Sarem Journal of Reproductive Medicine
Year:2023 | Volume:8 | Issue:4|Papers Count:8

2Nurses are integral to the healthcare system. Nurse educators must adopt necessary measures to enhance nursing education systems and equip students for contemporary, complex healthcare environments. Transformative education (TE) is an advocated approach to enhance the quality of educational and health systems (1-4). TE is a methodology that asserts the transformation of the conventional notion of education, which primarily emphasizes the transmission of knowledge from the educator to the student (1, 2). Transformational leadership (TFL) is essential for TE. Leadership actions in educational processes influence the quality of teaching and learning, as well as educational results (2). Educational leaders possess significant influence over student learning outcomes and educational reforms. Transformational leadership in healthcare fosters a supportive and empowering environment. A transformative leadership style in healthcare encourages teams to collaborate in providing outstanding patient care and outcomes. Leadership theories originated with the Great Man Theory during the Industrial Revolution, emphasizing hierarchical, leader-centric decision-making that prioritized command-and-control, productivity, and a linear, mechanistic view of organizations. Although TLF began in the political sphere, the word is applicable to any system or organization where a leader inspires and motivates personnel or followers to innovate and adopt constructive change. Nurses in leadership positions must embrace a management approach that motivates, intellectually engages, and favorably impacts team members to enhance both staff and patient satisfaction (5, 6). Transformational nurse leaders cultivate a culture of respect and transparent collaboration. They engage in active listening, tackle both new and persistent issues, and adhere to the same standards they impose on others. An excellent nurse manager exemplifies leadership via actions while fostering robust communication and a collaborative work environment. Characteristics of transformational nurse leaders encompass: • Exemplifying leadership to foster a culture of excellence and perpetual enhancement. • Engaging in ordinary work with creativity and a positive outlook instead of viewing them as just obligations. • Delivering comments and guidance to assist team members in realizing their potential. Be mindful of their individual boundaries to prevent emotional fatigue. Transformational healthcare executives consistently embrace innovative perspectives. They not only share their experiences and vision but also actively solicit feedback from their colleagues. To enhance patient care, one must prioritize patients' values, needs, and preferences throughout therapy. The principles for enhancing patient care encompass collaboration with patients, improvement of patient access, and provision of emotional support. Safety concerns in healthcare, including adverse events, pharmaceutical errors, falls, and surgical errors, are the primary sources of morbidity and mortality worldwide (2,4,7). Researchers are correlating negative patient safety outcomes with ineffective leadership, whereas relational leadership styles, such as Transformational Leadership (TFL), are consistently linked to diminished bad patient outcomes (2,7). A notable proportion of studies indicated that TFL enhances quality patient outcomes and safety, either directly or indirectly. This was hypothesized to stem from TFL exerting a beneficial direct influence on the psychological work environment. Additional evidence directly associates TFL with improved patient outcomes, diminishing the likelihood of adverse events and enhancing the quality of care. TFL is an essential enabler that can enhance job satisfaction in healthcare and mitigate bad outcomes. Evidence indicates that nursing managers with strong transformational leadership traits are likely to enhance nursing staff happiness and reduce the risk of burnout by fostering a supportive and inclusive work environment, either directly or indirectly.

2Pharmacogenetics plays a crucial role in personalized treatment. This field investigates how genetic variations influence drug responses, focusing on how genes affect the body's reaction to medications. This study explores the impact of genetic polymorphisms on the metabolism of efavirenz, a drug used in the treatment of HIV. The objective is to compare the effects of CYP450 polymorphisms on the metabolism of efavirenz using a network meta-analysis approach. This research, conducted following PRISMA guidelines, examines the pharmacogenetic effects on the efficacy and prevention of adverse drug reactions (ADRs) of efavirenz. The search strategy included a review of observational and interventional studies without language or publication date restrictions. Inclusion criteria involved studies assessing drug concentration, AUC, ADRs, and genotype comparisons. Two independent researchers selected studies and managed data. Data analysis was performed using STATA software, employing a combination of methods to assess heterogeneity and the overall impact of genetic polymorphisms. For continuous and binary outcomes, SMDs and ORs or HRs were used, respectively. Egger’s test was conducted to identify publication bias. In this systematic review and meta-analysis, a comprehensive assessment of the relationship between genetic variants and efavirenz metabolism was conducted. Out of 19,861 records, 96 studies were reviewed. These studies, from various countries, had sample sizes ranging from 20 to 6,045 participants. The results indicated that specific variants in genes such as CYP2B6 were significantly associated with changes in plasma efavirenz concentrations. These findings underscore the importance of genetic influences on drug metabolism in the treatment of HIV and the management of its side effects. This extensive systematic review and network meta-analysis evaluated the role of various genes in the metabolism of efavirenz and rivaroxaban. The analyses revealed that specific polymorphisms in the CYP2B6 gene significantly affect the plasma concentration of efavirenz, which is crucial for improving HIV treatment and reducing drug-related side effects. These findings highlight the significance of pharmacogenomic research and the consideration of genetic diversity in therapeutic management.

2The diagnosis of chronic endometritis presents a challenge in patients with infertility issues and recurrent miscarriages. It not only poses problems before pregnancy but also manifests complications during pregnancy. Issues such as recurrent miscarriages, repeated implantation failure, endometriosis, cervical insufficiency, second-trimester miscarriages, and a decrease in the number of live births are associated with it. There is still no consensus on the diagnosis and treatment of endometritis. Diagnosis is typically done through biopsy, which is relatively expensive and invasive, and relies on histological examination and the presence of plasma cells. There are many conflicting reports on this matter. In recent years, the uterine microbiome has garnered attention. This study reviews recent literature to explore the causes, pathophysiology, diagnostic methods, and treatments for this disease.

2Human Papillomavirus (HPV) is a leading cause of cervical cancer, with various genotypes exhibiting differing levels of carcinogenic risk. This study investigates the prevalence and distribution of HPV genotypes among patients who tested positive during routine gynecological visits at Nigeb Laboratory. Conducted from January to June 2022, this cross-sectional study involved 152 women aged 18 and older. Cervical samples were collected and analyzed for HPV DNA using Real-Time Polymerase Chain Reaction (RT-PCR) analysis to determine genotype distribution. Among the participants, 68.4% were positive for carcinogenic HPV genotypes, with HPV 16 being the most prevalent (13.8%), followed by HPV 56 (12.5%) and HPV 66 (12.5%). Benign HPV genotypes were found in 19.1% of the samples, with HPV 6 (16.4%) being the most common. These findings underscore the need for comprehensive HPV vaccination and regular screening programs. The high prevalence of high-risk HPV genotypes not covered by current vaccines suggests the necessity for broader vaccine formulations. This study provides valuable data for informing public health strategies and highlights the importance of continuous HPV surveillance and research in under-researched populations.

2In this study, we intend to compare the functional, radiographic, and postoperative complications using different surgical approaches in patients with type A2 intertrochanteric fractures who underwent surgery in 1400 at Karaj Madani Hospital. This study was conducted as a retrospective cohort. Demographic information, type of surgery and fixation device, functional results including joint range of motion and weight bearing of the patient were recorded using Harris Hip Score. Complications after surgery were also considered, including the rate of infection, failure and non-union after surgery. The patients were followed up at intervals of 6 weeks and 3 months later. Statistical analysis was done using SPSS software version 26. A total of 150 people including 55 (36.7%) men and 95 (64.3%) women were included in the study. The pain level of patients in the time periods of 6 weeks after surgery and 3 months after surgery and the level of Haris Hip score of patients 2 months after surgery are significantly better in patients treated with cephalomedullary nailing method. The treatment method of cephalomedullary nailing can be considered as the method of choice, due to the lower amount of pain according to the VAS criterion during six weeks and three months after surgery, higher scores in the Haris hip test in the period of two months after surgery and the overall failure rate as a method. Considered preferable for these patients.

2Advancements in prenatal diagnostics have significantly improved early detection of fetal chromosomal abnormalities, particularly through noninvasive prenatal testing (NIPT). This systematic review compares two prominent NIPT technologies—microarray-based cell-free DNA (cfDNA) and next-generation sequencing (NGS)-based cfDNA—for detecting trisomy 21 (Down syndrome). By analyzing cell-free fetal DNA in maternal blood, these methods offer crucial insights into fetal health, reducing the need for invasive procedures like amniocentesis. The review encompasses a comprehensive search of PubMed, MEDLINE, EMBASE, and the Cochrane Library, identifying studies up to July 2023. Eight studies met the inclusion criteria, comparing the diagnostic accuracy, failure rates, and clinical implications of both cfDNA technologies. Microarray-based cfDNA exhibited high sensitivity and specificity (99.2% and 99.8%, respectively), with lower failure rates (2.8%). NGS-based cfDNA also showed high sensitivity and specificity (99.6% and 99.9%) but had higher failure rates (up to 12.4%). While NGS-based testing offers broader genomic coverage and can detect additional chromosomal abnormalities, it also poses a higher risk of incidental findings, which may lead to overdiagnosis and parental anxiety. This review highlights that microarray-based cfDNA is generally more cost-effective and suitable for routine prenatal screening due to its lower failure rates and high accuracy. NGS-based cfDNA, despite being more complex and costly, is advantageous for detailed chromosomal analysis in high-risk pregnancies. The choice between these technologies should consider clinical context, cost-effectiveness, and patient preferences to optimize prenatal care. Future research should aim for standardized reporting and direct comparative studies to further refine NIPT methodologies, potentially integrating hybrid approaches that combine the strengths of both technologies.

2Kidney and urinary tract stones are one of the most important problems in pediatrics, which are increasing in prevalence today due to sedentary life, improper nutrition, wrong habits in fluid consumption, and improper use of drugs. Kidney stones can be caused by various reasons, including metabolic disorders, urinary tract anomalies, and urinary infections. The purpose of this research is to investigate the prevalence and causes of kidney and urinary tract stones in pediatric patients aged 1-15 years admitted to Shahid Beheshti Hospital in Kashan. This was a descriptive-analytical retrospective cross-sectional study in which the files of 68 children aged 1-15 years referred to Shahid Beheshti Hospital in Kashan in the period of 2010-2019, in which the presence of stones in them was proven through ultrasound, were examined. All cases were examined in terms of family history, urine culture, examination of urine crystals and anatomical disorders. Data analysis was done using SPSS statistical software and descriptive statistics. In this study, 68 children (70% male and 30% female) with an average age of 5.19 ± 4.22 years were investigated. 25% had a family history of urinary stones. The most common complaint when patients came to visit was abdominal pain, followed by restlessness and renal colic. In 28% of cases where urine culture was done, the result was positive. The most common anatomical disorder in patients was bladder-ureteral reflux (VUR) and ureter-pelvic junction obstruction (UPJO). At least one metabolic disorder was present in 75% of cases, the most common metabolic disorder in this study being Hypercalciuria. 50% of cases had kidney stones. In this study, the most common disorder associated with urinary stones in children was hypercalcemia. The most common anatomical disorders in these patients are VUR and UPJO, the most common site of stone formation is the kidneys, and the most common symptom when the patients were referred was abdominal pain.

2In hospitals, healthcare-associated infections (HAI), also referred as nosocomial infections (NI), pose a significant challenge, leading to prolonged hospitalization, increased healthcare costs, and mortality. Pathogens can be transmitted through high-touched surfaces, healthcare worker hands, and contaminated medical equipment. These infections are often caused by Multi-Drug Resistance Organisms (MDROs), which are bacteria resistant to multiple antimicrobial agents. Patients with higher illness severity scores, older age, and longer ICU stays are at increased risk. The most common side effect of healthcare is nosocomial infections, which can happen in any setting. Bacterial, fungal, and viral infections are potential causes for them, spread through direct or indirect contact. MRDOs, such as Methicillin-resistant Staphylococcus aureus (MRSA), Vancomycin-resistant Enterococci (VRE), and bacteria that produce Extended-spectrum beta-lactamases (ESBLs), pose a significant problem because of their antibiotic resistance. Preventive measures such as air filtration, hand hygiene, and environmental cleaning are important. Enhanced hand cleanliness, implementing contact precautions, and surveillance are crucial in managing MDROs. It is essential to use antibiotics judiciously and implement appropriate clinical measures. Further research is necessary to combat the proliferation of resistant strains. In conclusion, nosocomial infections caused by MDROs have significant public health implications. Effective prevention, control, and diagnosis are crucial in managing these infections. Preventive measures and proper antibiotic use are essential in controlling the spread of resistant bacteria.