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Background When curative treatments are no longer available for cancer patients, the aim of treatment is palliative. The emphasis of palliative care is on optimizing quality of life and provided support for patients nearing end of life. However, chemotherapy is often offered as a palliative therapy for patients with advanced cancer nearing death. The purpose of this review was to evaluate the state of the science relative to use of palliative chemotherapy and maintenance of quality of life in patients with advanced cancer who were at end of life. Materials and methods Published research from January 2010 to December 2019 was reviewed using PRISMA guidelines using PubMed, Proquest, ISI web of science, Science Direct, and Scopus databases. MeSH keywords including quality of life, health related quality of life, cancer chemotherapy, drug therapy, end of life care, palliative care, palliative therapy, and palliative treatment. Findings 13 studies were evaluated based on inclusion criteria. Most of these studies identified that reduced quality of life was associated with receipt of palliative chemotherapy in patients with advanced cancer at the end of life. Conclusion Studies have primarily been conducted in European and American countries. Cultural background of patients may impact quality of life at end of life. More research is needed in developing countries including Mideastern and Asian countries.

There is a significant focus on the role of the host microbiome in different outcomes of human parasitic diseases, including cystic echinococcosis (CE). This study was conducted to identify the intestinal microbiome of patients with CE at different stages of hydatid cyst compared to healthy individuals. Stool samples from CE patients as well as healthy individuals were collected. The samples were divided into three groups representing various stages of hepatic hydatid cyst: active (CE1 and CE2), transitional (CE3), and inactive (CE4 and CE5). One family member from each group was selected to serve as a control. The gut microbiome of patients with different stages of hydatid cysts was investigated using metagenomic next-generation amplicon sequencing of the V3–V4 region of the 16S rRNA gene. In this study, we identified 4862 Operational Taxonomic Units from three stages of hydatid cysts in CE patients and healthy individuals with a combined frequency of 2,955,291. The most abundant genera observed in all the subjects were Blautia , Agathobacter , Faecalibacterium , Bacteroides , Bifidobacterium , and Prevotella . The highest microbial frequency was related to inactive forms of CE, and the lowest frequency was observed in the group with active forms. However, the lowest OTU diversity was found in patients with inactive cysts compared with those with active and transitional cyst stages. The genus Agatobacter had the highest OTU frequency. Pseudomonas, Gemella, and Ligilactobacillus showed significant differences among the patients with different stages of hydatid cysts. Additionally, Anaerostipes and Candidatus showed significantly different reads in CE patients compared to healthy individuals . Our findings indicate that several bacterial genera can play a role in the fate of hydatid cysts in patients at different stages of the disease.

Background Caring for patients during a pandemic can be difficult for healthcare workers, the patients themselves, and healthcare systems. Nurses are expected to recognize ethical dilemmas and make sound judgments when confronted with them. Sensitizing nurses to ethical issues strengthen their ability to identify ethical dilemmas and make ethical choices. As a result, this study aimed to determine a relationship between moral sensitivity and caring behavior among nurses during the coronavirus (COVID-19) pandemic. Method The current study is a cross-sectional study of 406 nurses who worked in a single hospital during the COVID-19 epidemic. We used a demographic questionnaire and the caring behavior inventory (CBI) tool to collect data online. The data were analyzed using descriptive and correlational statistics. Findings Eighty-three point seven percent of participants in this study were female, and 71.9% were married. 47.5% reported caring for a COVID-19 patient for longer than a month; their average work experience was 13.1 years. Additionally, Moral Sensitivity correlated positively with caring behavior and its dimensions ( r  = 0.164, P  = 0.001). However, a significant and inverse link existed between the dimension \"following the rules\" and the nurse's caring conduct ( r  = -0.117, P  = 0.019). Conclusion During the pandemic, nurses' moral sensitivity was moderate and significantly connected with their caring behavior. Because nurses encounter numerous obstacles while caring for patients in critical conditions, they require ethical empowerment to perform correctly, as caring behavior improves with increased moral sensitivity.

Global warming can cause deep and extensive changes in the Earth’s climate and changes in the time and place of climatic phenomena. The present trend analysis study assesses cold stress using the thermo-hygrometric index (THI) in the two seasons of autumn and winter in outdoor environments in Iran. The data related to the average of the two variables of daily air temperature and relative humidity from 60 synoptic meteorological stations for a statistical period of 30 years were obtained from the Iranian Meteorological Organization. The THI index was calculated for autumn and winter, and the level of thermal discomfort was determined for each station. The Mann–Kendall statistical test with the help of Minitab ver17.1.0 software was also used to investigate the changes in air temperature, relative humidity and THI index. The THI for autumn increased in 68% of the stations, and this increasing trend is statistically significant in 51% of these stations. The THI for winter increased in 83% of the stations, and this increasing trend is statistically significant in 51% of these stations. In autumn, 53% of the stations were in the range of thermal discomfort, and in winter only 5% were in the range of thermal comfort. The decreasing trend in THI in some climatic types, along with the increasing trend in air temperature, can indicate the decrease in relative humidity in the monitored stations during the studied years. It is recommended to know the temporal and spatial distribution and the probability of occurrence of cold stress through the use of THI in order to adopt preventive measures and policies in the outdoors in Iran.

Background Human cystic echinococcosis (CE), caused by the metacestodes of Echinococcus granulosus , is a significant zoonotic helminth infection with medical and economic concerns in endemic regions. The metacestode, known as hydatid cyst, is frequently populated by some bacterial species. Our knowledge is poor on the nature and significance of interplay between the bacteria and hydatid cysts. This study aimed to investigate the presence of bacterial species in human hydatid cyst. Methods A total of 101 human hydatid cyst samples isolated from liver and lungs, were collected and examined using both bacteriological and molecular techniques. The cyst materials were primarily cultured in thioglycolate medium with subsequent specific bacteriological methods of identification including bacterial culture and differential biochemical examinations. Molecular identification was performed through bacterial 16 S rDNA PCR with pan-specific primers. Also, PCR-sequencing on partial mitochondrial cox1 gene was used for molecular identification of E. granulosus isolates. The K1, K2, and RMPA primers were utilized to identify hypervirulent strains of Klebsiella pneumoniae. Results The results demonstrated that 7 out of 101 samples (6.9%) were tested positive for bacteria. The most frequent bacteria found were Klebsiella species including five K. pneumoniae , one K. oxytoca and one Staphylococcus aureus . Notably two hypervirulent variants of K. pneumoniae were detected. Molecular analysis of the metacestodes indicated the presence of Echinococcus granulosus G1 and E. canadensis G6 genotypes. Conclusion Our study highlighted K. pneumoniae as a common bacterium in hydatid cysts. Further in-depth studies are warranted on the potential association between bacteria and the pathogenesis of E. granulosus . Clinical trial number Not applicable.

Occupational exposure to heat stress may lead to changes in blood cell count. The objective of this retrospective descriptive-analytical field study is to investigate the relationship between heat stress exposure and some immunological parameters among foundry workers. This study was carried out on 55 subjects of which, 35 were working in a foundry unit (exposed group) and 20 were working in a computer numerical control (CNC) machining unit (control group). The measurement method consisted of taking 10 cc of the subjects’ blood between 10 am and 2 pm and then performing the automated blood cell counting and enzyme-linked immunosorbent assay (ELISA) on the sample. Environmental parameters such as noise levels, lighting, and the wet-bulb globe temperature (WBGT) index were measured at the subjects’ workstations. All measurements were made in the first half of the month of July. The mean WBGT index was 22.5 ± 2.16 °C for the control group and 32.97 ± 3.22 °C for the exposed group. The laboratory test results show a significant decrease in white blood cell count and lymphocyte levels and a significant increase in neutrophil levels and neutrophil to lymphocyte ratio in exposed group compared with control ones (P < 0.05). IgM levels decrease under heat stress, but we do not observe significant differences between IgG and IgA levels between two groups. A significant negative correlation was observed between white blood cell count, lymphocyte levels, and IgM concentration with WBGT index and significant positive correlation was observed between neutrophil and neutrophil to lymphocyte ratio with WBGT index. No significant correlation was observed between sound pressure levels and light intensity with studied immunological parameters. In conclusion, under heat stress conditions, leukocytes levels and immunoglobulin concentration may reduce and it may weaken and suppress the human immune system.

Background Dogs are the most important definitive hosts of zoonotic taeniid helminths worldwide. Different Echinococcus and Taenia species of domestic and wild carnivores pose a potential risk to human population. High populations of free-roaming dogs (FRDs) in urban areas of Iran and widespread contamination of the environment with dog feces is a potential source of infecting people living in the urban regions with cystic echinococcosis (CE). Our knowledge on the risk of CE transmission in the urban settings in the endemic regions is limited. The present study surveyed the species and genotypes of E. granulosus sensu lato and other taeniids by examining feces of free-roaming dogs in the urban areas in the city of Kerman, southeastern Iran. Methods The city was divided into 100 consecutive blocks of which 25 blocks were randomly selected. Fecal samples of FRDs were counted, mapped and fresh samples were collected. Then Zinc chloride flotation, and sequential sieving was performed, and the samples were examined under an inverted microscope. Single individual taeniid eggs were isolated, partial nad1 gene was amplified and sequenced to identify species and genotypes. Results In total 5607 fecal samples of dogs were mapped and 83 fresh samples were collected. Taeniid eggs were detected in nine fecal samples (10.8%) from seven out of the 25 city blocks (28.0%). Echinococcus eggs were found in four samples (4.8%) from three city blocks, two samples containing E. granulosus sensu stricto (2.4%), two samples containing E. canadensis G6/7 (2.4%). In addition, three samples contained eggs of Taenia hydatigena (3.6%), and one sample of Taenia serialis (1.2%). Conclusions This study documented the potential risk of CE transmission to humans resulting from the feces of dogs roaming freely in urban areas. Graphical Abstract

Introduction: Coronary artery disease (CAD) is one of the major causes of mortality all over the world. In this relation, coronary artery bypass grafting (CABG) is one of the most important treatments for CAD patients. However, it leads to a lot of stress in the patient. The aim of this study was to use the Neuman model to moderate the stressors in patients undergoing coronary artery bypass graft. Methods: This study was a randomized clinical trial of two groups performed on patients admitted to the coronary artery bypass graft; and the study completed with 64 patients. The intervention was performed by the researcher according to the format of the Neuman Model, which included the investigation of the stressors, and the determination of the goals and strategies for the actions. Intrapersonal, interpersonal, and extra personal factors were evaluated using a Revised Cardiac Surgery Stressor Scale (RCSSS). The intervention program was designed by the researcher based on prevention levels using scientific resources. The collected data were analyzed in SPSS ver. 13 using descriptive and inferential statistics. Results: Before the intervention, the mean score of the stressors was not significantly different between the two groups. But immediately after the intervention and before discharging the intervention group, it was significantly less than the control group. Conclusion: Using a Neuman-based program as an effective and low-cost intervention can moderate the stressors and reduce the stress of patients awaiting coronary artery bypass graft. This theory can be a good guide to offering the roles needed to provide health services in the community.