Background
Palliative care (PC) is a new concept in Iraq, and there is no training for health care specialists or the public. The lack of education and training programs is the most important barrier ...for PC. Intermediate training is needed for nurses who regularly manage patients with life-threatening diseases. The End-of-Life Nursing Education Consortium for pediatric palliative care (PPC) program is intended for nurses who are interested in providing care to children with life-limiting diseases or providing support in the event of an accident or unexpected death.
Objective
Our trial aims to evaluate the effect of a web-based training course, using the Normalization Process Theory. It focuses on how complex interventions become routinely embedded in practice and on training of a sample of academic nurses in the application of PPC in routine daily practice. It hypothesizes that nurses will be able to provide PC for the pediatric population after completing the training.
Methods
This is a multicenter, parallel, pragmatic trial in 5 health care settings spread across a single city in Babylon Province, Iraq. Participants will be recruited and stratified into 2 categories (critical care units and noncritical care units). In the experimental condition, 86 nurses will be trained in the application of PPC for 2 weeks through a web-based training course powered by the Relais Platform. The nurses will be invited to participate via email or instant messaging (WhatsApp, Telegram, or Viber). They will provide end-of-life care in addition to usual care to children and adolescents with life-limiting conditions. In the control condition, 86 nurses will continue usual care. The program’s effectiveness will be assessed at the level of nurses only. We will compare baseline findings (before the intervention) with postintervention findings (after completing the training course). A further assessment will be performed 3 months after the course. As numerous unidentified factors can influence the effect of the training, we will perform a progressive evaluation to assess sample selection, application, and intervention value, as well as implementation difficulties. The nursing staff will not be blinded to the intervention, but will be blinded to the results.
Results
The study trial recruitment opened in July 2020. The first outcomes became available in December 2020.
Conclusions
The trial attempts to clarify the delivery of PC at the end of life through the implementation of a web-based training course among Iraqi nurses in the pediatric field. The study strengths include the usual practice setting, staff training, readiness of staff to participate in the study, and random allocation to the intervention. However, participants may drop out after being transferred to another department during the study period.
Trial Registration
ClinicalTrials.gov NCT04461561; https://clinicaltrials.gov/ct2/show/NCT04461561
International Registered Report Identifier (IRRID)
PRR1-10.2196/23783
In event of zoonotic emergencies, an OH approach provides platform for an effective response, aiding in accurate decision making, proper situational assessment and well-structured response leading to ...better management of events in form of less mortality 9, 10. ...there are economic benefits, as there is efficient use of limited resources in handling outbreaks, which when coupled with the effectiveness of the mutisectorial collaboration results in the reduction of cost incurred by the government and other partners, and also the indirect losses the society bears from the interruption and disruption in livelihood and economic activities 7. The need for collaboration with support from key partners, proper pandemic mitigating plans, strong surveillance system, coordinated mechanism, infection prevention measures and total community engagement and communication is relevant as never before in the fight against zoonotic infections like MVD.Declaration of competing interest We hereby declare that there is no conflict of interest among all the authors of this manuscript.
Human milk comprises a diverse array of microbial communities with health-promoting effects, including colonization and development of the infant’s gut. In this study, we characterized the bacterial ...communities in the Egyptian mother–infant pairs during the first year of life under normal breastfeeding conditions. Out of one hundred isolates, forty-one were chosen for their potential probiotic properties. The selected isolates were profiled in terms of morphological and biochemical properties. The taxonomic evidence of these isolates was investigated based on 16S rRNA gene sequence and phylogenetic trees between the isolates’ sequence and the nearest sequences in the database. The taxonomic and biochemical evidence displayed that the isolates were encompassed in three genera: Lactobacillus, Enterococcus, and Lactococcus. The Lactobacillus was the most common genus in human milk and feces samples with a high incidence of its different species (Lacticaseibacillus paracasei, Lactobacillus delbrueckii, Lactiplantibacillus plantarum, Lactobacillus gasseri, and Lacticaseibacillus casei). Interestingly, BlastN and Jalview alignment results evidenced a low identity ratio of six isolates (less than 95%) with database sequences. This divergence was supported by the unique physiological, biochemical, and probiotic features of these isolates. The isolate L. delbrueckii, ASO 100 exhibited the lowest identity ratio with brilliant probiotic and antibacterial features suggesting the high probability of being a new species. Nine isolates were chosen and subjected to probiotic tests and ultrastructural analysis; these isolates exhibited antibiotic resistance and antibacterial activity with high probiotic characteristics, and high potentiality to be used as prophylactic and therapeutic agents in controlling intestinal pathogens.
Objective: This research aims to assess the knowledge, perceptions, practices, and education of pediatric critical care nurses regarding oral care for critically ill children. The study addresses the ...existing gap in evidence-based oral care in this population and emphasizes the importance of understanding these factors for the development of effective oral hygiene practices in pediatric critical care settings. Methods: A descriptive cross-sectional study was conducted between October 2022 and March 2023 in Babylon Governorate. Four hospitals located in Hillah City, Babylon Province, were selected as the study sites. The sample included nurses working in specific critical care units within these hospitals, with a total of 170 nursing personnel participating. Data collection involved the distribution of questionnaires to the nurses, and statistical analysis was performed using SPSS software. The study obtained the necessary administrative and ethical approvals for data collection. Results: The sample consisted of 170 intensive care unit nurses, selected through stratified sampling based on gender (105 female and 65 male). Recruitment for the study commenced in February 2023. The mean score for oral health knowledge was moderate (2.14), However, the oral care practice score was good (2.02). No significant differences were observed in comprehensive mouth care scores based on age and educational qualification. Nevertheless, a significant difference was found in the mean score for complete oral care between male and female nurses (18.37 vs. 17.85, p = 0.021). Moreover, knowledge and practice scores varied significantly based on years of experience. Conclusions: This study provides valuable insights into the knowledge, perceptions, and practices of intensive care unit nurses regarding oral care. Implementation of standardized oral care protocols, along with adequate resources and support, can contribute to enhancing comprehensive mouth care in intensive care units.
: The BaeR protein is involved in the adaptation system of
and is associated with virulence factors responsible for systemic infections in hospitalized patients. This study was conducted to ...characterize putative epitope peptides for the design of vaccines against BaeR protein, using an immune-informatic approach.
: FASTA sequences of BaeR from five different strains of
were retrieved from the UNIPROT database and evaluated for their antigenicity, allergenicity and vaccine properties using BepiPred, Vaxijen, AlgPred, AntigenPro and SolPro. Their physio-chemical properties were assessed using the Expasy Protparam server. Immuno-dominant B-cell and T-cell epitope peptides were predicted using the IEDB database and MHC cluster server with a final assessment of their interactions with TLR-2. Results: A final selection of two peptide sequences (36aa and 22aa) was made from the 38 antigenic peptides. E1 was considered a soluble, non-allergenic antigen, and possessed negative GRAVY values, substantiating the hydrophilic nature of the proteins. Further analysis on the T-cell epitopes, class I immunogenicity and HLA allele frequencies yielded T-cell immuno-dominant peptides. The protein-peptide interactions of the TLR-2 receptor showed good similarity scores in terms of the high number of hydrogen bonds compared to other protein-peptide interactions.
: The two epitopes predicted from
in the present investigation are promising vaccine candidates for targeting the TCS of
in systemic and nosocomial infections. This study also demonstrates an alternative strategy to tackling and mitigating MDR strains of
and provides a useful reference for the design and construction of novel vaccine candidates against this bacteria.
Hairy cell leukemia (HCL) is rare hematologic malignancy with an extremely rare manifestation of extramedullary involvement, which can occur with or without bone marrow infiltration. We report a ...42-year-old man with extramedullary HCL in the right parotid gland without cytopenia, bone marrow infiltration, or splenic involvement. Core biopsy showed infiltration by small to medium lymphoid cells with oval nuclei containing homogenous chromatin and inconspicuous nuclei with distinct borders; the surrounding cytoplasm was clear and abundant. Immunohistochemistry was positive for leukocyte common antigen (LCA), cluster of differentiation (CD)-10, CD20, CD25, B-cell lymphoma (BCL)-2, BCL6, and cyclin D1; negative for CD3 and CD5; with a Ki-67 score of 10% to 15%. Cyclin D1 positivity is also seen in mantle cell lymphoma. In our patient, molecular analysis showed BRAF V600E mutation with a frequency of 34.2%, a more sensitive and specific marker for HCL. Positron emission tomography (PET) computed tomography (CT) showed a soft tissue mass (4x2.7 cm) in the superficial lobe of the right parotid gland (maximum standardized uptake value SUVmax, 7); a metabolically active, ill-defined soft tissue mass (4.5x4 cm) in the right suprazygomatic masticator space, infiltrating the lateral pterygoid and temporalis with erosions in the mandibular condyle (SUVmax, 9.5); and metabolically active foci in both femurs, the lower sacrum, the L1 vertebra, and the left third rib (SUVmax, 8). He received cladribine and 8 doses of weekly rituximab. Extramedullary involvement does not warrant special treatment, except local radiation in select cases for symptomatic and larger lesions; our patient did not require local radiation. Post therapy, he had very good clinical and radiologic improvement with complete resolution of the parotid gland lesions; PET CT showed mild uptake in the left scapula (SUVmax, 2.6) and the right femoral epicondyle (SUVmax, 2.4). Bony lesions are the most common extramedullary involvement of HCL; glandular involvement is extremely rare. To our knowledge, this is one of the few reported cases of salivary gland involvement by HCL. Further summary of the reported cases will be reviewed at the poster session.
Amiodarone- (AM-) induced pulmonary toxicity (AIPT) is still a matter of research and is poorly understood. In attempting to resolve this issue, we treated Sprague-Dawley rats with AM doses of 80 ...mg/kg/day/i.p. for one, two, three, and four weeks. The rats were weighed at days 7, 14, 21, and 28 and bronchoalveolar lavages (BAL) were obtained to determine total leukocyte count (TLC). For each group, lung weighing, histopathology, and homogenization were performed. Fresh homogenates were used for determination of ATP content, lipid peroxides, GSH, catalase, SOD, GPx, GR activities, NO, and hydroxyproline levels. The results showed a significant decrease in body weight and GSH depletion together with an increase in both lung weight and lung/body weight coefficient in the first week. Considerable increases in lung hydroxyproline level with some histopathological alterations were apparent. Treatment for two weeks produced a significant increase in BAL fluid, TLC, GR activity, and NO level in lung homogenate. The loss of cellular ATP and inhibition of most antioxidative protective enzymatic system appeared along with alteration in SOD activity following daily treatment for three weeks, while, in rats treated with AM for four weeks, more severe toxicity was apparent. Histopathological diagnosis was mostly granulomatous inflammation and interstitial pneumonitis in rats treated for three and four weeks, respectively. As shown, it is obvious that slow oedema formation is the only initiating factor of AIPT; all other mechanisms may occur as a consequence.
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