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The quality of life in was analyzed in 248 patients with liver cirrhosis with portal hypertension after portosystemic shunting. All patients underwent decompressive surgery options, in 135 cases - a selective distal splenorenal anastomosis, in 113 cases- different versions of the central decompression. In the study used a questionnaire developed by Younossi ZM et al. (1999) for patients with chronic liver diseases - The Chronic Liver Disease Questionnaire (CLDQ). It is proved that PSS not only does not degrade the quality of life indicator in patients with risk of hemorrhage from esophageal and gastric varices, but also slightly improves the value. In the remote period after the shunting, progressive pathological process in the liver contributes to the development of functional disability of hepatocytes, that in terms of adequate decompression is the main cause of a fatal outcome. This trend was obtained for all parameters of the analysis of the quality of life indicator, with a gradual deterioration of values with increasing of observation period length. Depending on the type of decompression, noted the following features. In patients with the central anastomoses, the range of liver complications was dominated (liver failure, encephalopathy). On the background of selective decompression, in which in the short term is possible to maintain a high residual portal pressure, noted the prevalence of edematous-ascitic syndrome and the development of a hemorrhagic syndrome, even in the functional capable shunt. At the same time, to 6-12 months after the distal anastomosis, hemodynamic reorganization in the portal system generally leads to an increase in the degree of decompression, leveling the rate of specific complications for this type of shunting.

Abstract Rapid wound healing using platelet‐rich growth factors (PRGF), stem cells, and probiotics is important due to their positive effects on skin regeneration and antibacterial activities. A novel method was employed to fabricate a biomaterial multi‐layered electrospun scaffold composed of polyurethane, PRGF, and gelatin fibers. This scaffold was used to induce mesenchymal stem cells with fibroblast cells (co‐cultured cells) and Lactobacillus plantarum. The scaffolds were analyzed for physical, mechanical, and biological characteristics. The results showed that the nanocomposite scaffolds had a higher Young's modulus and decreased contact angle. Scanning electron microscope and MTT assays demonstrated improved spreading, density, and proliferation of co‐culture cells and L. plantarum on the PU/PRGF/gelatin/PU scaffolds. Additionally, L. plantarum showed antibacterial effects on Pseudomonas aeruginosa, Staphylococcus aureus, and Escherichia coli. Furthermore, in vivo studies showed that the PU/PRGF/gelatin/PU scaffold with Co and L.p was implanted on the full‐thickness skin wound of the rat's dorsal area, resulting in high pathological scores and aesthetic macroscopic results that demonstrated greater wound repair efficacy compared to the control groups. Based on the results, PU/PRGF/gelatin/PU containing the co‐culture cells and L. plantarum showed better potential for cell attachment, angiogenesis, proliferation, prevention of infection, and accelerated wound healing in rats. Highlights Multi‐layered scaffold designed to mimic the architectures found in tissue layers. Co‐culture involves diverse cell populations with varying levels of interaction. Antibacterial activity inhibits target bacteria growth without harming nearby tissues. Full‐thickness wounds penetrate beyond the dermis and epidermis layers of the skin. Wound healing involves a number of stage‐specific molecular pathways.

Abstract Background Innovation in nursing involves applying new knowledge to create novel ideas, methods, or technologies, resulting in higher-quality care and improved patient outcomes. Adequate support for innovation is crucial for progress in nursing. This study aimed to translate the Innovation Support Inventory (ISI-12) into Persian and assess its psychometric properties specifically among clinical nurses. Methods A methodological cross-sectional study was conducted from September 2022 to July 2023 to evaluate the face, content, and construct validity of the ISI-12. Construct validity was assessed through confirmatory factor analysis (CFA) and convergent and discriminant validity evaluation using data obtained from 321 clinical nurses. The test–retest stability and internal consistency of the ISI-12 were also evaluated to assess its reliability. Results The Persian version of the ISI-12 validation through confirmatory factor analysis has confirmed its fit with the proposed three-factor model. The ISI-12 demonstrated high reliability, as evidenced by a Cronbach's alpha coefficient (α = 0.969), McDonald's omega coefficient (ω = 0.922), coefficient H (H = 0.979), and mean inter-item correlation (ρ = 0.418). Additionally, the stability of the ISI-12 during two weeks among 40 clinical nurses was found to be excellent, with an ICC of 0.951. Conclusion The Persian version of the ISI-12 is a valid inventory for evaluating the innovation Support of clinical nurses.

Amylases are one of the biotechnologically important enzymes that have multiple applications in the food, pharmaceutical, cosmetics, textile, detergent, paper and pulp, bioremediation and nano-biotechnology industries. Amylases can be isolated from animals, plants and microbial regions, but nowadays enzymes from prokaryotic species have gained more importance. Among the microbes, amylases from Bacillus cereus have gained considerable demand in various industrial sectors. Growing industrial demand for enzymes compels the availability of enzymes in large quantities that can only be achieved by employing efficient fermentation techniques. Therefore, the current study is aimed at the statistical optimisation of the production conditions for extracellular amylase production from Bacillus strain AS2. In a recent study, the optimum amylase producing AS2 strain was identified on a molecular level, and it was found that it has close relation with the already reported strains of Bacillus cereus. The further enzyme production was optimised by using a statistical optimisation tool. A full-factorial central composite design (CCD) consisting of 53 experiments was designed using six significant variables (incubation period, pH, temperature, carbon and nitrogen source and metal ion). The analysis revealed that the optimal media concentrations were 54.34 g.L-1 starch, 0.63 g.L-1 CaCl2, 1 g.L-1 glycine, pH 7.0, 76 h, and 40 °C, respectively. A 1.23-fold increase in the enzyme yield (1 050 IU.mL-1.min-1) was noticed as compared to the original production level. The statistical optimisation approach gives the exact variables that influence the enzyme production and, hence, offers the best way to optimise the bioprocess. The optimised enzyme can be used in industries for various purposes such as de-sizing, de-inking, hydrolysing starch residues, etc.

Abstract Background Improving the ethical competencies of nursing students, as an important dimension of professional competence, is a primary objective of nursing education. Thus, this study aimed to explore a guide for codes of ethics for the development of ethical competence among nursing students in the healthcare system of Iran. Methods This is a systematic review and meta-synthesis of qualitative studies conducted in the healthcare system of Iran. The review included studies published between January 1, 2000 and March 2024. We conducted a comprehensive search in various international and national databases, including Web of Science, PubMed, Embase, PsycINFO, Cochrane Library, CINAHL, Scopus, Barakatns, MagIran and SID. Initially, 86 qualitative studies were identified, and after a meticulous screening process, 39 studies were carefully reviewed. Finally, 10 qualitative studies were selected for analysis. The meta-synthesis employed an interpretive approach by thematic synthesis. Results Based on our results, four main themes and 10 categories, along with summarized codes, were extracted as crucial elements of the codes of ethics for the professional competence of Iranian nursing students. The main themes identified were knowledge, standards, experiences, and attitudes (KSEA). Conclusions The concept of codes of ethics for developing professional competencies in Iranian nursing students was detected as a multidimensional concept with four major areas. By emphasizing the rights of clients and the standardization of nursing practice, this set of ethical codes can contribute to preventing clinical errors and legal issues at hospitals and educational settings. Furthermore, it fosters a positive environment that encourages professional behaviors among nursing students. Nursing students, as future nurses, should apply codes of ethics when facing emerging ethical challenges. Nurse educators have a crucial role in providing students with the necessary preparation and guidance during their professional socialization process in nursing schools.

Abstract Background Effective feedback is fundamental in clinical education, as it allows trainers to constantly diagnose the trainees’ condition, determine their weaknesses, and intervene at proper times. Recently, different feedback-based approaches have been introduced in clinical training; however, the effectiveness of such interventions still needs to be studied extensively, especially in the perioperative field. Therefore, this study sought to compare the effects of apprenticeship training using sandwich feedback and traditional methods on the perioperative competence and performance of Operating Room (OR) technology students. Methods Thirty final-semester undergraduate OR technology students taking the apprenticeship courses were randomly allocated into experimental (n = 15) and control (n = 15) groups through the stratified randomization approach. The students in the experimental group experienced Feedback-Based Learning (FBL) using a sandwich model, and the students in the control group participated in Traditional-Based Training (TBT) in six five-hour sessions weekly for three consecutive weeks. All students completed the Persian version of the Perceived Perioperative Competence Scale-Revised (PPCS-R) on the first and last days of interventions. Also, a blinded rater completed a checklist to evaluate all students’ performance via Direct Observation of Procedural Skills (DOPS) on the last intervention day. Besides, the students in the FBL filled out a questionnaire regarding their attitude toward the implemented program. Results The mean total score of the PPCS-R was significantly higher in the FBL than in the TBT on the last intervention day (P

Antibiotic-resistant bacteria have increased in livestock and poultry over recent years. However, to date, there have been few studies that have investigated the antibiotic resistance bacteria among environmental and animal samples. Hence, the main purpose of this research was to isolate Enterobacteriaceae from the wastewater of poultry farms and investigate the pattern of antibiotic resistance in these bacteria. In this study, 100 wastewater samples were isolated from different poultry farms. These strains were identified using biochemical tests. The antibiotic resistance pattern was determined by the disk diffusion method (Kirby–Bauer). The isolated bacteria were investigated in terms of resistance patterns to cephalexin, tylosin, doxycycline, and erythromycin. A total of 170 Gram-negative bacteria from the Enterobacteriaceae family were isolated from poultry wastewater samples. The most isolated strain was Escherichia coli (35.33%), followed by Klebsiella (17.65%). According to this study, the most resistance was to cephalexin and doxycycline antibiotics. The results of this research indicate a high level of antibiotic resistance in bacterial isolates from wastewater. This is probably be due to the improper use of antibiotics in the poultry industry.

Abstract Background Moral distress is a multifactorial and complex phenomenon influenced by various individual, cultural, and systemic factors. This study aimed to investigate the frequency and intensity of nurses’ moral distress, explore their experiences, and develop the conceptual model of risk factors of moral distress in surgical units and operating rooms. Method This is a sequential mixed-method study conducted at four teaching hospitals affiliated with the Qom University of Medical Sciences. In the first step, the moral distress of nurses in surgical units and operating rooms was investigated by a survey. The participants included nurses who worked in the operating room and surgical units. (n = 180). The data was collected by a Moral Distress Scale-Revised (MDS-R) questionnaire. In the second step, the experiences of nurses regarding risk factors of moral distress were explored using semi-structured interviews and analyzed using the conventional content analysis by Graneheim and Lundman’s approach. Results One hundred eighty nurses participated in this study. The mean total moral distress scores ranged from 12 to 221, with a mean (SD) of 116.8 (42.73). The causes of moral distress cited with the highest frequency and intensity related to the ‘role of healthcare providers’. The experiences of the participants in the theme ‘Inductive process of moral distress development’ were categorized into three categories: ‘Melting into the faulty system’, ‘Power and the system as distress promotors’, and ‘Perceived unpleasant consequences’. Conclusion The results indicated that the frequency of moral distress in operating rooms and surgical units was at a moderate level and the distress intensity of nurses was at a moderately high level. The results indicated that in the investigated system, the “inductive moral process of distress development” was continuously understood by the participants. This process was influenced by systemic and individual factors. Weak assertiveness, conservative compromise, and desensitization to unprofessionalism as individual factors were effective in causing distress. Risk factors at the systemic level led nurses to melt into the faulty system and created adverse outcomes at the individual level. The lack of systemic support and the stabilization of mobbing by powerful system members had a negative impact on the individual factors of distress development. Also, these factors directly cause negative consequences.

Hepatitis B virus (HBV) is the causes of liver infection and associated with cirrhosis, carcinoma, and fibrosis of liver. In this research study, we conducted an observational study to evaluate the distribution of HBV infection and its genotypes in selected cities of Khyber Pakhtunkhwa, Pakistan. A total of 426 samples were collected from selected cities of Khyber Pakhtunkhwa. Mardan (n = 163), Dir (Lower) (n = 116), Malakand (n = 53), Miran Shah (n = 29), Dera Ismail Khan (n = 28), Swat (n = 22), and Hangu (n = 15). For molecular identification of hepatitis B virus infection, the ICT (Immunochromatographic techniques) kits were used for the Screening of Hepatitis B virus infection among general population. The positive samples of ICT test were further subjected to Real-time Polymerase chain reaction (PCR), of which 282 (66.2 %) were males, and 144 (33.8 %) were females. Out of 426 ICT kit positive samples, 218 (51.18 %) were found PCR positive. The maximum number of positive cases, 157 (36.86 %), was found between 15 and 34 years. Sixty samples were further processed for HBV genotyping. A mixed genotype was detected in 29 (48.3 %) individuals, followed by genotype D in 23 (38.3 %) and untypable in 8 (13.3 %). The positivity rate of HBV was recorded high among males compared to females. Most patients who reported positive for HBV were co-infected with two genotypes. This research will help to provide background information to government and health authorities to raise public awareness and improve the capacity of the healthcare delivery system for hepatitis B virus infection.

Background and purpose: Antimicrobial property is one of the important features of sealers, which plays an essential role in limiting microorganisms from the root canal system. This study was conducted to investigate the antimicrobial properties of EndosealMTA, Sure seal root, and AH26 sealers on Enterococcus faecalis bacteria. Materials and methods: In this study, ceramic sealers Endoseal MTA, suersealroot, and resin sealer AH26 were used. Each of these sealers was placed in wells in the agar medium for 10-15 minutes to spread and then immediately incubated at 35±2°C for 24 hours. Statistical analysis was performed using SPSS (V.22), with the application of Shapiro-Wilk, Kruskal-Wallis, and ANOVA tests. Results: The highest mean halo of non-growth was related to the Endoseal MTA group. The antimicrobial property of Suresealroot sealer was lower compared to AH26 sealer, but this difference was not statistically significant. (P=0.368). The antimicrobial property of Endoseal MTA sealer was higher compared to AH26 sealer, but this difference was not statistically significant (P=0.368). The antimicrobial properties of Suresealroot sealer were lower compared to Endoseal MTA, but there was no statistically significant difference (P=0.48). Conclusion: Ceramic sealers Suresealroot, Endo seal MTA and AH26 resin sealer showed antimicrobial properties against Enterococcus faecalis; But the antimicrobial properties of Ceramic Sealers were not different from resin sealer on Enterococcus faecalis

Cleft lip and palate as one of the most common congenital malformations of the oral cavity is affected by genetic and environmental factors. Subsequent aspiration during feeding, aesthetic, speech, or functional problems, and dental malformations are the main problems of neonates born with cleft lip and palate. The management of neonates with cleft lip and palate has been remarkably improved in recent years. The use of modern surgical techniques and its combination with such methods as presurgical nasoalveolar molding (NAM) is on the rise. The efficacy of preoperative casting in repairing deformed nasal cartilage in neonates with cleft lip and palate has been confirmed based on the literature. Here, we present the case of a 20-day-old neonate with bilateral cleft lip and palate who underwent presurgical nasoalveolar molding to facilitate feeding and recover facial appearance. The bony cleft of maxillary segments in the child was molded and repositioned with a combination of extra-oral elastic and intra-oral appliances. Elastic forces caused backward pressure against the protruding pre-maxilla and careful use of forces on the cleft segments improved their positions and allowed definitive muscles and lip repair. In this technique, a nasal stent was attached to the intra-oral mouth plate and was designed to improve nasolabial anatomy.

BACKGROUND: With the escalating utilization of online health education programs and the growing prevalence of infertility, there is an urgent requirement for a comprehensive and effective online platform that caters to the unique needs of couples facing infertility. This study aims to investigate and understand the needs and potential benefits of implementing an online reproductive health education program for infertile couples. MATERIALS AND METHODS: This research was a qualitative study conducted in Shahroud City, Iran from May 2022 to June 2022. Sixteen semi-structured interviews were conducted with infertile people and key informants. Sampling method used in this study was purpose-based with maximum variety. All interviews were digitally recorded and transcribed verbatim in Persian and analyzed using conventional content analysis approach. MAXQDA software version 12 was used to facilitate data analysis. RESULTS: From the data analysis, 2 themes, 3 main categories, and 16 subcategories emerged. The themes included “Reproductive Health Education Needs” and “Preferences for Internet-based Reproductive Health Education and Support.” The first theme consisted 2 categories Reproductive health literacy and Emotional and Psychological Support. The second theme included one category: Technical and Logistical Considerations. CONCLUSION: The data analysis of this study has revealed significant insights into the needs and preferences of infertile couples regarding Internet-based reproductive health education and support. These findings provide valuable guidance for the development and implementation of Internet-based reproductive health education programs tailored to the specific needs of infertile couples.

Background and purpose: Palate and lip cleft are prevalent congenital deformities in children that have a multi-factorial etiology involving both genetic and environmental factors. The present study assessed the orthodontic-related quality of life in children with palate and lip cleft. Materials and methods: This descriptive cross-sectional study was conducted in 83 people with palate and lip cleft attending private dental clinics in Sari, Iran. They were selected via convenience sampling. Orthognathic quality of life questionnaire was completed by patients. The validity and reliability of the questionnaire is confirmed. The quality of life of the participants was determined from different dimensions, including social aspects, dental-facial beauty, oral function, and awareness of dental-facial beauty. One-way analysis of variance, t-test, and Pearson's correlation coefficient were used to analyze the data. Results: The study included 41 girls and 42 boys with mean age of 12.46 years (8-18 years of age). The frequency of cleft lip and palate, cleft lip, and cleft palate were 49.4%, 22.9%, and 27.7%, respectively. The study showed no significant difference between patients with different types of cleft lip and palate in terms of the total score for quality of life and its dimensions (P=0.02). We found no significant relationship between age and dimensions of quality of life (P

Abstract Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease started in late 2019 and still continues as a global pandemic, spreading among people around the world. There is limited knowledge about the role of contaminated environmental surfaces, especially high-touch public surfaces, in the transmission of the disease. The objective of the present investigation was detection of different variants (Delta, UK, and Omicron) of SARS-CoV-2 RNA (genome) on inanimate surfaces in high-touch public environmental surfaces in different seasons. Automated teller machines of banks (ATM), point-of-sale (POS) machine, gas station pump nozzles, and escalator handrails of malls were selected as high-touch environmental surfaces in public places. Overall, 75 samples were collected from these places and examined for the presence of SARS-CoV-2 RNA (genome), and 21 samples (28%) were positive. Although the role of fomite transmission of COVID-19 is understood, more studies should be conducted to determine the virus survival rate as well as the required efforts to prevent the spread of SARS-CoV-2 such as frequent cleaning and the use of efficient disinfectants on environmental surfaces, especially high-touch public places. In conclusion, the results address the importance of touching contaminated inanimate objects as well as transmission through environmental surfaces, and they could be used to establish an effective protocol to prevent indirect environmental transmission of SARS-CoV-2, slow down the spread of the virus, and reduce the risk of infection.

Abstract Starch is added to the fabric surface to secure weaving process. During finishing these sized particles are removed from the fabric and prepared it for printing and dyeing. Chemicals de-sizing agents damage fabric surfaces and reduce the quality of the product. An alternative to these conventional desizing agents is the use of biological molecules i.e. enzymes. The current study compares traditional de-sizing to bio-based de-sizing methods, as well as the optimization of fabric desizing settings using crude amylase. Amylase-producing Bacillus cereus AS2 was isolated from indigenous soil samples. The maximal fermentative de-sizing capability was discovered at 72 h, with no fabric surface degradation. Chemical desizing showed that the fabric lost all sizing agents to TEGEWA scale 9 within 1 h in presence of 5N HCl. Optimal studies for desizing showed that 1000 IU/ml of amylase resulted in maximum de-sizing within 15 h at 60 °C and 0.5% Triton-X. Water absorbance and weight loss, both parameters were used to check the desizing efficacy and it was found that de-sizing to same scale was occurred in the case of enzyme as well as commercially desized fabric. Enzyme desized cloth was found to be free of any starch particles in SEM micrographs, identical to industrially de-sized fabric, ensuring bioprocess efficacy.

Innovative approaches are urgently required to treat divestating bacterial diseases in the face of rising bacterial resistance rates. The current investigative work focused on hydro-distilling Tasmanian blue gum (Eucalyptus globulus) to isolate the essential oil, which was then tested for bioactivity, antioxidant capacity, and antibacterial activity using in-vitro and in silico assays. The antioxidant activity was avualated against DPPH and FRAP. With results of 69.63 RSA (%) (µL/L AAE) at a concentration of 5 mL/L and 51.56 (µL/L AAE) at concentration of 90 ppm in the 2,20-diphenyl-1-picryl hydrazyl (DPPH) and ferric reducing antioxidant power (FRAP) assays, respectively, the extracted oil indicated considerable antioxidant activity. The extracted oil demonstrated powerful antibacterial activity in in-vitro tests against both Gram-positive and Gram-negative bacterial strains, including Bordetella bronchiseptica (21 mm), Staphylococcus epidermidis (19 mm), and Staphylococcus aureus (19 mm), with significant minimal inhibitory (MIC) and minimum bactericidal (MIB) concentrations. Additionally, GC-MS analysis of the oil from E. globulus identified several low-molecular-weight compounds, including Eucalyptol, γ-Terpinene, Shisool acetate, 1,3-trans,5-cis-Octatriene, 2,6-Dimethyl-1,3,5,7-octatetraene, E,E, Cyclohexene, 1-methyl-4-(1-methylethylidene), Benzene, 1-methyl-4-(1-methylethenyl), Butanoic acid, 3-methyl-, 3-methylbutyl ester, and 1,3,8-p-Menthatriene. Several other compounds were also identified, including Fenchol, 2-Methyl-trans-3a,4,7,7a-tetrahydroindane, (E,E,E)-2,4,6-Octatriene, 1,2,3,6-Tetrahydrobenzylalcohol, acetate, Alloaromadendrene, Phenol, 2-ethyl-4,5-dimethyl, Phenol, 2-methyl-5-(1-methylethyl)-, p-Cymen-7-ol, 1,5,5-Trimethyl-6-methylene-cyclohexene, 1,3-Cyclohexadiene, 1-methyl-4-(1-methylethyl)-, 2,6-Octadien-1-ol, 3,7-dimethyl-, acetate, (Z), and more. The bioactive potential of Eucalyptus globulus essential oil against 1AJ6 and 1R4U was highlighted by molecular docking analyses, suggesting its utility as a natural source of antioxidant and antibacterial compounds with the potential to replace chemical disinfectants in a variety of applications.

Abstract Background Vaginal birth management is vital to midwifery education and practice in which midwives are most likely to be directly involved. This situation requires strong cognitive, technical, communicational, and teamwork skills. Therefore, the present study was conducted to evaluate the effect of normal vaginal birth simulation training before formal clinical education on the clinical skills of midwifery students compared with routine clinical education. Methods This quasi-experimental study was conducted at the Shoushtar Faculty of Medical Sciences from September 2018 to August 2021. Sixty-one midwifery students participated in the intervention group (n = 31) and in the control group (n = 30). The intervention group participated in the simulation-based training before entering the formal clinical education courses. The control group received no simulation-based training before their formal clinical education. The clinical skills of these students for performing normal vaginal birth in the real field were evaluated by observational examination in the three years (fourth, fifth, and sixth semesters). Data were analyzed by descriptive (mean, SD, and percentage) and inferential statistics (independent t-test and chi-square). A P-value less than 0.05 was considered significant. Results The mean score of midwives’ skills in the control group was (28.10 ± 3.42) and in the intervention group, it was (31.15 ± 4.30). The difference in the skill score between the groups was statistically significant (3.40 ± 0.68). The results showed that in the intervention group, 29 students (93.93%) were evaluated from a good to an excellent level, while only ten students (32.71%) in the control group achieved a good level, and others (n = 30) were evaluated at a low level (p

Abstract Background The mental health and well-being of millions of people worldwide are negatively impacted by infertility. A promising solution to meet the needs of people suffering from infertility is e-health interventions, such as online counseling and support groups. This study aims to review the current literature on e-health interventions and how they impact people with infertility. Main body of the abstract Relevant studies were searched in PubMed, Web of Science, and Scopus databases. Articles were entered into the EndNote software and screened for duplicates and relevance. Two authors then reviewed full-text articles independently, with a third person resolving any disagreements. Thirteen studies conducted between 2007 and 2022 were identified. The interventions aimed to meet various needs, including training on drug use (n = 23), lifestyle modifications (n = 1), periconceptional behavior modifications (n = 1), drug management (n = 1), IVF training (n = 4), psychological support to reduce distress (n = 4), and promoting a positive sexual self-concept (n = 1). Short conclusion The limited number of e-health interventions for infertile patients, the heterogeneity of interventions, and the lack of long-term effectiveness data make it challenging to compare e-health interventions to nonelectronic alternatives. However, the increasing use of technology in healthcare, especially during and after the Covid-19 pandemic, suggests that e-health educational interventions such as those using the Internet, psychological support, and patient interaction will continue to play a crucial role in healthcare.

Background: The outbreak of Coronavirus Disease 2019 (COVID-19) has originated from Wuhan, China and rapidly spread all over the world. This disease is caused by a coronavirus termed Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) that mainly infects the human respiratory tract. Herbal agents including Atractylodes lancea, Ephedra, Curcumin, and Echinacea purpurea had immunomodulatory effects and antiviral activities on other respiratory viruses including Influenza virus. They strengthen the innate immunity through increasing the phagocytic activity and anti-inflammatory activity. These herbs could be used as a complementary therapy to prevent entry of COVID-19 and improve immune system. This review delves into the role and therapeutic compounds of various herbal agents in relation to immunity, their effectiveness in treating other viral respiratory illnesses, and their potential influence on COVID-19 disease.

Staphylococcus aureus is part of normal human flora and is widely associated with hospital-acquired bacteremia. S. aureus has shown a diverse array of resistance to environmental stresses and antibiotics. Methicillin-resistant S. aureus (MRSA) is on the high priority list of new antibiotics discovery and glycopeptides are considered the last drug of choice against MRSA. S. aureus has developed resistance against glycopeptides and the emergence of vancomycin-intermediate-resistant, vancomycin-resistant, and teicoplanin-resistant strains is globally reported. Teicoplanin-associated genes tcaR-tcaA-tcaB (tcaRAB) is known as the S. aureus glycopeptide resistance operon that is associated with glycopeptide resistance. Here, for the first time, the role of tcaRAB in S. aureus persister cells formation, and ΔtcaA dependent persisters’ ability to resuscitate the bacterial population was explored. We recovered a clinical strain of MRSA from a COVID-19 patient which showed a high level of resistance to teicoplanin, vancomycin, and methicillin. Whole genome RNA sequencing revealed that the tcaRAB operon expression was altered followed by high expression of glyS and sgtB. The RNA-seq data revealed a significant decrease in tcaA (p = 0.008) and tcaB (p = 0.04) expression while tcaR was not significantly altered. We knocked down tcaA, tcaB, and tcaR using CRISPR-dCas9 and the results showed that when tcaA was suppressed by dCas9, a significant increase was witnessed in persister cells while tcaB suppression did not induce persistence. The results were further evaluated by creating a tcaA mutant that showed ΔtcaA formed a significant increase in persisters in comparison to the wild type. Based on our findings, we concluded that tcaA is the gene that increases persister cells and glycopeptide resistance and could be a potential therapeutic target in S. aureus.

Coeliac disease (CD) is associated with alterations in gut microbiota composition. This study evaluated the effects of probiotics on gut microbiota composition and clinical symptoms of treated CD patients. In this double-blind, placebo-controlled trial study, 31 CD patients that were randomly classified as probiotics (n = 15) and placebo (n = 16) groups received 109 colony-forming units/capsule for 12 weeks. Fecal samples were collected before and after probiotics, or placebo administration and the changes in intestinal microbiota were assessed by quantitative real-time PCR. Probiotic administration improved the patients' clinical symptoms when compared to the placebo group. Fatigue score was significantly reduced by the intake of probiotic supplements (P = 0.02). Except for Staphylococcus spp., the relative abundances of Bacteroidetes, Lactobacillus spp., Bifidobacterium spp., Clostridium cluster I, Enterobacteriaceae, and Firmicutes were higher in probiotics group. Accordingly, a 12-week multi-strain probiotic treatment regimen may modify the composition of intestinal microbiota and improve GI symptoms in CD patients.

Citrobacter freundii is characterized by AmpC β-lactamases that develop resistance to β-lactam antibiotics. The production of extended-spectrum β-lactamase (ESBL) is substantially high in Escherichia coli, C. freundii, Enterobacter cloacae, and Serratia marcescens, but infrequently explored in C. freundii. The present investigation characterized the ESBL C. freundii and delineated the genes involved in decrease in antibiotics resistance. We used the VITEK-2 system and Analytical Profile Index (API) kit to characterize and identify the Citrobacter isolates. The mRNA level of AmpC and AmpR was determined by RT-qPCR, and gel-shift assay was performed to evaluate protein-DNA binding. Here, a total of 26 Citrobacter strains were isolated from COVID-19 patients that showed varying degrees of antibiotic resistance. We examined and characterized the multidrug resistant C. freundii that showed ESBL production. The RT-qPCR analysis revealed that the AmpC mRNA expression is significantly high followed by a high level of AmpR. We sequenced the AmpC and AmpR genes that revealed the AmpR has four novel mutations in comparison to the reference genome namely; Thr64Ile, Arg86Ser, Asp135Val, and Ile183Leu while AmpC remained intact. The ΔAmpR mutant analysis revealed that the AmpR positively regulates oxidative stress response and decreases β-lactam and aminoglycosides resistance. The AmpC and AmpR high expression was associated with resistance to tazobactam, ampicillin, gentamicin, nitrofurantoin, and cephalosporins whereas AmpR deletion reduced β-lactam and aminoglycosides resistance. We conclude that AmpR is a positive regulator of AmpC that stimulates β-lactamases which inactivate multiple antibiotics.

Background: No evidence exists for the lowest effective dose of magnesium on menstrual pain. Objective: To determine and compare the effects of two different doses of magnesium on pain intensity and menstrual blood loss in students with primary dysmenorrhea. Methods: Sixty dysmenorrhea patients were randomly assigned to one of two therapeutic groups and one placebo group (receiving one tablet a day of 300 or 150 mg magnesium sulphate or placebo from the 15th cycle day until no pain existed on the following cycle). Visual analogue scale (VAS) and Hjgham collected data for two cycles before and two cycles after the intervention. The data were analyzed using one-way ANOVA and ANCOVA tests. Findings: No significant difference was observed between the groups in terms of baseline characteristics. Both intervention groups outperformed the placebo group in terms of pain intensity (adjusted differences of -2.9, 95% confidence intervals of -3.3 to -2.4 and -1.9, -2.4 to -1.5, respectively) and menstrual bleeding (-20.0, -26.0 to -14.0, and -13.0, -19.0 to -7.0, respectively), as well as the secondary outcome, i.e. rest duration and ibuprofen consumption. In terms of pain alleviation and menstrual bleeding, participants in the 300 mg magnesium group outperformed those in the 150 mg magnesium group. No significant difference was observed between intervention groups regarding secondary outcomes. Conclusion: Both magnesium levels are useful in alleviating pain and reducing menstrual bleeding, although 300 mg of magnesium was more effective.

Excessive abstraction of groundwater aquifers in the country has caused a sharp drop in the aquifer water level and the loss of aquatic aquifers, the effects of which is the phenomenon of subsidence. In this study, simulation of groundwater level changes in Marvdasht-Kharameh basin from a validation period and processing of a large set of raw data in Modflow mathematical model was used. The output results of sensitivity analysis of effective parameters in the calibration of Marvdasht aquifer show the maximum effect of hydraulic conductivity parameters and horizontal hydraulic conductance anisotropy and a set of linear groups of water supply network. Therefore, it is in line with the statistics of the Fars Regional Water Organization that there are wells with high discharge in these areas. According to the conditions of the aquifer, if the current operation trend continues, it is predicted that the groundwater level will drop by 15 meters during the years 2019 to 2029. Also, according to the average land subsidence, which averages 0.76 meters per 10 meters. The average land subsidence with the current harvest trend in the next ten years is predictable 114.78 cm and with a 30% increase in harvest, the rate of aquifer decline over the next 20 years is about 37 meters with an annual decline of about It is 1.9 meters. Land subsidence in this case is also predicted to be about 280 cm. Finally, according to the maps prepared from Marvdasht aquifer, due to the alluvial nature of the groundwater aquifer, the effect of water level drop can be observed from a short distance. The rate of subsidence in the southern and southwestern margins of the plain due to the low thickness of sediments and in the northern and northeastern parts of the plain due to coarse-grained sediments, is less than the central parts of the plain.