Hospital Practices and Research

Abstract Hand hygiene is crucial in preventing healthcare-associated infections. Despite global efforts, hospital-acquired infections persist, and hand hygiene compliance remains low, averaging around 40%. While alcohol-based hand rubs (ABHR) effectively prevent infection spread, improper glove use and non-compliance with the World Health Organization's five moments for hand hygiene are common challenges in healthcare settings. A key barrier to compliance is the high workload of healthcare workers, who often lack time to remove gloves and disinfect hands between patient interactions. In situations where glove changes are impractical, glove disinfection may offer a feasible alternative. Evidence suggests that disinfecting gloves with ABHR could reduce contamination and improve compliance. With limited personal protective equipment resources in hospital settings, glove disinfection has shown potential benefits, including reduced workload, cost savings, and environmental impact. Studies demonstrate that regular glove disinfection significantly reduces microbial transmission compared to the gold standard of hand hygiene. Despite these findings, further research is necessary to assess the long-term safety and effectiveness of glove disinfection before it can be widely adopted as an alternative to glove removal and hand hygiene.

Abstract Background: Leishmania major is one of the main causative agents of cutaneous leishmaniasis in many world regions, including Iran. Common treatments for this disease include pentavalent antimonial compounds, amphotericin B, and paromomycin-based formulations. However, these treatments face challenges such as drug resistance, high toxicity, and high costs. Consequently, there is a growing need for alternative therapeutic approaches.
Objectives: The present study evaluates the inhibitory effect of nano-chitosan loaded with Allium ursinum (A. ursinum) extract against L. major under in vitro conditions.
Methods: Initially, chitosan/extract nanoparticles (NChi/Ex) were synthesized by loading A. ursinum extract onto chitosan, and their physicochemical properties were analyzed using Fourier-transform infrared spectroscopy (FTIR), dynamic light scattering (DLS), and field emission scanning electron microscopy (FESEM). Subsequently, Leishmania major parasites were cultured in RPMI 1640 medium, and the effect of NChi/Ex on the parasites was assessed using the MTT assay.
Results: The results showed that the average size of the synthesized nanoparticles was 145.3 nm, with a polydispersity index (PI) of 0.277, indicating a relatively uniform particle distribution. The FTIR spectrum confirmed the successful loading of A. ursinum extract onto chitosan, as characteristic peaks corresponding to the functional groups of both components were observed. The NChi/Ex nanoparticles exhibited a dose-dependent inhibitory effect, with the highest inhibition occurring at a concentration of 50 µg/ml after 48 hours, achieving 100% inhibition of Leishmania major.
Conclusion: The results demonstrated that NChi/Ex exhibited greater efficacy than chitosan or A. ursinum extract alone. This study underscores the potential of chitosan nanoparticles loaded with A. ursinum extract as a promising therapeutic strategy against Leishmania major, with potential applications in laboratory research and possibly in animal models.

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: Mothers of children with Autism Spectrum Disorder (ASD) often experience significant social stigma and challenges with distress tolerance, impacting their well-being and parenting effectiveness.
Objectives: This study aimed to evaluate the effectiveness of mindfulness-based parenting training and transdiagnostic therapy in reducing social stigma and improving distress tolerance among these mothers.
Methods: This study utilized a quasi-experimental, pretest-posttest control group design with three-month follow-up assessments. The target population comprised mothers of children aged 5 to 12 years, diagnosed with ASD, who were attending autism centers in Mashhad during 2024. A convenience sample of 45 mothers was recruited and subsequently randomly allocated to two experimental groups and a single waitlist control group. Data collection instruments included the Social Stigma Scale and the Distress Tolerance Scale. Statistical analyses were conducted using repeated measures analysis of variance (ANOVA), with Bonferroni post-hoc tests employed for pairwise comparisons.
Results: Findings demonstrated that both the mindfulness-based parenting intervention and transdiagnostic therapy yielded statistically significant reductions in perceived social stigma and increases in distress tolerance at both the post-test and follow-up assessments when compared to the control group (P<0.001). Additionally, no statistically significant difference was observed in the effectiveness between the two intervention modalities, indicating that they were statistically equivalent in their impact on social stigma and distress tolerance.
Conclusion: This research demonstrated that both mindfulness-based parenting and transdiagnostic therapy effectively reduced social stigma and improved distress tolerance in mothers of children with ASD, with sustained benefits observed during follow-up. Clinicians can consider either, or a combined approach, as both yielded equivalent improvements. This allows tailored interventions based on individual needs and preferences.

Abstract Background: Spiritual health literacy, as a multidimensional concept, encompasses the knowledge, awareness, and abilities necessary to understand spirituality, spiritual values, and spiritual connections in students' lives.
Objectives: This research was conducted with the aim of qualitatively analyzing the factors affecting spiritual health literacy in students.
Methods: The design of this qualitative research was based on the framework of thematic analysis. The statistical population included all specialists and experts in the field of health literacy and spiritual health at Gonabad University of Medical Sciences in 2024. By using a purposeful sampling and achieving data saturation, a semi-structured interview was conducted after explaining the purpose of the research. The interview guide was prepared with a combination of open-ended, probing, and supplemental questions regarding spiritual health literacy. With the consent of the participants, all interviews were digitally recorded and transcribed. Saturation was attained after interviewing 13 individuals. Interview data were analyzed using thematic analysis method.
Results: According to the findings of the present study, nine main themes emerged: culture, family factors, education, justice, characteristics of society, modeling, socio-economic conditions, belief in spirituality, and laws. These themes are based on 35 sub-themes, including existing values, Iranian culture, Islamic culture, cultural norms, ethnic structure, familial beliefs, types of relationships, quality of relationships, emphasized values, educational styles, formal education, informal education, methods of advertising, educational perspectives, social equality, individual equality, gender equality, equal conditions, types of democracy, types of policies, types of relationships, emphasized patterns, national heroes, historical heroes, etc., serving as precursors to the concept of spiritual health literacy.
Conclusion: The findings highlight that spiritual health literacy is a multifaceted concept influenced by cultural, familial, educational, and socio-economic factors, and can be cultivated through intentional practices and alignment with cultural values.

Abstract Background: The influence of social media on mental health and body image necessitates investigating its relationship with the pursuit of cosmetic surgery, particularly in women.
Objectives: The present study investigated the associations between social media addiction, psychopathology, and intentions to seek cosmetic surgery in women, examining the mediating role of self-esteem in these relationships.
Methods: This study utilized a cross-sectional, descriptive-correlational design. Two hundred women were recruited via convenience sampling. Participants were included if they expressed intentions to seek cosmetic procedures. Data were collected using the Symptom Checklist-90 (SCL-90), the Social Media Addiction Questionnaire, the Rosenberg Self-Esteem Scale, and the Cosmetic Surgery Tendencies Questionnaire. Statistical analyses were performed using SPSS-22 and AMOS-22.
Results: This study found significant positive correlations between social media addiction and both cosmetic surgery tendencies and psychopathology in women, and a significant negative correlation between self-esteem and cosmetic surgery tendencies (P<0.001). Self-esteem significantly mediated the relationships between both social media addiction and psychopathology with cosmetic surgery tendencies (P<0.001). The model demonstrated a good fit to the data (RMSEA = 0.060, IFI = 0.97, CFI = 0.96, and GFI = 0.96).
Conclusion: This study found significant correlations between social media addiction, psychopathology, and intentions to seek cosmetic surgery in women, with self-esteem playing a crucial mediating role. These findings underscore the importance of integrating self-esteem enhancement into interventions designed to address body image concerns and mitigate the influence of social media and psychological distress on intentions regarding cosmetic procedures.

Abstract Background: Diabetes is a chronic disease requiring ongoing self-care, which can be emotionally challenging and lead to difficulties with coping and adherence, ultimately impacting health outcomes.
Objectives: This study investigated the impact of Acceptance and Commitment Therapy (ACT) on self-care behaviors and coping strategies in individuals with diabetes.
Methods: The present study used a quasi-experimental design incorporating pre-test, post-test, and follow-up assessments with a control group. The study population consisted of female patients aged between 30 and 50 years with a diagnosis of type 2 diabetes who were registered with the Ahvaz Diabetes Association between January and April 2023.Thirty participants with type 2 diabetes were recruited using convenience sampling and subsequently randomly assigned to either the intervention group (n = 15) or the control group (n = 15). The intervention group participated in eight weekly 90-minute sessions of ACT, whereas the control group received treatment as usual. Data were collected at three time points (pre-intervention, post-intervention, and follow-up) using the Summary of Diabetes Self-Care Activities (SDSCA) questionnaire and the Coping Inventory for Stressful Situations (CISS). Repeated measures analysis of variance (ANOVA) was performed using SPSS version 26 for data analysis.
Results: Findings indicated a significant effect of ACT, leading to decreased utilization of avoidance strategies and increased engagement in problem-focused coping and self-care behaviors among individuals with diabetes (P<0.001). Conversely, ACT did not demonstrate a significant impact on emotion-focused coping strategies in this population.
Conclusion: This study supports the potential benefits of ACT for improving diabetes self-care. Significant reductions in avoidance and increases in problem-focused coping and self-care following ACT suggest its potential to empower individuals to actively manage their condition. While ACT did not demonstrate a statistically significant impact on emotion-focused coping, its positive effects on other coping mechanisms and self-care highlight its potential to improve patient outcomes.

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.