Hospital Practices and Research

Abstract Non-cardiac CT angiograms may be helpful when searching for the etiology of cardiac arrest in out-of-hospital cardiac arrest cases and may be effective in the decision of early percutaneous coronary intervention. We want to share an experience related to this topic. A 51-year-old male patient returned home after travelling by plane from abroad and suddenly collapsed while hugging his relatives at home, followed by cardiac arrest (CPA). CTA showed no obvious pathology in the aorta and pulmonary artery, but the proximal left anterior descending artery (LAD) branching from the left main coronary artery (LMCA) was not contrast enhanced and was thought to be an occluded lesion. The cardiology unit was contacted and the patient was taken to the emergency coronary angiography unit. Coronary angiography revealed a critical stenosis in the proximal LAD. In this case, the patient's heart rate was not suitable for a coronary CT angiography (90 beats/minute), and the option of slowing the heart down was not an option as the patient was unstable and had ROSC after CPA. In addition, no radiologic editing of the images for artifacts due to heart rate was performed. Thoracic aorta angiography is not a standard imaging method for coronary artery lesions. However, in this case, it raised suspicion of coronary artery occlusion and was indicative of an occlusion that could not be detected on ECG.

Abstract Background: Knee Osteoarthritis (OA) is a common degenerative joint disease characterized by ongoing pain and reduced physical function.
Objectives: We aimed to systematically review and meta-analyze the clinical trials that evaluated the impact of transcranial Direct Current Stimulation (tDCS) on knee OA pain.
Methods: A comprehensive search was performed on Scopus, Web of Science, PubMed/MEDLINE, EMBASE, ProQuest, CENTRAL via Cochrane, and PEDro from the inception of these databases until May 31, 2023 with no language restrictions. The objective of the search was to find publications that examined the impact of active tDCS compared to sham tDCS or other interventions in individuals with knee OA.
Results: The meta-analysis comprised ten studies including 517 patients with knee OA. Active tDCS resulted in significantly lower pain scores compared to sham tDCS/ Transcutaneous Electrical Nerve Stimulation (TENS) immediately (effect sizes from pre-test–post-test-control design (dppc2) = -0.83, I² = 61.8%), short-term (dppc2 = -0.74, I² = 43.5%), and mid-term (dppc2 = -1.94, I² = 87.8%) follow-ups, but not in the long term (dppc2 = -0.25, I² = 29.6%). However, the certainty of the evidence was assessed as low to very low.  Moreover, function was significantly improved with active tDCS immediately after the last treatment session either by McMaster Universities Osteoarthritis Index (WOMAC) or Knee Injury and Osteoarthritis Outcome Score (KOOS) (dppc2 = -0.38, I² = 6.6% and dppc2 = 0.87, I² = 60.1%, respectively). The certainty of the evidence was very low. No serious adverse effects of tDCS were reported by the majority of studies.
Conclusion: More than half of the included trials had unclear or high risk of bias and there were no patient follow-ups beyond three months. Given the criteria of reduced I² and sufficient number of studies, no potential sources of heterogeneity were identified. Further high-quality randomized clinical trials with extended follow-up periods are required to determine the true effects of tDCS on knee OA.

Abstract Background: Urinary tract infections are among the most prevalent human infections, primarily caused by Enterobacteriaceae. Currently, a significant number of Enterobacteriaceae produce extended-spectrum beta-lactamases (ESBLs), rendering them resistant to beta-lactam antibiotics and resulting in treatment failures.
Objectives: The aim of this study was to determine the frequency of blaSHV and blaTEM genes in Enterobacter isolates from clinical samples at Amir al-Momenin Hospital in Maragheh city in 2023, as well as to assess their antibiotic and probiotic resistance patterns.
Methods: One hundred urine samples from patients with urinary tract infections hospitalized at Amir Al-Momenin Hospital were included in the study. ESBL-producing bacteria were identified using the agar disk diffusion method according to CLSI criteria, employing 30 µg ceftazidime and cefotaxime antibiotic disks, both with and without clavulanic acid. PCR was utilized to amplify the genes for examining the frequency of blaTEM and blaSHV genes. Electrophoresis of the samples was conducted on a 1% agarose gel.
Results: Of the 21 samples, the ESBL index was negative in 7 samples, resulting in a frequency of 33.33%, while it was positive in 14 samples, with a frequency of 66.67%. The frequency of the blaTEM gene in positive bacterial samples was 95.23%, and the frequency of the blaSHV gene was 92.52%.
Conclusion: The disk diffusion test on antibiotic-sensitive samples found that the highest average growth inhibition zone was associated with the CTC antibiotic, while the lowest average growth inhibition zone was related to the NA antibiotic.

Abstract Background: Effective inventory management and control have been associated with numerous benefits for healthcare institutions, including improved organizational performance and enhanced competitive advantage.
Objectives: This study aimed to investigate the practices, impacts, and challenges of inventory management and control in two public hospitals in Ghana.
Methods: A qualitative phenomenological approach was adopted in this study. Thirty participants—comprising procurement managers, officers, storekeepers, and other relevant administrative staff—were selected through purposive and convenience sampling. Data were collected using in-depth interviews and focus group discussions. Thematic content analysis served as the primary analytical technique, complemented by interpretative phenomenological analysis to deepen the understanding of participants' lived experiences.
Results: Participants reported key inventory control practices such as First-In-First-Out (FIFO), Last-In-First-Out (LIFO), and First-Expiry-First-Out (FEFO). Positive outcomes identified included improved availability of medical supplies, reduced waste and cost, and enhanced patient safety. However, challenges included limited financial resources, delays in supplies, and instances of mismanagement or misuse of stock by healthcare staff.
Conclusion: The study recommends enhanced collaboration among healthcare stakeholders to address persistent inventory management challenges. It further encourages policymakers and hospital administrators to invest in inventory systems and staff capacity-building to strengthen overall healthcare delivery.

Abstract Background: Major Depressive Disorder (MDD) often presents with cognitive deficits, including impairments in attention and short-term memory, which can significantly impact patients' quality of life.
Objectives: This study investigated the effectiveness of repetitive Transcranial Magnetic Stimulation (rTMS) on attention and short-term memory in patients with MDD.
Methods: This study adopted a quasi-experimental, pretest-posttest control group design, conducted in Yazd, Iran, during 2023. A convenience sample of thirty patients, aged 20-50 years, diagnosed with MDD, was recruited and subsequently randomized into either an intervention or a control group (n=15 per group). All participants received antidepressant medication (SSRI); however, the intervention group also underwent ten sessions of 5Hz rTMS at an intensity of 120% of the motor threshold, targeting the left dorsolateral prefrontal cortex (DLPFC), while the control group received sham rTMS. Cognitive function, specifically attention and short-term memory, was evaluated using the Wechsler Memory Scale. Statistical analysis was performed using SPSS-27, with analysis of covariance (ANCOVA) employed to assess treatment effects.
Results: Participants in the study included 30 individuals with MDD (male and female), with a mean age of 43.65 ± 6.49 years. The findings indicated that rTMS yielded statistically significant changes in attentional and short-term memory performance among these patients (P<0.01). This outcome demonstrates a beneficial impact of rTMS on cognitive domains affected by MDD, providing empirical evidence for its potential therapeutic role.
Conclusion: This study demonstrates that rTMS targeting the DLPFC significantly enhances attention and short-term memory in MDD patients. Consequently, these results suggest rTMS as a valuable adjunctive therapy for mitigating cognitive deficits associated with MDD through its neuromodulatory effects, offering a potential strategy to improve patients' daily functioning and overall quality of life.

Abstract Background: Patients undergoing hemodialysis often experience significant suffering, encompassing various psychological and existential components that negatively impact their quality of life.
Objectives: This study aimed to compare the effectiveness of Mindfulness-Based Cognitive Therapy (MBCT) and Spiritual Self-Care Training (SSCT) in reducing the components of suffering—physical, psychological, and existential—among patients undergoing hemodialysis.
Methods: This study utilized a three-group quasi-experimental design, employing a pre-test, post-test, and follow-up protocol with MBCT, SSCT, and control groups. The target population comprised hemodialysis patients residing in Isfahan, Iran, during the autumn of 2024. A convenience sample of 60 participants was drawn from this population and subsequently randomly allocated to three distinct groups (n = 20 per group). The Life Suffering Questionnaire served as the instrument for measuring the dependent variable across all three assessment time points. The experimental groups received 10 weekly therapeutic sessions each lasting for 90 minutes, with MBCT and SSCT administered, while the control group was a waitlist control receiving no intervention during the study period. Data were analyzed using repeated-measures analysis of variance (ANOVA), supplemented by Bonferroni post-hoc tests, via SPSS version 26.
Results: The findings revealed statistically significant differences across three domains of suffering—physical, psychological, and existential—when comparing MBCT, SSCT, and the control group (P<0.01). Notably, SSCT exhibited superior efficacy relative to MBCT in alleviating both physical and psychological suffering (P<0.05). Conversely, no significant difference in effectiveness was observed between the two intervention groups with respect to existential suffering.
Conclusion: SSCT outperformed MBCT in reducing physical and psychological suffering in hemodialysis patients, while both interventions equally mitigated existential suffering. These findings highlight the need for tailored interventions, specifically by integrating spiritual components into cognitive therapies, to address the multifaceted suffering of chronically ill patients. Clinically, incorporating such integrated interventions into hemodialysis care could enhance patient well-being and quality of life.

Abstract Background: Anxiety disorders are highly prevalent among adolescents, particularly girls. These disorders can significantly impair academic performance, social relationships, and overall quality of life, with long-term consequences into adulthood.
Objectives: The research aimed to predict anxiety in adolescent girls using a multilayer perceptron model based on self-awareness and metacognitive beliefs.
Methods: In this correlational study, the statistical population consisted of adolescent girls aged 16-18 enrolled in secondary schools in Ahvaz during the academic year 2022-2023. A total of 215 individuals were selected using multi-stage cluster sampling. Data were collected using the Beck Anxiety Inventory (BAI), the Five Facet Mindfulness Questionnaire (FFMQ), and the Metacognitions Questionnaire (MCQ-30) to assess anxiety, self-awareness, and metacognitive beliefs, respectively. The data were analyzed using Pearson’s correlation coefficient, simultaneous regression, and a multilayer perceptron model, performed with SPSS version 27 and MATLAB version 2019.
Results: The results revealed a significant negative correlation between self-awareness and anxiety in adolescent girls (r = -0.60). Furthermore, metacognitive beliefs also showed a significant negative correlation with anxiety in adolescent girls (r = -0.53). Additionally, a significant combined predictive effect was found for self-awareness and metacognitive beliefs on anxiety in adolescent girls (P<0.001). The results of the multilayer perceptron model indicated that self-awareness had the strongest predictive power in relation to anxiety in adolescent girls.
Conclusion: Higher self-awareness and stronger metacognitive beliefs correlate with lower anxiety levels in adolescent girls. Interventions aimed at improving these cognitive factors, such as mindfulness and cognitive restructuring, could effectively reduce anxiety. Integrating these strategies into clinical and educational settings can empower adolescent girls with crucial coping mechanisms. By fostering self-awareness and healthier metacognitive beliefs, we can equip them to manage anxiety, improve their overall mental well-being, and enhance their academic and social functioning.

Abstract Background: Cutaneous larva migrans (CLM) is a parasitic infection caused by the accidental penetration of canine hookworm larvae into the superficial layers of human skin. Although typically self-limiting, delayed diagnosis may result in complications such as secondary infections or allergic reactions.
Case Presentation: The case involved a 54-year-old man with a history of hypertension who presented with a creeping, erythematous lesion on his left leg, accompanied by severe pruritus and a history of contact with a pet dog. After confirming the dog’s hookworm infection and conducting further clinical evaluation, a diagnosis of CLM was established. Treatment with albendazole and an antihistamine resulted in complete resolution of the patient’s symptoms.
Conclusion: Although CLM is typically a self-limiting condition, timely initiation of treatment can significantly reduce the duration and severity of symptoms. The growing trend of pet ownership has increased the risk of CLM transmission, underscoring the importance of implementing effective preventive measures.