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The blood-brain barrier (BBB) is considered as the most challenging barrier in brain drug delivery. Indeed, there is a definite link between the BBB integrity defects and central nervous systems (CNS) disorders, such as neurodegenerative diseases and brain cancers, increasing concerns in the contemporary era because of the inability of most therapeutic approaches. Solid lipid nanoparticles (SLNs) and nanostructured lipid carriers (NLCs) have already been identified as having several advantages in facilitating the transportation of hydrophilic and hydrophobic agents across the BBB. This review first explains BBB functions and its challenges in brain drug delivery, followed by a brief description of nanoparticle-based drug delivery for brain diseases. A detailed presentation of recent progressions in optimizing SLNs and NLCs for controlled release drug delivery, gene therapy, targeted drug delivery, and diagnosis of neurodegenerative diseases and brain cancers is approached. Finally, the problems, challenges, and future perspectives in optimizing these carriers for potential clinical application were described briefly.

Paint sludge is considered hazardous waste due to its heavy metals and high organic compounds. Incineration and landfilling are the methods of disposing of sludge collected from the paint spray of ...

Autophagy is a catabolic process that captures cellular waste and degrades them in the lysosome. The main functions of autophagy are quality control of cytosolic proteins and organelles, and intracellular recycling of nutrients in order to maintain cellular homeostasis. Autophagy is upregulated in many cancers to promote cell survival, proliferation, and metastasis. Both cell-autonomous autophagy (also known as tumor autophagy) and non-cell-autonomous autophagy (also known as host autophagy) support tumorigenesis through different mechanisms, including inhibition of p53 activation, sustaining redox homeostasis, maintenance of essential amino acids levels in order to support energy production and biosynthesis, and inhibition of antitumor immune responses. Therefore, autophagy may serve as a tumor-specific vulnerability and targeting autophagy could be a novel strategy in cancer treatment.

Despite the fact that the tablets are the most widely used dosage form, they are not suitable for young children and patients with swallowing difficulties, especially the elderly. Orodispersible films (ODFs) dissolve rapidly in the mouth and deliver an accurate amount of the active ingredient, which makes them an easy-to-use dosage form that can improve drug acceptability and, therefore, treatment adherence. The findings of the 4 studies that we discussed in this review prove that ODFs have experimentally-proven good acceptability in all age groups and that they are clinically superior to tablets and syrups in terms of acceptability. Therefore, despite some limitations, ODFs are still an innovative and patient-centered dosage form that can contribute to improving drug acceptability and treatment adherence particularly in children and elderly patients. Pharmaceutical companies should focus on developing more ODF-based drugs and also other innovative dosage forms that can make the drug-taking experience even-easier.

Diabetes mellitus is a chronic disease that occurs when the pancreas is unable to produce enough insulin. Indonesia is the 7th most DM sufferer in the world. Patients when diagnosed with DM experience psychological stress, anxiety because they are no longer like normal people, causing depression. The way to reduce depression is to do physical activity such as gymnastics. The purpose of this study was to determine the effect of diabetic exercise on the reduction of depression scores at Persadia RSI Klaten. This study used a quasy experimental pre post test design with a cross sectional approach. The study population was type II DM patients who joined Persadia Islamic Hospital Klaten. The sampling technique was purposive sampling with a total of 30 respondents. The data collection instrument used the PHQ questionnaire. Bivariate data analysis using the Wilcoxon test. The results of the research on the characteristics of respondents were dominated by women as many as 23 (76.7%). The average age of the respondents was 49 years. The ethnic group is dominated by Javanese as many as 28 (93.3%). Most of the respondents' occupation is Labor 12 (40.0%). The average score for depression before the intervention for diabetic exercise was 7,400 and after the intervention for diabetic exercise decreased to 2.166. The results of the Wilcoxon test showed that there was a significant effect of diabetes exercise on the reduction of depression scores in type II diabetes mellitus patients at Persadia RSI Klaten values ??(p = 0.000, Z = -4.813). Conclusion based on the results of the study, the average depression score in Type II DM patients before diabetes exercise was 7,400. Meanwhile, the average depression score after diabetes exercise was 2.166. The results of statistical tests showed that there was an effect of diabetes exercise on depression scores in Type II DM patients with a p value of 0.000.

Background: Good nutritional status is very important for infant growth. A good nutritional status will support growth, development, energy production, body defense, brain structure and function. Nutritional problems suffered by babies can have serious consequences for their health and their future. Poor nutrition can cause the baby to be prone to disease and stunted body tissue growth. Objective: To understand the characteristics of the respondents and to know the description of the nutritional status of children under five in the village of Sidorejo, Kemalang, Klaten. Methods: Design This study is a quantitative descriptive study. This research was conducted to determine the description of the nutritional status of children under five in the village of Sidorejo, Kemalang. The sampling technique in this study was total sampling. The sample in this study was 31 toddlers. The instrument used in this study was a demographic data questionnaire that was filled out via google form. Results: The characteristics of toddlers who were respondents in this study were at least 0 months and a maximum age of 52 months with an average age of 17.45 months and more of the toddlers who were female with a percentage of 54.8%. The results of this study were the nutritional status of children under the category of good nutrition, which was 61.3% compared to children who had less nutrition with a percentage of 19.4%, malnutrition with a percentage of 12.9%, and over nutrition with a percentage of 6,5%.

Objectives Any preventable event related to drugs that may cause harm to a patient is known as "medication error". Errors occur due to a lack of knowledge, poor performance, and psychological lapses. The pharmacists has a major role along with physicians, nurses, and administrators to examine and improve the healthcare system in order to ensure patient safety. The objective of this study was to determine the frequency, causes, and types of medication errors in the secondary-care intensive care unit. Materials and methods All medical records of intensive care unit patients, above 14 years of age, listing their co-morbid/non-co-morbid conditions, occupation, caste, and gender, were checked for medication errors for a period of 6 months at Government Head Quarters Hospital, Udhagamandalam. Results According to the results of this study, 116 medication errors were found in 103 patients in the intensive care unit. The number of medication errors was higher in men than in women. The most common medication errors were prescription errors, which were due to illegible handwriting; the use of lookalike drugs; and incomplete dose, dosage, and frequency. Conclusion Considering the results of this study, it is important to increase awareness among healthcare professionals of varying stature about the significance of medication errors. It is also necessary to change the existing prescribing techniques and clearly differentiate lookalike drugs to avoid medication errors.

Chronic obstructive pulmonary disease is a progressive lung disease characterized by chronic obstruction of the lung airflow that interferes with normal bleeding and is not fully reversible. Chronic smoking is the most common risk factor for COPD causing severe cough, wheezing, labored breathing and reduced functionality. COPD not only exerts pulmonary symptoms but also has a spill over the extra pulmonary effects. Owing to the impact of the disease, it may lead to conditions like osteoporosis, cardiovascular complications as well as to psychological effects such as depression and anxiety. Such comorbidities are hidden and are not effectively treated. Depression, one of the most common hidden comorbidities is known to be present but never diagnosed. Various scales like HAM-D and Bode Index can be used to diagnose the extent of depression. Our review mainly focuses on the various studies conducted worldwide and comparing the results of the same. Based on the worldwide analysis, depression is known to affect a COPD patient at later stages and requires immediate diagnosis and appropriate treatment.

The factors influencing the growth and development of children are internal factor, external factor which is prenatal factor, during giving birth factor and after giving birth factor. Prenatal factors include nutrition, mechanism, toxin, endoctrine, radiation, and mother’s psychological condition, while for the factors after giving birth are nutrition, psychological condition, social environment and stimulation. Family and culture factors involve parents’ job and income, educational levels and knowledge. The purpose of this research is to know the correlation between parents’ educational levels and income with the growth of children under five measured by using Body Weight/Body Height (BB/TB) and Body Height/Age (TB/A). The method applied analytical observational using cross sectional approach. The samples were children under five aged 0-5 years as many as 75 respondents. The technique to collect the data used WHO’s growth table consisting of body height per age (TB/U) and body weight per body height (BB/TB), parents’ job and income were collected by using questionnaires and analyzed bivariately by using chi Square test. The results of this research showed a correlation between parents’ educational levels and income with the growth (TB/U), a correlation between parents’ educational levels and the growth of the children (BB/TB) and no correlation between parents’ income with the growth of the children (BB/TB)

Neurocysticercosis (NCC) is a rare central nervous system infection that is preventable and is caused by the Taenia solium tapeworm larval stage. This disorder is the world’s most common cause of acquired epilepsy and a significant cause of neurological morbidity. This disease is pleomorphic due to several complex factors such as cysticerci characteristics, stages of development, and many more which leads to difficulties in inaccurate diagnosis and adequate stage-wise care. The introduction of cystidical medications, however, has led to a stronger prognosis of NCC-affected patients with an increase in the patient’s clinical course of the disease. After diagnosis most seizure patients do not experience epilepsy. Since Neurocysticercosis remains a neglected tropical disease, the management, and prevention of T. so ilium transmission and strategies for eradicating NCC from endemic areas should be highlighted and prioritized in global healthcare to minimize the significant burden on healthcare and the economy.

Objective The purpose of this case report was to create awareness among scientific fraternity and those who are in the regular usage of the yellow phosphorous compound. Yellow phosphorus is an inorganic element that is poisonous to humans (yellowish, waxy, crystal-clear solid with a pungent odor). Case presentation The patient treatment chart was reviewed and the patient’s condition was evaluated daily. Consumption of toxic doses causes shock and cardiovascular failure within 2–3 h of ingestion, and peak levels are reached when distributed to all tissues after absorption. Here, we report a case of self-harm with the ingestion of rat killer paste, and the patient suffered internal bleeding and acute liver failure. Conclusion Rodenticides remain the primary cause of morbidity and mortality, internal bleeding is the major risks of rodenticide poisoning.

Introduction: Psychological factors including depression and anxiety are the most critical risk factors in the treatment and prognosis of heart failure which should be addressed in treatment and care programs. The purpose of this study was to examine the effect of cognitive-behavioral training (CBT) on depression severity and self-care ability of patients with heart failure. Methods: This study was a randomized clinical trial that carried out on 80 patients with heart failure who had been hospitalized in 2018. The participants were divided into the CBT group (n= 40) and the conventional training (CT) group (n= 40), randomly. Data were collected using Beck Depression Inventory (BDI) and the Self-Care of Heart Failure Index (SCHFI) version 6.2 before and 8 weeks after the educational interventions. Data were analyzed in SPSS 21 using paired t-test, independent t-test, chi-square test, and covariance analysis. Results: The mean score of self-care in the CBT group turned out to be significantly higher than the CT group after receiving the intervention. Also, the mean depression score of the CBT group 26.95 (5.53) after intervention was significantly lower than the CT group 36.04 (8.45). Conclusion: Cognitive-behavioral intervention, compared with conventional training, had a greater positive impact on improving self-care and alleviating the severity of depression symptoms. Therefore, it is recommended that the principles of cognitive-behavioral therapy be integrated into routine educational programs.

PURPOSE: This study aimed to evaluate biphasic calcium phosphate coating (BCPC) on the secondary stability of dental implants compared to sand-blasted and acid-etched (SLA) implants. MATERIALS AND METHODS: This is a split-mouth study. Thirty subjects (20 males and ten females) underwent a dental implant procedure to replace mandibular first or second molars bilaterally. The subjects were randomly assigned to BCPC or SLA groups. The resonance frequency analysis measurements were performed two, four, six, and eight weeks after the implant placement. RESULTS: Sixty implants were placed in the two groups (30 implants per group). The mean ISQ was 52.26 ± 3.73 in group 1 and 50.21 ± 2.59 in group 2 on day 14 after the implant insertion, 63.20 ± 2.76 in group 1 and 58.80 ± 2.14 in group 2 on day 28, 72.30 ± 3.15 in group 1 and 64.53 ± 3.19 in group 2 on day 42, and 78.70 ± 1.56 in group 1 and 71.63 ± 3.22 in group 2 on day 56. The data analysis demonstrated significant differences between the two groups in terms of the mean ISQ at various evaluation times. CONCLUSION: Regarding ISQ measurements, the secondary stability in BCPC implants may be higher compared to SLA implants in two months after implant insertion.

Background : Breastfeeding will provide a wide range of benefits for both mother and baby. Breastfeeding is one of the physical adaptations and processes of changing maternal roles in postpartum mothers. Not all mothers can go through this process correctly . A small amount of milk production on the first day of postpartum is one of the complaints that is often felt by mothers. The hormone prolactin is one of the factors that influence milk production. One way to stimulate the production of the hormone prolactin is by breast treatment. Breast care will affect hypopise to release the hormone progesterone, estrogen , prolactin, and oxytocin more . Objective : The purpose of this study was to identify the effect of pressure on the Jianjing GB-21 acupressure point and Oketani massage on the level of the hormone prolactin. Method : The type of this research is a quasi-experiment with the design used is a pre-post-test design with the control group. Prolactin hormone levels were examined before the intervention (on the first day) and on a ninth day. The examination was carried out using the ELISA (Enzym Linked Immunosorbent Assay) technique. Data obtained was analyzed using an independent sample T-test . Result : The study showed that there was an increase in mean values of maternal prolactin levels after oketani massage intervention and pressure on GB-21 acupressure points. T he administration of a combination of interventions, namely Oketani massage and pressure at the GB-21 point, can increase the highest levels of the hormone prolactin, which is 3.41. Whereas in the control group that did not get any intervention, had the lowest levels of the hormone prolactin that is equal to 2,925 Conclusion: it can be concluded that oketani massage and applying pressure at the GB-21 point can increase the levels of the hormone prolactin, respectively.

The aim of this study was to investigate the frequency of anti-N-methyl-D-aspartate receptor (anti-NMDAR) antibody positivity in patients presenting with transverse myelitis (TM) and/or optic neuritis (ON), to describe their neurologic and radiological characteristics, and to compare these characteristics with those reported in previous studies. This study included 179 patients (ON: 96, TM: 74, ON and TM: 9) who visited Isfahan Multiple Sclerosis Center from January 2017 to September 2019, for approximately 32 months. The respective neurological examinations were performed. Demographic data of the patients, as well as findings from radiological and serological investigations were obtained. Frequencies of anti-NMDAR seropositivity in patients with TM, ON, and concurrent TM and ON were approximately 3.4%, 1.4%, and 11.1%, respectively. None exhibited any psychiatric symptoms. Based on the frequency of seropositivity for anti-NMDAR antibody in our patients, positivity for this antibody appears to be more frequent than previously anticipated in patients presenting with these conditions. We recommend that the anti-NMDAR antibody presence in CSF/serum be checked and considered in addition to the routine examinations performed upon confronting demyelinating conditions such as TM and ON. We suggest considering the term “NMDAR spectrum disorder” to more clearly distinguish the potentially overlapping conditions with different etiologies in patients with CNS disorders.

Introduction:Bolus material is frequently used on patient’s skin during radiation therapy to reduce or remove build-up effect for high-energy beams. However, the air-gaps formed between the bolus and the skin’s irregular surface reduce the accuracy of treatment planning. To achieve a good treatment outcome using bolus, experimental investigations are required to choose its thickness and to quantify the air-gap effect.Material and methods:Measurements for a 6 MV photon beam with a fixed source surface distance were carried out using the 31021 Semiflex 3D chamber into the water phantom. Firstly, the depth of maximum dose (R100) and the dose value at surface (Ds) were evaluated as a function of bolus thickness for some square fields. Secondly, to test the effect of the air-gaps ranged from 5 to 30 mm with a step of 5 mm between the bolus and the phantom surface, a water-equivalent RW3 (Goettingen White Water) slab form of 10 mm thickness was considered as a bolus.Results:We observed that the linear behaviour of R100 in terms of the bolus thickness makes the choice of this parameter more convenient depending on field size. In addition, increasing the air-gaps widens the penumbra and created electrons that have a greater probability to quit the radiation field borders before reaching the surface. The dose spread of the off-field area could have a significant influence on the patient treatment.Conclusion:Based on dose distribution comparisons between the measurements with and without air-gaps for the field size of 100 mm × 100 mm, it has been demonstrated that a maximum air-gap value lower than 5 mm would be desirable for an efficient use of the bolus technique.

Pre-Eclampsia was recorded as a cause of maternal death in Indonesia in 2017, which was 28.8%. Hypertension is a sign of pre-eclampsia. Murattal Therapy Letter Yusuf is a non-pharmacological therapy that can be used to reduce blood pressure. The purpose of this study is to determine the effect of Murattal Therapy in reducing blood pressure in pregnant women with pre-eclampsia. The design of this study used the Quasy Experiment design with One Group Pretest and Posttest Design. As the population are pregnant women who are diagnosed with pre-eclampsia. 15 respondents were selected using purposive sampling. Data collection tool with an observation sheet and tensimeter. The data collection technique was carried out using the respondent placed in a conditioned room, then listening to the letter of Joseph for 15 minutes using a tape recorder and then his blood pressure was measured. From the 15 respondents after Murotal therapy, the result of a decrease in blood pressure with a statistical test using a paired t-test obtained a p-value of systolic blood pressure of 0,000 and diastolic blood pressure of 0,000. Murattal therapy can stimulate a controlled autonomic nerve and cause secretion of epinephrine and norepinephrine by the controlled adrenal medulla. Control hormones epinephrine and norepinephrine will inhibit the formation of angiotensin which can reduce blood pressure. Surah Yusuf's Murattal Therapy can reduce the blood pressure of pregnant women with pre-eclampsia.

Inherited hemorrhagic telangiectasia (HHT or Osler–Weber–Rendu syndrome) is a hereditary condition characterized by malformations of multiple blood vessels (vascular dysplasia), which may lead to bleeding (hemorrhaging). Chronic nosebleeds are often the first warning, and malformations in various blood vessels can lead to abnormalities in the lungs, brain, spinal cord, and liver. There are a number of therapies available for various aspects of HHT to improve the quality of life and avoid life-threatening complications. Individuals with HHT have an almost average life expectancy. HHT is inherited as a dominant autosomal trait. We have done this review to enlighten the scientific fraternity about HHT. In this review, we have tried to explain about HHT and its related management.

BACKGROUND Introducing a non-invasive method for determining disease activity is important in patients with ulcerative colitis (UC). So in this study, we aimed to assess the association between disease activity index and microalbuminuria in patients with UC. METHODS In the present cross-sectional study, 84 patients with UC were selected. The disease activity was calculated by the partial Mayo clinic score. Microalbuminuria was assessed using the immunoturbidimetric method in a first-voided sample in the morning in two consecutive days and the mean of these two measurements was reported as urinary microalbumin level. Serum C reactive protein (CRP), erythrocyte sedimentation rate (ESR), and fecal calprotectin were measured respectively using conventional turbidimetric immunoassay, Westergren method, and ELISA methods. RESULTS The mean age of the participants was 40.01 ± 12.85 years, 60.8% of them were female and 53.5% had microalbuminuria. The frequency of microalbuminuria was significantly higher in patients with active compared with inactive inflammatory bowel disease (IBD). There were significant differences between the patients with active and inactive disease regarding CRP, ESR, and calprotectin (p < 0.001). Moreover, there was a strong correlation between microalbuminuria and CRP (r = 0.89, p < 0.001), ESR (r = 0.92, p < 0.001), and calprotectin (r = 0.91, p < 0.001). CONCLUSION Microalbuminuria could be used as a non-invasive marker of disease activity in patients with UC.

Objective: To assess the attitudes, experiences, training levels, and interest in future education regarding the use of hypnosis by dentists working in Dental Clinic of Monastir, Tunisia . Material and Methods: A cross-sectional study was conducted among 330 dentists working in Dental Clinic of Monastir in November 2019. Students, internship, residents, and professors were randomly selected. This was a survey with a structured questionnaire mailed to all dentists. The questionnaire was pre-fabricated, simple, and close-ended. Data were analyzed using SPSS 24.0 statistical software. Results: A total of 202 dentists respond to this survey. 54% of the participants were interns with a female predominance (66.5%). Findings revealed that beliefs toward hypnosis in the sample were generally positive. Using a visual analogue scale, dentists reported having moderate acknowledge in hypnosis (3.4). 60% of the participants in our study consider that hypnosis is useful in dentistry and, more particularly, in pediatric dentistry. 78.2% of respondents want to follow training courses in hypnosis . Conclusion: Our survey highlights the weak knowledge of participants in hypnosis and reveals certain misconceptions about this procedure. More efforts are required to better educate dentists about hypnosis's benefits in their practice.

Recurrent thrombosis is a common complication in various pathologies and is part of the definition of antiphospholipid syndrome. We report an observation in which the patient presented with repeated thrombosis, due not only to an antiphospholipid syndrome with partial thromboplastin time with normal activator, but also to a resistance to active protein C linked to the existence of the Leiden factor mutation V. This observation confirms the most often multifactorial nature of thromboses and therefore encourages the search for resistance to activated protein C before an evocative clinic, especially if the routine coagulation assessment is normal.

Albinism is a hereditary disorder that causes decreased pigmentation (coloring) in the body. As a consequence, albinism individuals are mostly fair-skinned with light hair known as oculocutaneous albinism. Skin, hair and color of the eye may vary, however, as some people with albinism may have dark brown hair and green or hazel / blue eyes. In both cases, poor vision and varying degrees of nystagmus (uncontrolled side-to-side eye movements) are observed. Everyone with HPS has albinism but not all people with albinism have HPS. We recorded a case with multiple comorbidities of a 37-year-old female patient with Hermansky-Pudlak syndrome (HPS) here

Simple Summary Melanoma is one of the most aggressive skin cancers, characterized by metastasis to the lymph nodes and a high capacity to develop drug resistance. There is a lack of knowledge on the mechanisms contributing to lymphatic vessel formation and metastasis regulation in malignant melanoma. We previously reported the involvement of CD147, a transmembrane glycoprotein overexpressed in melanoma, in the regulation of the tumor microenvironment and angiogenesis. The aim of our study was to further determine how CD147 is involved in lymphangiogenesis regulation. Our results revealed that high CD147 expression is correlated with the number of lymphatic vessels in the human melanoma lymph nodes and that paracrine CD147 upregulates lymphangiogenesis through lymphangiogenic mediators in vitro and in vivo, suggesting that CD147 could be a promising target for melanoma-associated lymphangiogenesis inhibition. Abstract Malignant melanoma is one of the most aggressive skin cancers and is characterized by early lymph node metastasis and the capacity to develop resistance to therapies. Hence, understanding the regulation of lymphangiogenesis through mechanisms contributing to lymphatic vessel formation represents a treatment strategy for metastatic cancer. We have previously shown that CD147, a transmembrane glycoprotein overexpressed in melanoma, regulates the angiogenic process in endothelial cells. In this study, we show a correlation between high CD147 expression levels and the number of lymphatic vessels expressing LYVE-1, Podoplanin, and VEGFR-3 in human melanoma lymph nodes. CD147 upregulates in vitro lymphangiogenesis and its related mediators through the PROX-1 transcription factor. In vivo studies in a melanoma model confirmed that CD147 is involved in metastasis through a similar mechanism as in vitro. This study, demonstrating the paracrine role of CD147 in the lymphangiogenesis process, suggests that CD147 could be a promising target for the inhibition of melanoma-associated lymphangiogenesis.

Aim. The aim of this study was to evaluate the acid-neutralizing capacity (ANC) and other properties of antacid drugs marketed in Morocco. Methods. Samples of 12 antacids were collected from pharmacies and were subjected to the test described in the US Pharmacopoeia in order to measure their ANC. Other properties such as price and sodium content were also studied. Results. All the tested brands met the minimal requirement of 5 mEq. However, Aluminum hydroxide/Magnesium hydroxide combinations showed a superior acid-neutralizing capacity over other products and oral suspensions showed better results compared to other pharmaceutical forms. Regarding the cost of antacids, Aluminum hydroxide/Magnesium hydroxide combinations and calcium carbonate/magnesium carbonate combinations showed the most favorable ANC/price ratio. Some of the antacids studied contain a high amount of sodium. Conclusion. All the antacids marketed in Morocco meet the USP requirement regarding their ANC. However, the ANC value should be included in the antacids’ labels so that both patients and physicians can choose the most appropriate product. The ANC value should be evaluated according to the dose of the active substance instead of the minimum labeled dosage in order to allow a better result interpretation.

Background: Due to the importance of spiritual health in patients with thalassemia and its positive and significant effects on improving the treatment process and mental, psychological and social conditions of these patients and according to the results of previous studies, patients with thalassemia have high spiritual health. The lack of studies in this field, the present study was conducted to determine the spiritual health of adolescents with thalassemia major. Methods: This descriptive-analytical study was performed on 100 adolescents with thalassemia major. Sampling was done by available means. Patients' spiritual health was measured using the Poltzin and Ellison spiritual health questionnaire. Data were analyzed using descriptive statistics tests and the relationship between mean spiritual health and mean age of patients with Pearson correlation coefficient test, its relationship with gender and place of residence with independent t-test and its relationship with economic status with ANOVA. Results: The mean and standard deviation of patients' spiritual health score was 74.23 ± 11.45, which showed a moderate level of spiritual health. 12% of patients (12 patients) reported low spiritual health, 84% (84 patients) reported moderate spiritual health and 4% (4 patients) reported high spiritual health. There was no significant relationship between spiritual health and demographic characteristics (p value > 0.05). Conclusion: According to the results of this study which showed that adolescents with thalassemia have a moderate level of spiritual health and due to the high importance of spiritual health in improving treatment, adherence to treatment regimen, life expectancy and mental health of patients, It is necessary to take appropriate measures to improve the spiritual health of these patients.

Background: Staphylococcus aureus is one of the important bacteria causing nosocomial infections. Nowdays, because of overuse of antibiotics, resistance is increasing and this problem has caused anxiety all over the world. The aim of this study was to evaluation of antibiotic resistance pattern in S.aureus isolates from urinary tract infections in Shahid Beheshti educational and therapeutic center in Maragheh city. Methods: In this cross sectional study, 100 S. aureus isolates were collected from patients suffering from urinary tract infections. After doing the biochemical tests for diagnosis of S. aureus, these isolates were identified as S.aureus with proliferation of thermonuclease species-specific gene (nuc) by polymerase chain reaction (PCR) method. Kirby-Bauer method was used for investigation of antibiotic resistance patterns in S. aureus isolates. Results: No significant difference in genotype frequencies was observed between the T2DM patients and normoglycemic controls. The rs7903146 (C/T) polymorphism odds ratios for CC and TC genotypes were 1.75 (95% CI, 0.63 to - 4.88; p=0.28) and 0.94 (95% CI, 0.49 to - 1.79; p = 0.84) compared with the TT genotype, respectively. The rs46522 (C/T) poly-morphism odds ratios for TT and TC genotypes were 1.41 (95% CI, 0.58 to - 3.42; p = 1.41) and 1.22 (95% CI, 0.64 to - 2.35; p = 1.22) compared with the CC genotype, respectively. Conclusion: Results of current study showed high antibiotic resistance in nosocomial S. aureus isolates. Therefore, antibiotics consumption should be avoided without proper prescription and unnecessary usage of routine antibiotics for showed be prevented.

Introduction: Breastfeeding is a physiological task for postpartum mothers. At the postpartum the condition of the body, especially the breast and hormonal system are prepared to support the lactation process. Not all mothers however can carry out this new task smoothly. Many complaints experienced by the mothers at the beginning of the lactation process including breast milk not coming out, breast milk in small amount, nipple blisters and so on. One of the factors that influences milk production is hormonal factors, namely prolactin and oxytocin. Breast care will stimulate the breast and affect hypopise to release more progesterone, estrogen and oxytocin hormones. The oxytocinhormone will cause contractions in other cells around the alveoli so that milk flows down towards the nipples. Methodology: This type of research is a quasi-experiment using the pre post test design with control group. Results: The study showed that there was an increase in the mean value of oxytocin hormone in the mothers after receiving the Oketani massage intervention and pressure on the jianjing GB-21 acupressure point. Discussion: Massage can help reducing daily stress, improve the immune system and generally make people feel healthier and more relaxed. Massage has been shown to facilitate increased release of natural oxytocin. Acupressure technique at Jianjing point GB-21 is a point to stimulate let down reflexes which can stimulate lactogen hormone secretion and can increase blood circulation in the breast (Betts, 2003). Relaxation conditions experienced by the mother will increase comfort so that it increases the let down reflex and increases levels of the prolactin and oxytocin hormones (Rahayu, et al., 2015).

Loss of tumor suppressor liver kinase B1 (LKB1) promotes cancer cell proliferation but also leads to decreased metabolic plasticity in dealing with energy crises. Autophagy is a protective process involving self-cannibalization to maintain cellular energy homeostasis during nutrient deprivation. We developed a mouse model for Lkb1-deficient lung cancer with conditional deletion of essential autophagy gene Atg7 to test whether autophagy compensates for LKB1 loss for tumor cells to survive energy crises. We found that autophagy ablation was synthetically lethal during Lkb1-deficient lung tumorigenesis in both tumor initiation and tumor growth. We further found that autophagy deficiency causes defective intracellular recycling, which limits amino acids to support mitochondrial energy production in starved cancer cells and causes autophagy-deficient cells to be more dependent on fatty acid oxidation (FAO) for energy production, leading to reduced lipid reserve and energy crisis. Our findings strongly suggest that autophagy inhibition could be a strategy for treating LKB1-deficient lung tumors.

Despite the great progress in medical sciences, cancer is still a major health problem. Since the majority of cancer treatment protocols include first-generation chemotherapeutic agents, side effects and drug resistance are still a concerning issue. Therefore, targeted and selective solution for standard chemotherapeutics is needed more than ever. Gold nanoparticles (GNPs) have remarkable size and surface properties that make them the ideal vehicle for targeted and selective drug delivery. Different in vitro and in vivo experiments proved that these particles can be easily engineered in such a way that the chemical drug can be delivered directly to the tumor site. Moreover, different types of ligands can be loaded on the surface of GNPs to enhance selectivity or modulate drug release. Furthermore, the anti-angiogenic and photothermal properties of these particles can be used to potentialize the drug action. However, more studies must be conducted to elucidate all the toxicity issues and to acquire additional knowledge on the long-term health effects and interaction with all the human body's physiological mechanisms.

Antimicrobial resistance is a global public health challenge, which has accelerated by the overuse of antibiotics worldwide. Increased antimicrobial resistance is the cause of severe infections, complications, longer hospital stays and increased mortality. Steps must be taken to reverse the damage that has already been done and prevent further resistance from developing. This work will examine the context and societal situations that led to this acceptance of antibiotic overuse and misuse seen in both health care professionals and the public, the biochemical and genetic pathways that allow a microbe to develop drug resistance, the consequences that could follow if this trend of antibiotic overuse is allowed to continue and the various methods and solutions that have been suggested to prevent and reverse this problem.

Epidural myeloid sarcoma revealing chronic myeloid leukemia is scarce. Herein, we describe a patient that presented with back pain and bilateral sciatica secondary to root compression due to epidural deposition of leukemic cells. The magnetic resonance imaging showed epidural masses, causing a slight restriction of the spinal canal with bilateral L5 root compression. Laboratory examinations showed hyperleukocytosis (white blood cell count: 83 × 109/L, absolute neutrophil count: 60 × 109/L). The bone marrow cytology and immunophenotypic findings confirmed the diagnosis of myeloid leukemia. The diagnosis of spinal myeloid sarcoma revealing chronic myeloid leukemia during the blast phase was established. The patient underwent induction chemotherapy. Then, bone marrow cytology revealed less than 3% of blasts, which correspond to cytological remission. Three months later, MRI showed complete disappearance of the epidural masses. A literature review was conducted by searching PubMed using these terms: “Leukemia, Myeloid” AND “Spine” AND “Sarcoma, Myeloid”. We emphasize clinical and radiological findings of spinal myeloid sarcoma. This diagnosis should be considered when the MRI reveals epidural mass lesion. The early management of this disease is necessary, and the treatment of myeloid sarcoma is not codified. Our case highlighted that chemotherapy treatment could be sufficient to lead to the disappearance of myeloid sarcoma and the remission of leukemia.

Menurut Badan Penelitiandan Pengembangan Kesehatan dalam Riset Kesehatan Dasar 2013 tercatat jumlah balita di Indonesia sebanyak 26,7 juta. Dari jumlah tersebut 17,9% atau 4,7 juta balita menderita gizi kurang dan 5,4% atau 1,3 juta balita menderita gizi buruk. Gizi kurang berdampak langsung terhadap kesakitan, kematian dan juga berdampak terhadap pertumbuhan, perkembangan intelektual dan produktivitas.. Dampak lain dari gizi kurang adalah menurunkan produktivitas yang diperkirakan antara 20-30%. Penelitian ini bertujuan untuk meneliti hubungan faktor pengetahuan ibu tentang gizi seimbang dengan status gizi balita. Penelitian ini merupakan penelitian deskriptif korelatif dengan pendekatan crossectional . Penelitian dilaksanakan bulan Juni-Agustus 2019 di wilayah Desa Gogik, Kec. Ungaran Barat Kab. Semarang. Sampel dipilih dengan teknik Prposif sampling sebesar 80 ibu dan 80 balita berumur 13-60 bulan. Variabel bebas: pengetahuan. Variabel terikat: status gizi. Teknik pengumpulan data menggunakan kuesioner . Analisis data yang digunakan adalah Chi square . Hasil penelitian menunjukkan karakteristik subjek penelitian sebagian besar dalam kategori usia reproduksi sehat yaitu 68 (85%), sebanyak 53 (66%) adalah bekerja, sebanyak 39(48,8%) memiliki tingkat pendidikan dasar dan sebanyak 44 (55%) memiliki pendapatan kurang dari UMR. Sebanyak 39 (48,8%) subjek penelitian memiliki tingkat pengetahuan tentang gizi balita dalam kategori baik, sebanyak 58 (72.5%) subjek penelitian memiliki status gizi dalam kategori normal. Secara statistik terdapat hubungan signifikan antara pengetahuan ibu tentang gizi dengan status gizi balita dengan nilai p = 0.000 < dari 0.05. Sebagian besar subjek penelitian memiliki tingkat pengetahuan dalam kategori baik, dan sebagian besar subjek penelitian memiliki status gizi dalam kategori normal. Terdapat hubungan signifikan antara pengetahuan ibu tentang gizi dengan status gizi balita. Kata Kunci : Pengetahuan, Gizi seimbang, Status Gizi, Balita

Spotting blood in urine can be alarming. In many instances the cause is harmless, but blood in urine can indicate a serious disorder. Haematuria can be categorized into two categories, such as gross haematuria and microscopic haematuria. Gross haematuria is visible with naked eyes, and easily identifiable, whereas microscopic haematuria can be identified after doing a urine test under a microscope. It is important to know the primary cause of bleeding. It can be either due to medications, kidney disorders, urinary tract infections or strenuous exercise's. Here we report a case series of gross haematuria for three patients where it has been caused by anticoagulant drug heparin. Our case series illustrates a strong causal relation with heparin causing gross haematuria.

Non-steroidal anti-inammatory drugs (NSAID) are regularly utilized for pain relieving and are among the most often medications in this world. The adverse effects of NSAID on the upper gastrointestinal tract are very much portrayed. Evidence shows that NSAID can be unsafe to the small intestine tract. The prevalence of NSAID-induced enteropathy is insecure. The utilization of NSAID has been related with little intestinal strictures, ulcerations, perforations, diarrhoea and villous atrophy. The reports of NSAID abuse and NSAID use issue are exceptional. In contrast to stomach, NSAID-induced lower gastrointestinal wounds are not brought about by concealment of prostaglandin union because of restraint of cyclooxygenase (COX) action. The pathogenesis of NSAID- induced enteropathy is unpredictable and not clearly understood. Until now, no new drugs have been developed for the treatment of NSAID-induced enteropathy. This case report portrays an investigation on the mechanism of NSAID induce enteropathy with comorbid condition.

Summary Attenuated auto-lysosomal system has been associated with Alzheimer disease (AD), yet all underlying molecular mechanisms leading to this impairment are unknown. We show that the amino acid sensing of mechanistic target of rapamycin complex 1 (mTORC1) is dysregulated in cells deficient in presenilin, a protein associated with AD. In these cells, mTORC1 is constitutively tethered to lysosomal membranes, unresponsive to starvation, and inhibitory to TFEB-mediated clearance due to a reduction in Sestrin2 expression. Normalization of Sestrin2 levels through overexpression or elevation of nuclear calcium rescued mTORC1 tethering and initiated clearance. While CLEAR network attenuation in vivo results in buildup of amyloid, phospho-Tau, and neurodegeneration, presenilin-knockout fibroblasts and iPSC-derived AD human neurons fail to effectively initiate autophagy. These results propose an altered mechanism for nutrient sensing in presenilin deficiency and underline an importance of clearance pathways in the onset of AD., Graphical Abstract, Highlights • Presenilin (PS)-knockout or AD mutations attenuate CLEAR network activity • Amino-acid-sensing function of mTORC1 is dysregulated in PS-deficient cells • Increase of cellular calcium or Sestrin2 re-regulates mTORC1 and CLEAR activity • Dysregulated mTORC1 accounts for low autophagy in PS deficiency, Reddy et al. find that the amino-acid-sensing function of mTORC1 is dysregulated in cells deficient in the AD-associated presenilin proteins. Constitutively active mTOR in these cells inhibits CLEAR network activity, leading to degeneration. Attenuation of the CLEAR network leads to the onset of AD-like pathophysiology in vivo.

Biodegradable polymers have become a promising option to prevent the accumulation and replacement of non-destructive petroleum-based plastics. Among all biopolymers, starch films have been considered due to their unique characteristics, especially abundance, cheapness and biocompatibility for packaging industries. Recently, absorbing ultraviolet (UV) rays plays a key role to increase the durability of food and pharmaceutical products. But common organic UV absorbers pose risks to human health and the environment. In this research, date palm syrup (DPS) that is an edible ingredient, has been used to add UV absorption properties to the starch films. UV–Vis spectroscopy showed that these films have good UV absorption and stability in the UV range due to the presence of C O, C C, and O–H functional groups. With the addition of DPS, hydrophilic of these films have been increased. Mechanical properties tests have shown that DPS increases the tensile strength to be about 7.3%, reduces the ductility to be about 26.5%, and also increases the thermal stability of prepared films.

Introduction: Oketani massage and oxytocin is one of the breast care methods that do not cause pain. Massage can stimulate oketani pectoralis muscle strength to increase milk production and make the breasts become more soft and elastic so meumudahkan baby to suck milk. Massage oketani will also provide a sense of relief and an overall comfortable on respondents, improving the quality of breast milk, to prevent mastitis and nipple blisters and can fi x / reduce lactation problems caused by putting a fl at (fl at nipples), nipples that enter into (inverted). Method: This research was a quasi experimental with post test only design. Result: The results showed that there are different breastfeeding frequency, frequency of bowel, bladder frequency of respondents who do massage and oxytocin oketani. Discussion: one milk production assessment is to assess the frequency and volume of urine bladder baby. Normal babies will urinate 6-8 times a day, with a clear yellow color of urine is urine volume between 30-50 mg daily. This result is consistent with research conducted by Budiarti (2009) and Mardianingsih (2010) which states that the milk production can be judged from the frequency of micturition babies as many as 6-8 times a day Key words: oketani massage, oxytocin massage, milk production

Phenytoin is an antiepileptic drug and is commonly prescribed for generalized tonic-clonic seizure. It blocks the voltage gated sodium channel and produce the action. It has a narrow therapeutic index. Adverse effects are very common with phenytoin but idiopathic ataxia is rarely observed. We report a case of a 30-year-old male patient who had chief complaints of ataxia, giddiness and vomiting. He had past medical history of epilepsy for which he was adherent to phenytoin from past four years. Key words: Phenytoin, Ataxia, Male, Epilepsy, Adverse drug reaction.

An adverse drug reaction is a causal relationship between a drug and an event. Alcohol consumption remains a huge threat to the global health. A seizure is an event accompanied with loss of motor activity and alterations in the patients EEG. Phenytoin is one of the most commonly employed anti-seizure medications. Manifestations of chronic phenytoin use may induce phenytoin toxicity and psychosis. Here we report a case of a 45 year old male patient with probable phenytoin induced psychosis while being treated for seizures in the in-patient ward. The long term use of phenytoin may manifest psychotic symptoms in certain population. There is a definite need of more evidence in this field and proper diagnostic and management approaches. Key words: Adverse drug reaction, Alcohol, Phenytoin, Probable, Psychosis, Seizures.