Medicine and Health Sciences Commons^™

The Effect Of Heparinoid As Systemic Prophylactic Anticoagulants On Covid-19 Patient Mortality And Its Safety Profiles: A Systematic Review And Meta-Analysis, Ariska Deffy Anggarany, Rani Sauriasari, Muhammad Alkaff, Famila Takhwifa, Hayatun Nufus, Diana Paramita

Pharmaceutical Sciences and Research

Coagulopathy is one of the complications of COVID-19 and is associated with a higher risk of mortality. However, evidence regarding the effectiveness and safety of anticoagulant therapy in various doses among COVID-19 patients is limited. This systematic review and meta-analysis aims to review and explore the effect of using heparinoids as a systemic anticoagulant at prophylactic doses on mortality in COVID-19 patients. Systematic searches were conducted of various databases (Pubmed, ScienceDirect, SpringerLink, Scopus, and ProQuest) covering the period 2019-2021. We assessed the quality of the articles using the STROBE checklist. Studies with a high risk of bias were excluded before …

Swimming Training On Moderate Intensity Significantly Reduces Total Cholesterol And Bodyweight On Hypercholesterolemic Rat Model, Anindya Mar'atus Sholikhah, Mochamad Ridwan

Jurnal Keolahragaan

It is well established that regular exercise has many positive benefits on health. Exercise at the appropriate intensity and level has been shown to improve lipid profile and reduce the risk of cardiovascular disease. This study investigates the effect of swimming training on total cholesterol levels and body weight in male Wistar rats. Thirty rats weighing 150-200 grams were randomly divided into one control (C) and two treatment groups (ST=swimming training, SED=sedentary activity). Rats in control (C) group were fed a standard diet, while rats in both treatment groups were fed high-fat diet-induced hypercholesterolemia for three weeks. Rats in ST …

Hubungan Antara Sindrom Metabolik Dengan Kebugaran Jasmani Pada Lansia, Prijo Sudibjo, Cerika Rismayanthi, Krisnanda Dwi Apriyanto

Jurnal Keolahragaan

Prevalensi sindrom metabolik pada lansia cukup tinggi. Sindrom metabolik dapat dicegah salah satunya dengan aktivitas fisik. Aktivitas fisik juga dapat meningkatkan kebugaran kardiorespirasi, kelenturan sendi, keseimbangan dan kekuatan otot. Penelitian ini bertujuan untuk mengetahui hubungan antara sindrom metabolik dengan kebugaran kardiorespirasi, fleksibilitas, kekuatan, dan keseimbangan pada lansia. Penelitian ini merupakan penelitian cross sectional dengan teknik consecutive sampling pada 118 lansia di Yogyakarta. Sindrom metabolik ditetapkan berdasarkan kriteria diagnosis dari Adult Treatment Panel. Instrumen yang digunakan untuk mengumpulkan data adalah tes jalan 6 menit (6-minute walking test), sit and reach, hand grip dynamometer, leg and back dynamometer dan berdiri …

Aktivitas Olahraga Bulu Tangkis Dan Respon Perubahan Asam Urat Darah Usia Produktif, Angkit Kinasih, Ronaldo Lomi Djara, Ferry Fredy Karwur

Jurnal Keolahragaan

Penelitian ini bertujuan untuk mengetahui ada tidaknya respon perubahan pada kadar asam urat akibat aktivitas olahraga bulu tangkis. Desain penelitian ini adalah quasi eksperimen. Sampel yang digunakan sebanyak delapan responden dengan kriteria tertentu. Perlakukan aktivitas fisik dilakukan dua kali pada hari yang berbeda dengan 4 kali pengukuran kadar asam urat. Metode penelitian yang digunakan adalah repeated measure analysis. Ketika subyek diukur berulang kali dengan jumlah yang sedikit per percobaan maka repeated measures analysis dapat digunakan. Hasil penelitian menunjukkan bahwa perlakukan olahraga bulu tangkis memberikan respon perubahan yang signifikan terhadap perubahan kadar asam urat dengan nilai probabilitas sebesar 0,038. Hasil ini …

The Benefits Of Astaxanthin To Improve Pain Relief In Patients With Painful Diabetic Neuropathy: An Open-Label, Randomized Controlled Trial, Rizaldy Taslim Pinzon, Mary Rose Angelina Budi Harsana

Pharmaceutical Sciences and Research

Treatment of diabetic neuropathy is still carried out by providing symptomatic therapy, which only improves ± 50% of the total symptoms felt by patients, but does not tackle the underlying causes of the disease. Astaxanthin is a potent antioxidant, anti-inflammatory, and anti-diabetic carotenoid that could be an additional treatment option. We aimed to measure the effectiveness of administering astaxanthin as an additional therapy to improve the impact of pain and discomfort experienced daily by diabetes mellitus patients with painful diabetic neuropathy. We conducted a randomized experimental study with an open label design of 36 patients who had been diagnosed with …

An Assessment Of The Diagnostic Value In Syncope Workup: A Retrospective Study, Ashan T. Hatharasinghe, Kayvon Etebar, Ryan Wolsky, Hossein Akhondi, Napatkamon Ayutyanont

HCA Healthcare Journal of Medicine

Background

Patients with syncope often undergo costly testing, despite current guidelines and data supporting the contrary.

Objective

To determine the diagnostic value through positivity rate of electrocardiogram (EKG), computed tomography (CT) of the brain, magnetic resonance imaging (MRI) of the brain, transthoracic echocardiogram, nuclear and pharmacologic cardiac stress test, tilt table test and carotid ultrasound in patients diagnosed with syncope.

Methods

This is a retrospective study of 10,036 adults presenting to the emergency department or hospitalized with a primary diagnosis of syncope at 8 acute care facilities in the southwest United States from January 1, 2019, to December 31, 2019. …

Steroid-Refractory Lichenoid Eruption Associated With Pembrolizumab In A Patient With Non-Small Cell Lung Cancer, Leon Kou, Sanjay Agarwal, Alyssa Miceli, Logan Kolb, Karthik Krishnamurthy, Shawn Schmieder

HCA Healthcare Journal of Medicine

Programmed cell death receptor 1 (PD-1) inhibitors are promising and effective treatments for various cancers. Cutaneous adverse events, such as lichenoid drug eruptions, are well-known common side effects associated with PD-1 inhibitors. Lichenoid drug eruptions associated with PD-1 inhibitors show rapid improvement with high potency topical steroids and do not require cessation of the offending drug. We present the case of an 84-year-old female with progressive pembrolizumab therapy-associated lichenoid eruption that was resistant to several treatments and ultimately required discontinuation of pembrolizumab and treatment with methotrexate to resolve. This report includes histological findings of the pembrolizumab-associated lichenoid eruption.

Does Quran Memorization Influence Adolescents’ Intelligence Quotient And Memory Level?: A Cross-Sectional Study In Malaysia, Ismarulyusda Ishak, Amira Aqilah Shaidin, Dzalani Harun, Nor Malia Abdul Warif, Vanitha Mariappan, Arimi Fitri Mat Ludin, Ahmad Rohi Ghazali, Farah Wahida Ibrahim, Normah Che Din

Makara Journal of Health Research

Background: The process of memorizing various reading materials enhances the brain capacity to process, store, and assemble memories and increases the intelligence quotient (IQ) level. However, the connection between the memorization of Quran and the enhancement of memory level is not fully understood. Hence, a cross-sectional study was conducted to examine the correlation between Quran memorization and the IQ level among Muslim adolescents from selected Islamic schools in Selangor, Malaysia.

Methods: The Wechsler Abbreviated Scale of Intelligence was used to measure the student’s IQ level, whereas Digit Span and Rey Auditory Verbal Learning Test were used to evaluate …

A Snapshot Investigation Into The Availability And Access To Codeine-Containing Medications Amongst The Irish Population., Katie O'Brien, Pádraig Mckeown, Joseph Phelan

International Undergraduate Journal of Health Sciences

Codeine phosphate is a mild to moderate analgesic and has a weak cough suppressant activity that is available to purchase as an over the counter (OTC) painkiller in Ireland as a compound product. In recent years, countries such as Australia have introduced laws that prohibit the sale of the drug without a valid prescription. This move by Australia begs the question as to why this legislation was introduced and should Ireland follow suit.

The primary aims of the study were to determine knowledge among the general public of codeine-containing medications and their usage levels. The survey also investigated whether current …

An Investigation Into The Prevalence Of Vancomycin-Resistant Enterococci Within An Irish Hospital, Dylan Casey

International Undergraduate Journal of Health Sciences

Vancomycin-resistant enterococci (VRE) are well-recognised nosocomial pathogens that pose a significant threat to public health. Associated with poorer clinical outcomes than their vancomycin-sensitive counterparts, the prevalence of VRE in Ireland has increased in recent times, with the European Antimicrobial Resistance Surveillance Network reporting that out of 29 countries, Ireland demonstrated the highest rates of vancomycin resistance among invasive Enterococcus faecium isolates between 2011 and 2014 (2011; 34.9%, 2012; 44.0%, 2013; 42.7%, 2014; 45.1%). Herein, we investigate VRE prevalence in the Mercy University Hospital (MUH) – an acute care hospital in southern Ireland. A total of 21 first-time VRE infections were …

Deep Convolutional Neural Networks For Accurate Diagnosis Of Covid-19 Patients Using Chest X-Ray Image Databases From Italy, Canada, And The Usa, Amgad A. Salama, Samy H. Darwish, Samir M. Abdel-Mageed, Radwa A. Meshref, Ehab I. Mohamed

The University of Louisville Journal of Respiratory Infections

Introduction: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), famously known as COVID-19, has quickly become a global pandemic. Chest X-ray (CXR) imaging has proven reliable, fast, and cost-effective for identifying COVID-19 infections, which proceeds to display atypical unilateral patchy infiltration in the lungs like typical pneumonia. We employed the deep convolutional neural network (DCNN) ResNet-34 to detect and classify CXR images from patients with COVID-19 and Viral Pneumonia and Normal Controls.

Methods: We created a single database containing 781 source CXR images from four different international sub-databases: the Società Italiana di Radiologia Medica e Interventistica (SIRM), the GitHub Database, the …

Machine Learning Approach To Distinguish Ulcerative Colitis And Crohn’S Disease Using Smote (Synthetic Minority Oversampling Technique) Methods, Kris Ghimire, Walter Lai, Yasser Omar, Thad Schwebke, Jamie Vo

SMU Data Science Review

Irritable Bowel Disease (IBD) affects a sizable portion of the US population, causing symptoms such as vomiting, abdominal pain, and diarrhea. Despite the disease’s prevalence, the precise cause is not fully understood. This study consists of endoscopic and histological data from patients diagnosed with IBD and a control population for reference. The machine learning models' focus is to classify patients into IBD types. Several models were analyzed, including decision trees, logistic regression, and k-nearest neighbors. In addition, various methods of SMOTE were applied to determine the most effective transformation and ensuring that the dataset is balanced. The best model with …

Management Of Distal Tibial Fractures By Ilizarov Fixator With Or Without Minimal Internal Fixation, Moaaz Elgammal, Mostafa Elgahel, Ali Elgioshy

Al-Azhar International Medical Journal

Background: Ilizarov fixator has more advantages in some types of distal tibial fractures as open, type C3according to AO classification and give satisfactory results more than plates and screws fixation because it minimizes complications. The aim of the work: To estimate the techniques, results and complications of Ilizarov in management of distal tibial fractures with or without minimal internal fixation . Patient: During the period from August 2020 through June 2021, a prospective study was conducted on fifteen patients with fifteen tibial plafond fractures treated with Ilizarov fixator. The study consisted of 12 men and 3 women, with an average …

Neurophysiologic Study In Children With End Stage Renal Disease On Regular Hemodialysis, ‪Mohamed ‬ Hasan, Moftah Rabeea, Hassan Hassan, Ann Abd-Elkader, Eman Elzamarany

Al-Azhar International Medical Journal

Background: Patients undergoing hemodialysis for chronic kidney disease (CKD) commonly have neurological problems. Both the central and peripheral nerve systems may be affected by these problems. Uremic encephalopathy, cognitive impairment, peripheral neuropathies, and uremic myopathy are all common neurological consequences in CKD. Aim of the study: to detect neurophysiologic changes using electroencephalography (EEG), nerve conduction velocity (NCV) and electromyography (EMG) in children with CKD on regular hemodialysis and to correlate these changes with duration of dialysis and duration of disease. Patients and Methods: thirty patients with CKD who are on regular hemodialysis at pediatric nephrology unit at Al-azher university hospital. …

Hook Plating Versus Tension Band Wiring In Treatment Of Displaced Lateral End Clavicle Fracture, Alaa Elmohamady, Ehab Elzahed, Ismail Hammouda

Al-Azhar International Medical Journal

Abstract Background: Lateral end clavicular fractures represent about 15% of clavicular fractures. Nonunion rate is about 22 to 44% due to interacting forces between arm weight and trapezius muscle . Objective: To assess the clinical and radiological outcomes of fixation by HP versus TBW and to determine which technique provides enough stability to permit early range of motion. Patients and Methods: A prospective comparative study on 40 patients( 20 patients fixed by HP and others 20 by TBW) was done and followed up at Al-Azhar University Hospitals between December 2019 to April 2021. Results: The mean age of patients is …

Pectoral Etching In Early Grades Gynecomastia, Elsayed Shaaban, Mostafa Mikki, Hazem Dahshan

Al-Azhar International Medical Journal

Background: Nowadays there is a great introduction of 3D,4D and high-definition body contouring. Applicability and evaluation of such techniques in gynecomastia surgery needs more investigation. Objective: The aim of this study was to assess high definition liposculpture to get masculinized appearance of the chest for treatment of early grades gynecomastia. Patients and methods: 30 patients with grade I&II gynecomastia were selected with age group between 18 and 50 years old with mean 24.73 ± 2.62. It was a prospective observational cohort study to assess the applicability of pectoral etching in early grades gynecomastia. The study was conducted at Al-Azhar university …

Evaluation Of Adaptive Radiation Therapy In Treatment Of Locally Advanced Head And Neck Cancers, Mostafa Mostafa, Wael Elshishtawy, Ahmed Al-Agamawi

Al-Azhar International Medical Journal

Background: Radiation therapy is the main player in management of locally advanced head and neck squamous cell carcinoma. Intensity-modulated radiation therapy IMRT does not compensate for anatomical changes or tumor shrinkage during the treatment course. Adaptive radiation therapy may be the suggested solution to consider these changes. Aim of the Work: Evaluate dosimetric and clinical effects of adaptive RT. in advanced head and neck squamous cell carcinoma. Patients and Methods: A total number of 49 patients with a provisional diagnosis of locally advanced squamous cell carcinoma of head and neck treated with definitive concurrent chemo-radiotherapy with the original plan optimized …

Assessment Of Platelet Rich Plasma (Prp) Therapy In Prevention Of Chronic Wound Complications, Mahmoud Shehata, Amr Rezk

Al-Azhar International Medical Journal

Background: Delayed wound healing is a key factor in the development of chronic wound complications so we can utilize the wound healing promotion properties of platelet rich plasma in decreasing the incidence of these complications. Patients and Methods: A total number of 50 patients with open wounds resulting after surgical debridement of various types of soft tissue infection were included in this study, two groups with 25 patients for each were divided randomly. Group A patients were treated with PRP while group B was the control group treated with ordinary dressing. The two groups were monitored every other day for …

Study The Efficacy Of Repetitive Transcranial Magnetic Stimulation On A Sample Of Resistant Schizophrenic Patients With Positive And Negative Symptoms, Omar Aglan, Amgad Gabr, Mohamed Helmy

Al-Azhar International Medical Journal

Abstract: Background: Transcranial magnetic stimulation one of the tools that may help schizophrenic patients. Aims: To Examine the validation of rTMS in treatment positive and negative symptoms of refractory schizophrenic patients. Setting: Department of Psychiatry, Faculty of Medicine, Al-Azhar University, Cairo. Patients and methods: The study inclusive 40 resistance schizophrenic patients separated into two groups: Group A: 20 patients received 15 sessions of r-TMS for 3 weeks, With five daily sessions with a two day break, Group B: 20 patients were randomly (one every one patients) chosen for sham stimulation. The Positive and Negative Syndrome Scale was used to examine …

Assessment Of Cardiac Functions In Neonatal Sepsis, Mohamed Hassan, Ahmed Abdel Hakeem, Mahmoud Abdelmotalep, Tarek Eldahshan

Al-Azhar International Medical Journal

Background; One of the major organs influenced in neonatal sepsis is the heart. Echocardiogram gives real-time data on the cardiovascular execution instead of reliance on the clinical signs alone. Aim and objectives; to study the role of transthoracic echocardiogram in the assessment of systolic and diastolic cardiac functions in septic neonates . Subjects and methods; This cross sectional study was carried out on 80 neonate subdivided into 4 groups (septic full-term, septic preterm, non-septic full-term and non-septic preterm) admitted to the tertiary care NICU of Bab Elsheria Hospital, Al-Azhar University . Result; Septic patients gather had essentially higher myocardial execution …

Panniculectomy During Cesarean Section, Ahmed Elsharkawy, Farid Hassan, Wael Taha, Mohammed Khalifa

Al-Azhar International Medical Journal

ABSTRACT Background: Many women in clinical practice desire a panniculectomy following a cesarean section to remove excess skin and stretch marks that have grown during pregnancy. This study aimed to see how panniculectomy and cesarean section worked together. Subjects and methods: This is a prospective randomized controlled trial that took place in the obstetric department of a hospital. Elmahalla, Elkobra -general hospital. Eligible 66 patients had been randomly collected; the groups were divided into two equal groups using a computer-generated randomization table, with group assignments hidden in sealed opaque envelopes: (n=33) Control Group (C): Patients underwent elective CS alone. Combined …

Acute Cholecystitis In Elderly Patients; Management And Outcome, Mahmoud Mohamed, Mohamed Abdel-Maksoud, Mohamed El-Kaseer

Al-Azhar International Medical Journal

Background: The most prevalent consequence of cholelithiasis is acute cholecystitis (AC), which is also one of the most common diseases needing emergency surgery in the elderly. Aim and objectives: The goal of this training was to assess the characteristics, management, results, and danger factors for complications of acute cholecystitis in elderly patients. Furthermore, proof of our current management strategy or recommendations for its modification was sought. Patients and methods: Twenty patients over sixty-five years old with acute cholecystitis were submitted to elective laparoscopic cholecystectomy at Al-Azher University hospitals. Sixteen of them were females (80%) and four were males (20%). Result; …

Atrial Fibrillation Post Coronary Artery Bypass Grafting Surgery Incidence And Risk Factors, Ahmed Hamdy Basiony, Medhat Refaie, Ahmed Sultan

Al-Azhar International Medical Journal

Background: Atrial fibrillation is a common complication following cardiac surgery, especially coronary artery bypass grafting. Although this condition mostly benign but it can increase mortality and morbidity postoperative and leading to longer ICU stay and increase the costs. Aim of the work: to investigate and analyse the atrial fibrillation incidence and risk factors in patient undergoing CABG in addition to its effect on intensive care unit and postoperative hospital stay. Patients and methods: Our study was retrospective non-randomized. Between January 2018 and January 2020, 50 patients were recruited from a total of 225 patients who underwent coronary artery bypass graft …

Eradication Of Enterococcus Faecalis In Conventional Endodontic Retreatments (A Randomized Clinical Trial), Fadl H. Khaled, Roula S. Abiad, Khaled Abd El Galil, Essam Osman

BAU Journal - Creative Sustainable Development

Enterococcus faecalis is the most common bacteria isolated in conventional endodontic retreatments. Aim: To compare the impact of three irrigation modalities on the elimination of the isolated microbial strains of Enterococcus faecalis. Materials and Methods: Thirty patients requiring conventional endodontic retreatment for one of their mandibular premolars and tested positive for E. faecalis were chosen. Patients were randomly divided into three groups (n=10) according to the irrigation modality to be used; group I: syringe irrigation (NaOCl 2.625%), group II: NaOCl 2.625%+EndoActivator and group III: NaOCl 2.625%+diode laser. Before obturation, samples S2 were collected and PCR analysis was performed to identify …

Case Study--Jimmy (Zero Balancing And Cst), Judith Sullivan

Journal of Transformative Touch

Jimmy started receiving Zero Balancing and CranioSacral Therapy when he was 11 months old for significant torticollis and scoliosis. In 7 sessions between the beginning of November and the beginning of February. His x-rays show changes within normal ranges.

Study Of The D-Dimer, C-Reactive Protein, And Autoantibodies Markers Among Hbv Infected Patients In Babylon Province, Iraq, Ahmed Abdul-Abbas Bayram, Hussein O.M. Al-Dahmoshi, Noor S.K. Al-Khafaji, Raheem Tuama Obayes Al Mammori, Ali Husain Shilib Al-Shimmery, Morteza Saki

BioMedicine

Background: Hepatitis B can be defined as one of the dangerous diseases caused by the hepatitis B virus (HBV), which infects the liver and causes liver failure, cirrhosis, and death.

Aims: This study aimed to evaluate the D-dimer, C-reactive protein (CRP), and autoantibodies markers among HBV- infected patients in Babylon province, Iraq, compared to a healthy control group.

Methods: In this cross-sectional study, all patients referred to GIT and liver centers in Merjan Medical City, Babylon, Iraq from January 2016 to January 2018 were screened for HBV infection by quantitative real-time polymerase chain reaction (qPCR). Antinuclear antibody (ANA), dsDNA, D-dimer, …

Comparison Of Multiple Imputation Algorithms And Verification Using Whole-Genome Sequencing In The Cmuh Genetic Biobank, Ting-Yuan Liu, Chih-Fan Lin, Hsing-Tsung Wu, Ya-Lun Wu, Yu-Chia Chen, Chi-Chou Liao, Yu-Pao Chou, Dysan Chao, Hsing-Fang Lu, Ya-Sian Chang, Jan-Gowth Chang, Kai-Cheng Hsu, Fuu‑Jen Tsai

BioMedicine

A genome-wide association study (GWAS) can be conducted to systematically analyze the contributions of genetic factors to a wide variety of complex diseases. Nevertheless, existing GWASs have provided highly ethnic specific data. Accordingly, to provide data specific to Taiwan, we established a large-scale genetic database in a single medical institution at the China Medical University Hospital. With current technological limitations, microarray analysis can detect only a limited number of single-nucleotide polymorphisms (SNPs) with a minor allele frequency of >1%. Nevertheless, imputation represents a useful alternative means of expanding data. In this study, we compared four imputation algorithms in terms of …

Comparison Of Pregnancy Complications In Unintended And Intended Pregnancy: A Prospective Follow-Up Study, Mitra Eftekhariyazdi, Malihe Mehrbakhsh, Mahboubeh Neamatshahi, Manijeh Yousefi Moghadam

BioMedicine

Background and Objectives: Unintended pregnancy, as a pregnancy that is mistimed, unplanned or unwanted at the time of conception, is a common experience worldwide that puts mothers at risk for mental stress and its pregnancy complications. The aim of this study was to compare three common pregnancy complications, including preeclampsia, preterm labor, and low birth weight, between unintended and intended pregnancies in Sabzevar, northeast Iran in 2019.

Materials and Methods: This prospective follow-up study was conducted on 200 pregnant women (100 intended and 100 unintended pregnancies) who were between 18 and 35 years old and were referred for …

The Association Of Rs187238, Rs19465518 And Rs1946519 Il-8 Polymorphisms With Acute Kidney Injury In Preterm Infants, Fiva Aprilia Kadi

BioMedicine

ABSTRACT

Background: Interleukin 18 (IL-18) promoter polymorphisms (-656G>T, -607C>A, and -137G>C) affect serum IL-18 (sIL-18) levels and are associated with renal injury.

Purpose: This study aimed to determine the diagnostic utility of sIL-18 and urine IL-18 (uIL-18) as biomarkers for acute kidney injury (AKI) and analyse the association of IL-18 polymorphisms to AKI in preterm infants.

Methods: Blood and urine samples were collected from 56 preterm infants with AKI and 56 without AKI to measure serum creatinine (SCr), sIL-18, and uIL-18. Genotyping of polymorphisms was performed and analysed, with AUC-ROCs analysis used to evaluate …

The Experiences Of Patients With Multiple Sclerosis Of Self-Compassion: A Qualitative Content Analysis, Hanie Dahmardeh, Afsaneh Sadooghiasl, Eesa Mohammadi, Anoshirvan Kazemnejad

BioMedicine

Background: Self-compassion enhances self-care behavior in patients with multiple sclerosis. This concept has been defined in previous studies; however, in order to effectively enhance it, patients’ perceptions about and experiences with self-compassion should be first understood. Therefore, this study aims to explore the meaning of self-compassion experienced by patients with multiple sclerosis.

Methods: This directed qualitative study was conducted in 2019 in Iran. Twenty-three patients with Multiple sclerosis were selected purposefully and interviewed individually. Qualitative content analysis was used for data analysis according to Hsieh and Shannon’s method.

Results: Seventy-six primary codes were detected as well as the following …