathy among health sector employees, especially nurses.