Hospital Practices and Research

Abstract Letter to Editor

Abstract Background: Japanese Encephalitis (JE) is a serious public health issue in an Asian region, causing high mortality and disability rates across all age groups.
Objectives: The current study aims to examine the clinical characteristics, laboratory findings, treatment patterns, and discharge outcomes of JE-admitted patients at a tertiary care neurology hospital in the Northeast state of India.
Methods: The medical records of diagnosed JE patients were reviewed retrospectively between January 2021 and December 2022. Demographic and clinical characteristics were analyzed. Characteristics of the disease severity were assessed based on the discharge status: routine discharge, Discharge Against Medical Advice (DAMA), and mortality during the hospital stay.
Results: A total of 28 JE patients were included; their average age was 40.7 (±20.2) years, males predominantly (60.7%), and the majority belonged to the lower socioeconomic level (85.6%). The most common clinical symptom was fever with altered sensorium (89.3%), with involved hyperintensities in the thalamus (25.0%). Twenty-six patients required Neurological Intensive Care Unit (Neuro-ICU) management with tracheostomy-assisted ventilation due to neurological deterioration. Symptomatic treatment was prescribed such as prophylactic antibiotics and osmotic diuretics. JE patients’ mortality (25.0%) during a hospital stay due to superadded septic shock and elevated intracranial pressure, 21.4% were routine discharge, and 53.6% underwent DAMA.
Conclusion: The prevalent reasons for JE patient mortality were superadded septic shock, increased intracranial pressure, and disease severity. Fever with altered sensorium and thalamus involvement were major findings. Many patients were DAMA because of their low socioeconomic level, which was a barrier to monitoring the progression of the disease.

Abstract Background: Investigating the frequency pattern and types of skin diseases is considered to be extremely important in order to improve the diagnosis process and patients' conditions.
Objectives: The aim of this study was to investigate the epidemiological pattern of skin diseases in patients referred to the skin clinic of Baqiyatallah Hospital.
Methods: This cross-sectional study was conducted on 400 patients who had referred to the skin clinic of Baqiyatallah Hospital during 2016 and 2017. These participants were selected using a convinced sampling model. The type of skin diseases were determined in patients and then collected data were analyzed using the SPSS(V-22) software.
Results: Out of the 400 patients who had referred to the abovementioned clinic, 281 (70.3%) were women and 119 (29.7%) were men. The most common reasons for visiting the skin clinic were acne, warts, wrinkles and acute eczema, respectively. The most affected area was the face. The skin disease diagnosed in patients had a significant relationship with patients' age (P = 0.001), gender (P = 0.001), and education (P = 0.011).
Conclusion: According to the findings of the present study, acne, warts, and wrinkles are the most common skin problems in patients who had referred to the skin clinic of Baqiyatallah Hospital, respectively. Demographic and background factors have a significant effect on the type of skin disease.

Abstract Background: Hospital nurses are more exposed to health anxiety due to close contact with patients.
Objectives: This study aimed to determine the mediating role of mental toughness in the relationship between meta-emotion and co-rumination with nurses' health anxiety.
Methods: The research method was structural equations type correlation. The statistical sample of the research included 250 nurses from hospitals in West Azarbaijan province in 2022, who were selected by simple random sampling. Salkovskis and Warwick's (2002) health anxiety scale, Mitmansgruber et al.'s meta-emotion questionnaire (2009), Clough et al.'s (2002) mental toughness scale, and Davidson's co-rumination questionnaire (2014) were used to measure the variables. The data were analyzed using Pearson's correlation coefficient, Sobel test and bootstrap.
Results: Findings indicated that the meta-emotion and co-rumination variable interact with the mediating role of mental toughness which has a role in explaining the nurses’ model of health anxiety. In total, 38% of the variance of health anxiety was explained through the variables of negative and positive meta-emotion, co-rumination and psychological stability. The direct effect of positive meta-emotion (-0.327), negative meta-emotion (0.318), mental toughness (-0.452), and co-rumination (0.367) are significant in explaining the health anxiety model. Furthermore, the indirect effect of negative meta-emotion (0.158), positive meta-emotion (-0.161), and co-rumination (0.155) with the mediation of the role of mental toughness is significant.
Conclusion: Considering the direct and indirect effects of meta-emotion, mental toughness and co-rumination variables on the level of health anxiety variable, it seems that by strengthening positive meta-emotion and mental toughness, and improving co-rumination and negative meta-emotion, the health anxiety in nurses can be reduced.

Abstract Background: The Internet of Things (IoT) for patient care at home, which means that instead of going to the hospital and spending a lot of time and money, patients' clinical data can be viewed remotely and the data can be processed and then sent to the doctor.
Objectives: The use of any new technology by the society faces challenges. For this particular reason, before the introduction of any technology, the effective factors in its use must be investigated. In this research, the acceptance rate of the IoT for patient care at home is investigated.
Methods: This research was conducted using the grounded theory method with a case study of veterans who need home care. In order to collect information, 15 veterans and their nurses were interviewed in the statistical community of Zahedan.
Results: The findings of the present research revealed that the impact of IOT on the improvement of health services can be understood, and positive advertising about the performance of the IoT has a significant effect on its use and confidence. However, due to the unknown nature of the IoT and the security issue of users' information, there are doubts about its use.
Conclusion: In order to increase the use of IoT in order to take care of patients at home, the influencing factors of the IoT should be taken into account in order to create trust in IoT.

Abstract Background: In recent decades, some countries have experienced imbalanced and rapid development of physical spaces, leading to negative social, economic, and physical consequences. The trend towards urbanization, combined with recent disease outbreaks, has put a strain on healthcare services in large cities.
Objectives: To reduce vulnerability to natural disasters and improve adaptive capacity, it's important to evaluate, monitor, and plan for healthcare resilience. A comprehensive model for measuring hospital resilience to accidents and disasters, including the COVID-19 pandemic, is essential.
Methods: This research identifies, collects, and classifies factors that affect user resilience and spatial definition of healthcare services usage against COVID-19. To better quantify the results, the research combines the conceptual framework of the DPSIR model with the structural equation model (SEM-PLS).
Results: According to the fuzzy cognitive map, the index of economic factors with weights of 62%, 62%, and 5% respectively has a two-way and positive relationship with environmental and natural factors. This factor with a weight of 65% has a two-way and negative relationship with the index of social factors. In addition, the index of economic factors with a weight of 69% has a one-way and negative relationship with the index of physical factors.
Conclusion: The results also show that the economic factors in the model of redefining the spatial pattern of therapeutic uses of big cities at the time of the emergence of a pandemic disease with a resilience approach have more centrality than other factors.

Abstract The countries located in west Asia and other parts of Asia are positioned in important and strategic areas due to specific political and geopolitical conditions. These countries have faced various military and political threats, and it is crucial for them to strengthen their ability to foresee, prevent, and prepare for any biological threats. Meanwhile, with the progress made in science and technology, particularly in the field of biology, new biological threats and wars have surfaced. These threats and wars are self-replicating and can significantly expand the contaminated area, requiring advanced equipment and resources in the community in order to combat them effectively. The field of threat detection, cleanup, and contamination has been identified as an area of concern. Additionally, the hidden use of these factors in peacetime poses a potential danger, as does the possibility of deliberate casualties and damages, along with the incidence of intense fear and panic in the target population. Given the recent outbreak of the avian influenza virus in some countries, there is a concern that avian influenza virus outbreaks could be a precursor to a more widespread and severe biological attack, such as the Ebola virus, which presents with widespread biological and clinical symptoms.

Abstract Background: Abdominal trauma whether blunt or penetrating is a harbinger of the possibility of genitourinary injuries. The kidney is an organ frequently injured when there is a genitourinary injury. The menace of armed banditry has led to the increased presentation of life-threatening organ system injuries to our facilities such as a shattered kidney. The associated mortality can be significant even where there is a functioning trauma system.
Objectives: The aim of this study was to investigate a patient who survived shattered kidney injury despite non-existent functioning trauma system.
Case report: A 75-year-old farmer presented with a 4 h history of gunshot injury to the right flank and left cheek associated with bleeding, haematuria, and shock was investigated. His admitting packed cell volume was 16.4%. The serum chemistry was within normal range and no features of peritonitis was observed. He had resuscitation according to the principle of the Advanced Trauma Life Support protocol and emergency exploratory laparotomy with right simple nephrectomy.
Conclusion: The management of shattered kidneys involves prompt and simultaneous resuscitation using the Advanced Trauma Life Support (ATLS) protocol including emergency exploratory laparotomy and simple nephrectomy to guarantee patient survival.