The purpose of this study was to establish the relationship between the tolerance for uncertainty level and several psychophysiological and psychological qualities of military specialists for determining additional approaches to occupational selection. The study was conducted on a group of servicemen who performed special tasks and were capable of responding to terrorism – 49 men (main group) and 19 military doctors (control group) – men aged 25-34 years. Tolerance for uncertainty was studied based on the modified S. Badnder’s method. The level of manipulation score (MAC) was assessed by the adapted I.A. Romanova and O.O. Zhdanov questionnaire (estimated by the so-called "MacScale"). Psycho-physiological parameters were determined using a special computer program. Statistical analysis of data was performed by descriptive and nonparametric statistics, as well as a cluster, stepwise discriminant, and correlation analysis. A personality trait “tolerance for uncertainty” was valuable for the occupational activity of servicemen performing special tasks. The such feature had 63.3% of servicemen in the studied group. The specificity of the occupational activity of military doctors was the quality of manipulation of people. Moreover, those who were the most tolerant of uncertainty had an inverse relationship with Machiavellianism, which indicates the existence of compensatory psychological mechanisms balancing and harmonizing service and personal relationships among micro-teams of servicemen. Servicemen with a lower level of tolerance for uncertainty had positive relationships with several psychophysiological functions (strength and mobility of nervous processes, quality of dynamic memorization), which confirms the idea of psychophysiological mechanisms to enhance tolerance for uncertainty by increasing the working capacity of these people. Such personal quality as tolerance for uncertainty is a valuable occupationally important feature that allows performing the selection of servicemen who are more efficient and reliable in the performance of official duties tasks.
Following the crisis of coronavirus outbreak in numerous regions of the world, this epidemic enhanced promptly in most countries, including Iran, and sent a host of patients in need of medical services to hospitals. This study aimed to investigate the challenges of operational management of a reference military hospital during the pandemic COVID-19. Methods: This research is a qualitative study with the content analysis method with a deductive and guided approach. Data collection was conducted through a semi-structured interview method and utilizing a questionnaire designed based on the management functions of the Hospital Incident Command System (HICS). The targeted sampling method and participants in this study included senior-middle managers working in organizational positions of the reference hospital in 2020 employed during the organizational position in Covid-19 Pandemic. Classifications and coding were performed employing MAXQDA 2018 software. Results: The findings of this study were explored in the form of strengths, weaknesses, and challenges. Weaknesses included taking surprise, early and non-missionary entry into the COVID-19 crisis, lack of appropriate depot, instant management, deficiencies in the training of patients and staff, poor functioning of the crisis management system, deficiencies in monitoring, and poor provision of psychological support. The strengths were the devoted and altruistic presence of the medical staff and managers, the financial support of the headquarters, the effective field research of the management team of the organization, and the proper management of the volunteer forces. The most significant challenge was the poor coordination with the relevant organizations, including the headquarters, the Defense Organization, and the Ministry of Health. Conclusions: The findings of this study demonstrate that in the peak period of the COVID-19 pandemic to promote the operational management of the hospital, sticking to the general policies of the organization, structured coordination with internal and external organizations, organized management of equipment and human resources, generating a robust documentation structure and decision-making based on the evidence, effective and practical use of the crisis management system, systematic training of staff and patients, prioritizing the safety of patients and staff, organized dissemination of information and systematic monitoring as well as evaluation are the most significant points to deal with the epidemic crisis.
Melanoma outcome seems different between females and males, with a potential protective role of estrogen (E) through estrogen receptors (ER) expression into the tumor. In the study of ERs, both alfa (ERα) and beta (ERβ) is a well-known endocrine elements in non-melanoma tumors, like mammary and endometrial cancer. Immunohistochemistry (IHC) assessment of melanoma concerning ERs represents a path to explore the tumor profile to provide useful information concerning the prognostic and potential adjuvant treatment. Currently, this is not a routine practice, nor a mandatory step for deciding the medical therapy. Typically, IHCs are based on usual kits for mammary tumors regarding ERs configuration. Prior/concomitant use of oral contraceptives and hormonal replacement therapy is not correlated with a better prognostic in melanoma; neither have they represented a contraindication for survivors of melanoma; a subset of tumors might present a higher ER expression which is potentially targeted by the hormone-based treatment as SERMs (Selective Estrogen Receptors Modulator), for instance, tamoxifen. Experimental studies on melanoma cell lines confirmed the anti-tumor activity of ERβ which might function as a prognostic marker. G-protein-coupled estrogen receptors in melanocytes and keratinocytes might be involved, too. Additional crosstalk of TGF-β (Transforming Growth Factor β), respective IGF1 (Insulin-like Growth Factor), and ERα expression are involved in tumorigenic pathways. Recent preclinical studies showed the potential benefits of diarylpropionitrile, a selective agonist of ERβ; pyrazole derivates 21-23 can block ERs. Murine melanoma models showed the interference of anti-estrogenic medication (like molecule fulvestrant) to enhance immune checkpoint blockade, a modern approach to solid cancers. The proliferation of melanoma might be partially explained by ERs; whether this is generally applicable or there is a subgroup of tumors particularly related to E status is still debatable. The subject of E status in melanoma is far from clear at this point and further studies are necessary concerning this particular issue to implement it as a practical approach in the daily management of a disease that still has a very severe prognostic nowadays.
Background: Rotator cuff tendinopathy is most often described as a continuum between the normal cuff and rotator cuff tears with calcific tendinitis having its place along this continuum. Although many studies have focused on the role of magnetic resonance imagining (MRI) in diagnosing the extent of rotator cuff tears and their associated findings with good interobserver reliability, the same cannot be stated about MRI tendinopathy findings. Because of this discrepancy in diagnostic reliability, tendinopathy tends to be overtreated with injections when associated with symptoms, thus potentially increasing the risk of calcific tendinitis and progression toward rotator cuff tears. This study aims to assess whether diagnosing shoulder MRI tendinopathy patterns through dichotomization can accelerate clinical progress toward consensus. Methods: This study is a large retrospective cohort of 184 patients that underwent a 1.5T shoulder MRI for shoulder pain. Inclusion criteria were acromioclavicular arthrosis diagnosed in patients of any age. Exclusion criteria were partial or complete rotator cuff tears. Tendinopathy was considered the dependent variable and registered as a dichotomous variable while acromioclavicular joint arthrosis together with gender was categorical and age was the continuous variable. An attempt was made to generate a clinically significant binary logistic regression to assess the odds ratio of diagnosing tendinopathy based on age, gender, and acromioclavicular joint arthrosis status. Results: An overwhelming proportion of patients was positive for tendinopathy findings (95.11%). 64.12% of patients were within the active age group with patients within the 50-59 group being diagnosed the most with rotator cuff tendinopathy. Conclusions: Due to the high variability of MRI findings that can be considered positive for rotator cuff tendinopathy, an overwhelming skew toward a positive diagnosis was observed, thus dichotomizing tendinopathy diagnosis is not appropriate for clinically relevant conclusion-making.
The recent increase in life expectancy is the main argument for a better understanding of the pathophysiological mechanisms underlying aging. These, once known, can provide possible links to therapies to prevent aging or slow down the process. Normal aging is associated with a progressive decrease in the glomerular filtration rate. Accurate estimation of GFR in the elderly is under the suspicion of multiple errors mainly due to sarcopenia and decreased protein intake. Differentiation between chronic kidney disease and the physiological decline of GFR might be a challenge in clinical practice and this has consequences on the evolution and treatment of the numerous comorbidities of the elderly. The current trend to use non-invasive diagnostic techniques explains the need to identify a serological marker to help differentiate between decreased GFR secondary to kidney aging or the development of chronic kidney disease.
Trust in health care professionals is considered as a basis for patients’ care. This study aimed to compare the level of patients' trust in physicians and nurses in both general and COVID-19 wards in a reference hospital in Tehran during the pandemic. This was a cross-sectional descriptive study. The study population comprised patients from Baqiyatallah Hospital in 2022. The data collection tool was the scale of patients’ trust in nurses and the Wake-Forest physician trust scale. Data analysis was performed using SPSS-26 software. The level of patients’ trust in physicians in COVID-19 wards was significantly lower than in Non-COVID-19 wards (P<0.001), but there was no difference between the two groups in the trust of nurses. The lowest level of trust was in the receiving of required information from nurses, which had a lower score compared to other questions in the questionnaire, and the average amount of receiving required information for patients in general wards was significantly lower than that of patients in COVID-19 (P=0.006). Trust in nurses and physicians in both COVID-19 and general wards was optimum. During the COVID-19 pandemic, the medical staff worked tirelessly and despite the difficulties and complications of the pandemic, patients have high trust in physicians and nurses.
Improving the mental health of nurses and investigating the factors affecting it leads to the improvement of job performance and the quality of nursing care. Aim: The present study aimed to determine the relationship between mental health, life satisfaction, and job satisfaction of nurses in Ilam city in 2022. The present correlational study was carried out on 160 nurses working in educational hospitals of Ilam city and was selected by stratified random sampling in 2022. A four-part questionnaire was used: the first part included a question on demographic information. Minnesota Satisfaction Questionnaire (MSQ) (1977), Diener et al.'s Satisfaction with Life Scale (SWLS) (1985), and Derogatis et al.'s Symptom Checklist-90 (SCL-9) (1973) were included in the second, third and the fourth parts, respectively. Results showed no significant relationship between the total score of mental health and the total score of job satisfaction. There was a significant relationship between the total job satisfaction score and life satisfaction score (r=0.267, p=0.001). There was also an inverse and significant relationship between the total mental health score and the life satisfaction score (r=0.294, p=0.001). The collected data was analyzed using descriptive tests (frequency, mean percentage, and standard deviation) and non-parametric Spearman and Kruskal-Walli’s correlation tests in SPSS ver. 22. P- value<0.05 was considered as the significance level in all tests. Job satisfaction is effective in creating motivation, efficiency, responsibility, and social accountability in the personnel of any organization. Job dissatisfaction can lead to complications such as job burnout, illness, absenteeism, the job left, leaving many nursing jobs, and the reluctance of the young workforce to attend the wards. Therefore, it is necessary to make further efforts in this field by healthcare policymakers.
Hippo signaling has been recognized as a newly identified tumor suppressor signaling pathway that can regulate cellular processes including regeneration, cell death, differentiation, and development. Its dysregulation through overexpression of YAP (Yes-associated protein) and TAZ (PDZ-binding motif) as two main oncogenic factors of the Hippo pathway has a crucial role in several cancers. Because of the limited prognosis and therapeutic targets, further understanding of molecular pathways involved in tumorigenesis is one of the interesting issues in studies. Here, we demonstrated that some viruses, through dysregulation of the Hippo signaling pathway can be implicated in transformation, metastasis, and chemotherapeutic drug resistance in virus-related cancer and also help processes involved in the pathogenesis of viral infection such as persistence.
We wanted to evaluate the efficacy of intravenous immunoglobulin (IVIG) treatment in Covid-19 patients in the intensive care unit (ICU). Sixteen (66.7%) male and 8 (33.3%) female adult severe Covid-19 patients who were treated with IVIG in the tertiary ICU between April 2020 and October 2021 at Ankara City Hospital were retrospectively reviewed. The median age of the patients was 63 (interquartile range (IQR):19). The patients were evaluated in terms of laboratory values and clinical results before and after IVIG treatment. There was no statistically significant difference between survived and deceased Covid-19 patients treated with IVIG in terms of age, gender, the onset of symptoms, presence of concomitant diseases, APACHE-II scores, duration of mechanical ventilator support, and length of stay in the ICU. When the laboratory values before and after IVIG treatment were compared, a significant decrease was identified only in alanine transaminase levels (p=0.01). However, there was a statistically significant difference in mortality in 5 patients with Guillain-Barré syndrome who all survived (p=0.001). IVIG treatment was effective in Covid-19 patients with Guillain-Barré syndrome. However, IVIG treatment did not have a statistically significant effect on pre and post-treatment laboratory values, morbidity, and mortality of severe Covid-19 patients in the ICU.
As general population tends to have increasing life expectancy, the risk associated with developing chronic kidney disease (CKD) with multiple incapacitating concequences, also increases. Method: For the present study, we registered the data from the observation files of 37 patients diagnosed with CKD undergoing treatment by chronic hemodialysis and noted the CKD associated diagnoses included in the notion of comorbidities. We monitored their statistical incidence both in the whole group and separately, in women and men using TTEST and CORREL. Results: The median age of the subjects was 55.86 (± 12.00) years. The study population mean weight was 74.90 (± 14.44) kg, with a mean weight of 69.33 kg for female subjects, and 77.92 kg for males, respectively. Diabetes was identified in 35.13% of patients, whilst heart failure was present in 16.21% of patients. Conclusions: Following the analysis of the information about the patients with CKD in the dialysis program, which we included in the study group, we observed the existence of variations that occur with age, significant correlations between age and weight and between albuminemia and weight. The most common comorbidity is high blood pressure followed by anemia.
