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PURPOSE to investigate the clinical outcomes of transepithelial photorefractive keratectomy (tPRK) with actual epithelial thickness versus default software values. METHODS eighty-three patients with refractive spherical error of -1.50 to -7.00 diopters (D), and refractive astigmatism up to 4.00 D were consecutively enrolled and divided into two groups: group 1 undergone tPRK with actual central and peripheral epithelial thickness input in right eyes, group 2 undergone tPRK with actual central and 10 μm higher peripheral epithelial thickness in right eyes, left eyes underwent tPRK with default protocol in both groups. Outcome measures were induced refractive error, achieved optical zone (OZ), and wasted stromal tissue. SETTING Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, IranDesign: prospective controlled study. RESULTS Mean ± SD of induced spherical equivalent (SE) was +0.15 ± 0.39 D and +0.01 ± 0.35 D in right and left eyes of group 1 (p=0.01), and +0.04 ± 0.22 D and +0.03 ± 0.23 D in right and left eyes of group 2 (p=0.75), respectively. There was no statistically significant difference between wasted tissue between right and left eyes in group 1 and group 2 (p=0.77 and p=0.49, respectively). OZ contraction was significantly higher in right compared to left eyes in group 1 (p=0.05), but not in group 2 (p=0.95). CONCLUSION In tPRK, refractive outcomes, wasted tissue, and OZ contraction depend little on pre-existing corneal epithelial thickness in corneas with normal range epithelial thickness. However, OZ contraction may be a concern in lower amount of ablations.

Breastfeeding (BF) has been a proven means of providing young infants with the nutrients required for healthy growth and development. The process has also been known to reduce common childhood infections, which are the causes of high mortality and morbidity. Hence in achieving the best practice of BF, both knowledge and techniques are essential. Therefore, the study aims to assess the knowledge and practice on BF among mothers whose children were admitted at Mnazi Mmoja Hospital, Zanzibar. The study was a cross-sectional descriptive hospital-based carried out in the pediatric ward of MMH from April 2020 to July 2020 after approval by the hospital's health and ethics committee. Questionnaires were deployed to interview all consenting participants who were mothers aged from 18 to 50 years, breastfeeding a child, and having at least one previous child who had been breastfed earlier (Above 2 years) at the time of the study. Selected questions were used to assess and categorized a total of 199 mothers who were recruited into the study as those with knowledge, those without knowledge on Exclusive breastfeeding (EBF), breastfeeding (BF) for 2 years, and breastfeeding techniques (BFT). Data were analyzed using Statistical Package for Social Sciences version 16. Differences at P < 0.05 were considered significant. About 76.9% of the mothers studied had knowledge of EBF, while 65% had knowledge of BF for two years. A total of 42 (21.1%) had children below 6 months and were still BF, with the remaining 157(78.9%) having children above 6 months. Among the 157, only 58 (37%) practice EBF for 6 months. Also, 130 (65.3%) mothers breastfed their children up to 2 years in their previous child's upbringing. Most of them (42%) stopped because they became pregnant. The breastfeeding technique (BFT) was affected by the mother's age but not education level, as more of the older mothers had good positions and attachments than the younger ones. On overall techniques, 58.5% had good attachment compared to 49.7% who had proper position. Although most mothers were aware of the knowledge of EBF for 6 months, the practice is still low. However, older mothers, particularly the age group 31-40, have good BFT compared to younger mothers. There is a need for more education on EBF, BF, and BFT among women during Antenatal Clinic (ANC) and after delivery during the monthly clinic.

Summary: Background: Interleukin 6 is an important biomarker for distinguishing high-risk and low-risk patients, and is a constituent of the Nutrition Risk in the Critically III (NUTRIC) Score. Studies have indicated the beneficial effects of vitamin C on lowering IL-6 levels and reducing cytokine storm. However, there is still controversy about the exact effect, appropriate route, and dose of vitamin C usage. This meta-analysis was conducted to evaluate the current evidence base relating to vitamin C intervention on decreasing IL-6 levels. Methods: A systematic search was performed in PubMed, Scopus, Google Scholar, and Cochran databases, from database inception to July 3rd 2021, to obtain any possible randomized clinical trial for inclusion. After screening and removing unrelated and duplicate articles, 24 eligible articles remained for statistical analysis. Results: We found a significant lowering effect of vitamin C supplementation on IL-6 levels via peroral (PO) (WMD = -0.29 pg/l, 95% CI [-0.42, -0.16], P

Consanguineous couples are typically counseled based on familial pathogenic variants identified in affected children. The residual risk for additional autosomal recessive (AR) variants, however, remains largely understudied. First, we surveyed pedigrees of 1,859 consanguineous families for evidence of more than one AR disease. Second, we mined our database of 1,773 molecularly tested consanguineous families to identify those with more than one AR disease. Finally, we surveyed 88 women from consanguineous unions who have undergone targeted prenatal testing for a familial AR variant and followed the pregnancy outcome (n = 144). We found suggestive evidence of more than one AR disease in 1.94% of consanguineous pedigrees surveyed. Of 1,773 molecularly characterized consanguineous families, 2.93% had evidence of at least two AR diseases (3.54% for first cousin or closer and 2.72% for second cousin or more distant). Furthermore, we found that in 2.78% of pregnancies negative for the familial variant, the pregnancy outcome was a child with a different AR disease. Our results show that when counseling consanguineous couples for a familial AR variant, ~3% residual risk for additional AR variants should be discussed. This suggests that a broader testing strategy in consanguineous couples should be considered.

Background: Cardiovascular diseases are the leading cause of mortality worldwide. Therefore, it is important to predict the future consequences of the disease in patients who have recovered. Objectives: We sought to determine the relationship between troponin-I level and 6-month clinical consequences (i.e., re-infarction, death, re-angiography and coronary artery bypass grafting) in patients with acute coronary syndrome (ACS). Methods: This prospective cross-sectional study was performed among 60 patients with ACS admitted to Ayatollah Mousavi Hospital in Zanjan, Iran. The participants were chosen using the convenience sampling method. Troponin-I level in these patients was initially evaluated. Afterwards, they were followed up for six months in terms of clinical consequences. A checklist was prepared to collect the required data. The receiver operating characteristic (ROC) analysis was conducted to determine the predictive power of high-sensitivity troponin I for the mentioned consequences. Iodine index was calculated to determine the cutoff point for this enzyme in order to predict the consequences. Results: In general, 66.2% of the participants were male and the mean age was 60.46 ± 12.78 years. We found that 21.2% of the participants experienced one of the four clinical consequences in the follow-up period of 6 months. The sub-curved surface was calculated to be 0.705 for the prediction of consequences. The cutoff point for the prediction of consequences was 32.5; the negative predictive value for the cutoff point was 32.5, which was equal to 89.8%. Conclusion: Troponin-I has an acceptable predictive power to identify 6-month consequences of ACS. Moreover, considering the negative predictive value of troponin-I, it is recommended to use this biomarker in patients with ACS. In addition, healthcare providers should pay more attention to the follow-up of patients after discharge and design preventive programs.

The objective was to determine the feasibility and effectiveness of cardiac magnetic resonance (CMR) cine and strain imaging before and after cardiac resynchronization therapy (CRT) for assessment of response and the optimal resynchronization pacing strategy.CMR with cardiac implantable electronic devices can safely provide high-quality right ventricular/left ventricular (LV) ejection fraction (RVEF/LVEF) assessments and strain.CMR with cine imaging, displacement encoding with stimulated echoes for the circumferential uniformity ratio estimate with singular value decomposition (CURE-SVD) dyssynchrony parameter, and scar assessment was performed before and after CRT. Whereas the pre-CRT scan constituted a single "imaging set" with complete volumetric, strain, and scar imaging, multiple imaging sets with complete strain and volumetric data were obtained during the post-CRT scan for biventricular pacing (BIVP), LV pacing (LVP), and asynchronous atrial pacing modes by reprogramming the device outside the scanner between imaging sets.100 CMRs with a total of 162 imaging sets were performed in 50 patients (median age 70 years [IQR: 50-86 years]; 48% female). Reduction in LV end-diastolic volumes (P = 0.002) independent of CRT pacing were more prominent than corresponding reductions in right ventricular end-diastolic volumes (P = 0.16). A clear dependence of the optimal CRT pacing mode (BIVP vs LVP) on the PR interval (P = 0.0006) was demonstrated. The LVEF and RVEF improved more with BIVP than LVP with PR intervals ≥240 milliseconds (P = 0.025 and P = 0.002, respectively); the optimal mode (BIVP vs LVP) was variable with PR intervals 240 milliseconds. A lower pre-CRT displacement encoding with stimulated echoes (DENSE) CURE-SVD was associated with greater improvements in the post-CRT CURE-SVD (r = -0.69; P 0.001), LV end-systolic volume (r = -0.58; P 0.001), and LVEF (r = -0.52; P 0.001).CMR evaluation with assessment of multiple pacing modes during a single scan after CRT is feasible and provides useful information for patient care with respect to response and the optimal pacing strategy.

Objectives Postprandial distress syndrome (PDS) is associated with food indigestion. Efficacy of drugs used against PDS is limited whereas dietary modifications were shown to have important beneficial effects. Traditional Persian Medicine (TPM) sages suggested a dietary regimen known as Persian metabolic diet (PMD) for the management of PDS patients. In this study, the efficacy of PMD in alleviating the symptoms of PDS was explored. Methods This single-center, parallel-group, randomized clinical trial included 56 patients whom were randomly allocated to PMD group (29 participants) and Optional diet (OD) group (27 participants). They were instructed to follow the protocol for two weeks. Using a standard validated questionnaire, all outcomes were evaluated at baseline, end of the intervention period, and end of follow-up time. Results At the end of the intervention period, comparing the changes of severity scores between the groups showed a statistically significant difference in week 2 (p-value Conclusions This diet prepared based on Persian medicine seems to be effective in relieving the symptoms of patients with PDS.

INTRODUCTION: Randomised trials are often funded by commercial companies and methodological studies support a widely held suspicion that commercial funding may influence trial results and conclusions. However, these studies often have a risk of confounding and reporting bias. The risk of confounding is markedly reduced in meta-epidemiological studies that compare fairly similar trials within meta-analyses, and risk of reporting bias is reduced with access to unpublished data. Therefore, we initiated the COMFIT (COMmercial Funding In Trials) study aimed at investigating the impact of commercial funding on estimated intervention effects in randomised clinical trials based on a consortium of researchers who agreed to share meta-epidemiological study datasets with information on meta-analyses and trials included in meta-epidemiological studies. Here, we describe the COMFIT study, its database, and descriptive results.METHODS: We included meta-epidemiological studies with published or unpublished data on trial funding source and results or conclusions. We searched five bibliographic databases and other sources. We invited authors of eligible meta-epidemiological studies to join the COMFIT consortium and to share data. The final construction of the COMFIT database involves checking data quality, identifying trial references, harmonising variable categories, and removing non-informative meta-analyses as well as correlated meta-analyses and trial results.PRELIMINARY RESULTS: We included data from 17 meta-epidemiological studies, covering 728 meta-analyses and 6841 trials. Seven studies (405 meta-analyses, 3272 trials) had not published analyses on the impact of commercial funding, but shared unpublished data on funding source.CONCLUSIONS: We established the COMFIT consortium and database. Once completed, the database will enable comprehensive analyses of the impact of commercial funding on trial results and conclusions with increased statistical power and a markedly reduced risk of confounding and reporting bias. This article is protected by copyright. All rights reserved.

OBJECTIVE Poor outcomes have been reported in patients with type 2 diabetes and coronavirus disease 2019 (COVID-19); thus, it is mandatory to explore novel therapeutic approaches for this population. RESEARCH DESIGN AND METHODS In a multicenter, case-control, retrospective, observational study, sitagliptin, an oral and highly selective dipeptidyl peptidase 4 inhibitor, was added to standard of care (e.g., insulin administration) at the time of hospitalization in patients with type 2 diabetes who were hospitalized with COVID-19. Every center also recruited at a 1:1 ratio untreated control subjects matched for age and sex. All patients had pneumonia and exhibited oxygen saturation RESULTS Of the 338 consecutive patients with type 2 diabetes and COVID-19 admitted in Northern Italy hospitals included in this study, 169 were on sitagliptin, while 169 were on standard of care. Treatment with sitagliptin at the time of hospitalization was associated with reduced mortality (18% vs. 37% of deceased patients; hazard ratio 0.44 [95% CI 0.29–0.66]; P = 0.0001), with an improvement in clinical outcomes (60% vs. 38% of improved patients; P = 0.0001) and with a greater number of hospital discharges (120 vs. 89 of discharged patients; P = 0.0008) compared with patients receiving standard of care, respectively. CONCLUSIONS In this multicenter, case-control, retrospective, observational study of patients with type 2 diabetes admitted to the hospital for COVID-19, sitagliptin treatment at the time of hospitalization was associated with reduced mortality and improved clinical outcomes as compared with standard-of-care treatment. The effects of sitagliptin in patients with type 2 diabetes and COVID-19 should be confirmed in an ongoing randomized, placebo-controlled trial.

In recent years, Peripheral Nerve Blocks (PNB) have undergone a significant development due to the simplicity of management of patients under peripheral nerve blocks and especially the quality of postoperative analgesia. This study aims at reviewing the epidemiology and complications of Peripheral nerve blocks. We conducted a prospective surveillance study including all patients who had undergone surgery under peripheral nerve blocks for anesthesia or analgesia in the Trauma Department of the Military Hospital Mohammed V of Rabat over four (4) years. We recorded demographic characteristics, ASA class, effects of puncture, time of performing peripheral nerve blocks, failure, requirement for further block, perioperative and postoperative complications and theirmanagement. One thousand four hundred and twelve (1412) patients underwent nerve blocks during the study period, representing 49% of anesthetic activity in Trauma Department. The mean age is 35 years old. For 85% of patients, the indication of peripheral nerve blocks was advised for anesthesia and 15% PNBwere purely for analgesia. The most performed anesthetic nerve blocks were the infraclavicular blocks followed by blocks at the humeral canal. For analgesia, the ilio-facial and femoral blocks are the most performed. Minor complications are dominated by vascular punctures and paresthesia. As far asmajor complications are concerned, we noticed four (4) cases of convulsions and two (2) cases of neuropathies. Peripheral locoregional anesthesia is an effective and safe method for anesthesia and analgesia. Minor incidents are frequent, serious complications are possible. Their prevention is achieved through compliance to rules on peripheral nerve blocks performance, contraindication, benefit and risk analysis of each block and ultrasound skills.

Targeted delivery of therapeutics through the use of nanoparticles (NPs) has emerged as a promising method that increases their efficacy and reduces their side effects. NPs can be tailored to localize to selective tissues through conjugation to ligands that bind cell-specific receptors. Although the vast majority of nanodelivery platforms have focused on cancer therapy, efforts have begun to introduce nanotherapeutics to the fields of immunology as well as transplantation. In this article, we provide an overview from a clinician’s perspective of current nanotherapeutic strategies to treat solid organ transplants with NPs during the time interval between organ harvest from the donor and placement into the recipient, an innovative technology that can provide major benefits to transplant patients. The use of ex vivo normothermic machine perfusion (NMP), which is associated with preserving the function of the organ following transplantation, also provides an ideal opportunity for a localized, sustained, and controlled delivery of nanotherapeutics to the organ during this critical time period. Here, we summarize previous endeavors to improve transplantation outcomes by treating the organ with NPs prior to placement in the recipient. Investigations in this burgeoning field of research are promising, but more extensive studies are needed to overcome the physiological challenges to achieving effective nanotherapeutic delivery to transplanted organs discussed in this review.

Objectives Diabetes mellitus associated cognitive impairment is suggested to be due to oxidative stress. Considering the anti-diabetic, antioxidant, antihyperlipidemic, and anti-inflammatory effects of Zingiber officinale, the present study aimed to investigate its effect on memory and oxidative stress factors in streptozotocin (STZ)-induced diabetic rats. Methods The rats were allocated into five groups: Control, Diabetic, Diabetic + Ginger 100, Diabetic + Ginger 200, and Diabetic + Ginger 400. Following diabetes induction by STZ (60 mg/kg), 100, 200, or 400 mg/kg Ginger was given for eight weeks. Passive avoidance test (PA) was done and thiol, malondialdehyde (MDA), superoxide dismutase (SOD), and catalase (CAT) measurements were carried out in the brain. Results The latency into the dark compartment decreased (pZ. officinale extract reduced hippocampal and cortical MDA (p Conclusions Z. officinale extract could improve memory by reducing the oxidative stress in STZ-induced diabetes model.

Objectives Rhus coriaria L. (RC) is a deciduous shrub with several pharmacological activities. Evidence of the effects of RC on weight, hyperlipidaemia, hypertension and diabetes mellitus have been presented in this study. Books, thesis and internet-based resources such as PubMed, Web of Science, Scopus, EMBASE, Cochrane, Ovid and Google Scholar were searched for the English, Arabic and Persian literature from 1966 to 2020 (December). The keywords were Rhus coriaria L., Sumac, metabolic syndrome and all its medical conditions (hyperlipidaemia, hypertension, obesity and diabetes mellitus). The inclusion criteria were full-text animal and human studies conducted on RC to evaluate its efficacy on any components of metabolic syndrome (MetS). Jadad scale was used to assess the quality of evidence. Key findings Reviewing 23 relevant studies demonstrated that RC is able to decrease the level of blood glucose, glycated haemoglobin, serum insulin and insulin resistance. Studies on hyperlipidaemia and obesity have very contradicting results, and there is no definite conclusion on the effect of RC on lipid profile. However, the hypotensive and effect of RC was confirmed in the existing studies. Summary According to the literature, RC can be considered as a promising curative candidate for MetS. However, further studies with larger sample size and higher methodological quality are needed.

PURPOSE OF REVIEW Therapeutic methods for neuropathic are limited; available drugs can be inadequate or have adverse effects that compromise quality of life. Interest has grown in alternatives to pharmacologic therapy for neuropathic pain. We present a focused review of the literature about the relatively novel noninvasive, nonpharmacologic electrocutaneous nerve stimulation technique called scrambler therapy for treating noncancer neuropathic pain. RECENT FINDINGS Neuromodulation techniques targeting peripheral sites have changed rapidly in recent years. Several clinical studies have demonstrated the analgesic effect of scrambler therapy after 10 sessions of treatment for various types of pain. Although scrambler therapy was originally used for cancer pain, its indications have broadened to postoperative pain, chemotherapy-induced peripheral neuropathy, postherpetic neuralgia, low back pain, diabetic neuropathy, complex regional pain syndrome and central pain syndrome. That said, some of the studies are controversial owing to their small sample size, lack of appropriate scrambler therapy protocol and possible lack of experience of the operators. SUMMARY We present the historical perspective, mechanism of action and trial outcomes of scrambler therapy, representing an avenue for managing neuropathic pain without drugs. Well designed phase II/III clinical trials must be conducted to confirm the positive findings reported using scrambler therapy technology. If validated, scrambler therapy could be a game changer.

Rupture of the pyelocalyceal cavities or fornix is a rare and potential urological emergency. It is most often secondary to obstructive uropathy. It can lead to extravasation of urine at the perirenal or retro-peritoneal level, which can have serious consequences. The clinic reported the case of a 37-year-old patient who presented to the emergency department with hyperalgesic (right) renal colic. Intense right lumbar tenderness was found on clinical examination, renal function was preserved. The radiological examination, CT scan mainly, revealed a significant ureteralhydronephrosis by urinary meatus calculus measuring 3 mm with a density of 271 HU and a perirenal effusion and extravasation of the PDC at a late time. The emergency therapeutic management consisted of a bypass with a double J stent. The evolution was marked by a clinico-biological improvement.

Diverse ethnic genetic populations display variability in the risk regarding anti-seizure medicine (ASM)-induced severe cutaneous adverse reactions (SCARs). However, clinical and epidemiological data on ASM-induced SCARs in Asians is limited.We conducted a retrospective, post-market study until April 30, 2020 using VigiBase® for demographic characteristics, causative ASMs, complications and mortality. The study included adverse events as classified by Standardized Medical Dictionary for Regulatory Activities (MedDRA) queries of SCARs, mainly Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), drug rash with eosinophilia and systemic symptoms (DRESS), and SJS/TEN overlap reported for ASMs.A total of 694,811 adverse events were reported across the world while using ASMs. Of this, skin and subcutaneous tissue adverse events were 122,885 (17.6%). Among ASM-induced skin and subcutaneous tissue adverse events, SJS, TEN, DRESS and SJS/TEN overlap represented 11,181 (9.1%), 3,645 (3.0%), 5,106 (4.1%) and 6 (0.004%) cases, respectively. Female SJS/TEN/DRESS patients were 54.1%, and 75% of them were adults (18Y). Nearly 64% of the ASM-induced SCARs were serious and culminated in death (3.5%), life-threatening conditions (11.5%), and hospitalization/prolonged hospitalization (43.5%) of patients on ASM therapy. Carbamazepine (31.6%), phenytoin (29.6%), lamotrigine (24.3%), valproic acid (6.4%) and phenobarbital (5.7%) are the most commonly used ASMs linked with SCARs. ASMs associated with significantly higher risk of SCARs in Asians were carbamazepine [n = 3265, ROR 3.55 (95% CI 3.38-3.72, P 0.0001)], lamotrigine [n = 1253, ROR 3.90 (95% CI 3.63-4.18, P 0.0001)], gabapentin [n = 85, ROR 3.58 (95% CI 2.79-4.60, P 0.0001)], pregabalin [n = 68, ROR 3.16 (95% CI 2.40-4.16, P 0.0001)], clonazepam [n = 53, ROR 3.19 (95% CI 2.31-4.41, P 0.0001)], lorazepam [n = 31, ROR 3.07 (95% CI 2.06-4.59, P 0.0001)] and acetazolamide [n = 28, ROR 3.90 (95% CI 2.45-6.21, P 0.0001)].Based on our study, carbamazepine, lamotrigine, gabapentin, pregabalin, clonazepam, lorazepam, and acetazolamide are the most common causative ASMs for SCARs in the Asian population.

BACKGROUND Late recurrences in postmenopausal women with hormone receptor-positive breast cancers remain an important challenge. Avoidance or delayed development of resistance represents the main objective in extended endocrine therapy (ET). In animal models, resistance was reversed with restoration of circulating estrogen levels during interruption of letrozole treatment. This phase III, randomized, open-label Study of Letrozole Extension (SOLE) studied the effect of extended intermittent letrozole treatment in comparison with continuous letrozole. In parallel, the SOLE estrogen substudy (SOLE-EST) analyzed the levels of estrogen during the interruption of treatment. PATIENTS AND METHODS SOLE enrolled 4884 postmenopausal women with hormone receptor-positive, lymph node-positive, operable breast cancer between December 2007 and October 2012 and among them, 104 patients were enrolled in SOLE-EST. They must have undergone local treatment and have completed 4-6 years of adjuvant ET. Patients were randomized between continuous letrozole (2.5 mg/day orally for 5 years) and intermittent letrozole treatment (2.5 mg/day for 9 months followed by a 3-month interruption in years 1-4 and then 2.5 mg/day during all of year 5). RESULTS Intention-to-treat population included 4851 women in SOLE (n��= 2425 in the intermittent and n��= 2426 in the continuous letrozole groups) and 103 women in SOLE-EST (n��= 78 in the intermittent and n��= 25 in the continuous letrozole groups). After a median follow-up of 84 months, 7-year disease-free survival (DFS) was 81.4% in the intermittent group and 81.5% in the continuous group (hazard ratio: 1.03, 95% confidence interval: 0.91-1.17). Reported adverse events were similar in both groups. Circulating estrogen recovery was demonstrated within 6 weeks after the stop of letrozole treatment. CONCLUSIONS Extended adjuvant ET by intermittent administration of letrozole did not improve DFS compared with continuous use, despite the recovery of circulating estrogen levels. The similar DFS coupled with previously reported quality-of-life advantages suggest intermittent extended treatment is a valid option for patients who require or prefer a treatment interruption.

Purpose: To evaluate the microstructural corneal changes during acute endothelial graft rejection and following treatment using in vivo confocal microscopy (IVCM). Methods: Patients with a clinical diagnosis of severe acute endothelial graft rejection following penetrating keratoplasty were included in this study. IVCM was performed on the 1st day the patient presented with rejection signs and at the time of clinical resolution. Results: Twenty-three patients were included in this study. Inflammatory cells appeared as dendritic cells (DCs) and less frequently, as non-DCs in basal epithelial and subbasal areas. Activated keratocytes (AKs) (type 1: large cells with visible cytoplasmic processes; type 2: elongated and spindle-shaped keratocytes) were visible in acute phase. Following resolution, type 1 AKs considerably reduced, but type 2 cells were more often persisted. Multiple types of keratic precipitates (KPs) were also visible in acute phase which resolved following resolution of rejection. Conclusions: Acute graft rejection was associated with an increase in the number of DCs, activation of keratocytes, and aggregation of various types of KPs. Inflammatory process subsided in almost all cases, but the IVCM changes did not return to normal early after clinical resolution of rejection.

Purpose: The aim of this case–control study was to determine the impact of environmental factors on the predisposition to develop keratoconus in a sample of Western Algerian population. Subsequently, we were interested in the implication of two single nucleotide polymorphisms (SNPs) IL4 rs2070874 and FOXP3 rs3761548, previously described as contributing to the occurrence of allergy, in the development of keratoconus. Methods: The study included 70 unrelated KC cases and 70 controls originating from Western Algeria. DNA genotyping was done using predesigned probe-based allelic discrimination TaqMan® assays. Allele and genotype frequencies were compared between the cases and controls by Chi-square test and odds ratios with 95% confidence intervals. Results: A significant association between risk factors such as family history, atopy, eye rubbing, and the development of keratoconus was found in our sample. Smoking would provide a protective effect against the pathology. No statistically significant differences were found in the allele and genotype frequencies between cases and controls neither for IL4 rs2070874 nor for FOXP3 rs3761548. Conclusion: Our study provides, for the first time, a clear demonstration of the absence of association of the allergy-associated IL4 and FOXP3 polymorphisms with KC in a sample from Western Algerian population.

Purpose To report a case of Toxoplasma retinochoroiditis that was complicated by macular infarction following intravitreal clindamycin injection. Methods A 32-year-old otherwise healthy woman with the diagnosis of reactivation of Toxoplasma retinochoroiditis in her right eye, underwent intravitreal clindamycin injection. Shortly after injection, the visual acuity deteriorated, and the fundus examination revealed an extensive area of macular necrosis accompanied by vascular occlusion. Results The patient was observed. Unfortunately, the condition did not improve over time and resulted in a large area of retinal atrophy. Conclusion Macular infarction should be considered a rare but disastrous complication that can result in severe, irreversible visual loss.

Background Septic arthritis (SA) due to Staphylococcus aureus is a major cause of lameness in poultry with improper response to antimicrobial therapy. Objectives The study evaluates the effect of prophylactic administration of vitamin C on SA induced by methicillin resistant S. aureus in chickens. Methods One hundred and twenty chickens were randomly assigned into four groups: I. Negative control (NC), II. Positive control (PC) with SA induced at the age of 35 days by intra articular injection of S. aureus. III. Vehicle control (VC) and IV. Arthritic vitamin C‐treated (VitC) group (15 g/100 L of drinking water from day 25 to the end of the experiment). Samplings were performed on day 44 (sampling 1) and day 54 (sampling 2) of age. Results Arthritic birds showed an obvious decrease in body weight with severe clinical arthritis and lameness which were not significantly affected by vitamin C administration at both samplings. Moreover, marked increase in serum malondialdehyde (MDA) concentration of the PC group was observed in sampling 1. Administration of vitamin C successfully reduced MDA concentration at both samplings. In sampling 2, birds in the VitC group showed significantly higher total antioxidant capacity (TAC) than NC birds (p, Prophylactic administration of vitamin C especially for relatively longer period can ameliorate oxidative stress and histopathological changes due to staphylococcal arthritis in chickens.

Post-menopausal osteoporosis (PMO) is a multifactorial bone disorder in elderly women. Various vitamin D receptor (VDR) gene variants have been studied and associated with osteoporosis in other populations, but not in a homogenous Arab ethnic group. Herein, the current study explores the association between VDR polymorphisms and susceptibility to osteoporosis in Saudi postmenopausal women. In total, 600 Saudi postmenopausal women (N = 300 osteoporosis, N = 300 control) were genotyped for VDR gene variants (rs7975232, rs1544410, rs731236) using TaqMan® SNP genotyping assays. Bone mineral density (BMD) for the lumbar spine and femur was assessed using dual-energy X-ray absorptiometry (DEXA). The heterozygous frequency distributions AC of rs7975232, CT of rs1544410, and AG of rs731236 were significantly higher in the osteoporosis group than controls (p &lt, 0.05). Heterozygous AC of rs7975232 (1.6, 95% CI 1.1–2.3, p &lt, 0.023), CT of rs1544410 (1.6, 95% CI 1.1–2.4, 0.022), and AG of rs731236 (1.6, 0.024) were significantly associated with increased risk of osteoporosis, independent of age and BMI. In conclusion, VDR gene variants rs7975232, rs1544410, rs731236 had a significant effect on BMD and were associated with osteoporosis risk in Saudi postmenopausal women.

Aim: The aim of this study was to analyze the available research evidence on the reasons for, and advantages and disadvantages of elective cesarean section on maternal request. Design: Literature review. Methods: The review was conducted using Web of Science, PubMed, Embase, Scopus, ProQuest, and Google Scholar from 2009 to 2020, based on PRISMA guidelines, and Mesh keywords. All types of studies reporting on the subject of the research were included, excepting case reports. STROBE and JBI checklists were used to assess the quality of studies. Sixteen studies were included in this literature review. Results: Fear of complications during vaginal delivery was the most frequent maternal reason for elective cesarean section. Fear of physical injury to the infant during vaginal delivery was the most frequent neonatal reason for elective cesarean section. Birth experiences of family, friends, or relatives was the most frequent social maternal reason given for elective cesarean section. The most common advantage of cesarean section was reduction in neonatal injuries. The incidence of maternal wound infection and risk of neonatal respiratory distress syndrome were the most common disadvantages of cesarean section. Conclusion: Identifying the reasons for cesarean section on maternal request can help create a more precise roadmap for increasing awareness in women of the advantages of vaginal delivery, preventing prenatal complications, and reducing costs in healthcare systems.

Statins have been used as adjuvants to standard treatment in order to increase the eradication ratesof Helicobacter pylori infection. This study aimed to summarize the results of the efficacy of adding statins to standard treatments used for the eradicationof H. pylori infection. We conducted a systematic search using a comprehensive combination of keywords in PubMed/MEDLINE, Web of Science, and Scopus to retrieve relevant studies from 1990 to 2020. The estimate of pooled relative risk (RR), as the effect measure, was calculated using random effects meta-analyses in Stata 14. We finally included 5 studies (all of them were randomized controlled trials). The meta-analysis of all studies showed that the pooled RR (95% confidence interval) was 1.03 (0.64–1.68) in the random effects model, which was not statistically significant. In other words, based on our meta-analysis, the addition of statins as an adjuvant therapy to the standard treatment regimens does not increase the rate of H. pylori eradication. However, further evidence is needed to confirm this result as the number of available studies was small.

Introduction: Guillain-Barre Syndrome (GBS) is an autoimmune acute inflammatory demyelinating polyneuropathy usually elicited by an upper respiratory tract infection. Several studies reported GBS associated with Coronavirus Disease 2019 (COVID-19) infection. In this study, we described nine GBS patients following the COVID-19 vaccine. Methods: In this study, nine patients were introduced from six referral centers for neuromuscular disorders in Iran between April 8 and June 20, 2021. Four patients received the Sputnik V, three patients received the Sinopharm, and two cases received the AstraZeneca vaccine. All patients were diagnosed with GBS evidenced by nerve conduction studies and/or cerebrospinal fluid analysis. Results: The median age of the patients was 54.22 years (ranged 26-87 years), and seven patients were male. The patients were treated with Intravenous Immunoglobulin (IVIg) or Plasma Exchange (PLEX). All patients were discharged with some improvements. Conclusion: The link between the COVID-19 vaccine and GBS is not well understood. Given the prevalence of GBS over the population, this association may be coincidental; therefore, more studies are needed to investigate a causal relationship.

Intravenous (IV) sodium bicarbonate is considered standard therapy for high-dose methotrexate (HDMTX) urine alkalinization. Due to a national IV sodium bicarbonate shortage, an oral (PO) sodium bicarbonate protocol was implemented by Alberta Health Services (AHS) for HDMTX urine alkalinization. This study aims to evaluate the efficacy and safety of the PO sodium bicarbonate protocol compared to IV sodium bicarbonate for HDMTX urine alkalinization. A retrospective chart review of adult patients who received HDMTX (> 500 mg/m2) with sodium bicarbonate for urine alkalinization at 4 hospitals in Alberta was conducted. Patients who received IV sodium bicarbonate between January and June 2017 and PO sodium bicarbonate between July and December 2017 were compared for the primary outcome of time to methotrexate clearance. A total of 84 and 78 HDMTX cycles were included in the IV and PO cohorts, respectively. No difference in time to methotrexate clearance was seen between the IV and PO cohorts, 91.6 (± 35.4) hours and 95.2 (± 44) hours respectively; p = 0.5. The proportion of HDMTX cycles that experienced a > 25% increase in serum creatinine was not statistically significant, IV protocol 12% and PO protocol 5%; p = 0.13. Nausea and emesis occurred more frequently in the PO cohort than the IV cohort, though rarely resulted in refused doses or change to alternate sodium bicarbonate formulations. The results of this study indicate that the AHS PO sodium bicarbonate protocol was no different in time to methotrexate clearance or rates of increased serum creatinine when compared to IV sodium bicarbonate.

Introduction The concept of family presence during resuscitation and invasive procedures is a controversial issue and has not been universally adopted by health care providers. Owing to the sheer number of studies in this field, we conducted this umbrella study to provide an overview of this concept with the aim of investigating the impact of family presence on patients, families, and resuscitation and invasive procedures. Methods In this review, using the Joanna Briggs Institute levels of evidence umbrella methodology guidelines, the authors searched PubMed, Google Scholar, Embase, MEDLINE, Web of Science, Scopus, and the Cochrane database for systematic review and meta-analysis studies that evaluated the presence of family during resuscitation and invasive procedures without time limit until July 2020. The following key words were used for the search: family presence; family witness; parent presence; parent witness; and resuscitation. Results A total of 254 articles published between January 1967 and July 2020 were screened. Five articles (1 meta-analysis and 4 systematic reviews) met the inclusion criteria. The review showed that family presence during resuscitation or invasive procedures does not have negative effects on family members, patients, or the resuscitation or invasive intervention process. Family members focus on the patients, not the ongoing treatment. The presence of family members is beneficial for both family members and health care staff. None of the reviewed studies reported a negative effect on family members. Discussion The presence of parents and other immediate family members during resuscitation and invasive procedures has positive impacts on patients, families, and health care staff.

BACKGROUND: Traumatic brain injury (TBI) is one of the main causes of death and disability among the elderly patient population. This study aimed to assess the predictors of in-hospital mortality of elderly patients with moderate to severe TBI who presented during the Coronavirus disease 2019 (COVID-19) pandemic. METHODS: In this retrospective analytical study, all elderly patients with moderate to severe TBI who were referred to our center between March 2nd, 2020 to August 1st, 2020 were investigated and compared against the TBI patients receiving treatment during the same time period within the year 2019. Patients were followed until discharge from the hospital or death. The demographic, clinical, radiological, and laboratory test data were evaluated. Data were analyzed using SPSS-21 software. FINDINGS: In this study, 359 elderly patients were evaluated (n = 162, Post-COVID-19). Fifty-four patients of the cohort had COVID-19 disease with a mortality rate was 33.3%. The patients with COVID-19 were 5.45 times more likely to expire before discharge (P

Background: In this study, we have used the middle hepatic vein with the right lobe, and we studied the venous outflow dynamics immediately after transplant retrospectively meanwhile we studied the impact of the graft function on donor functionality and overall donor safety. Method: Between October 2017 to October 2020, we performed 40 adult to adult live donor liver transplants at Zheen International Hospital (Erbil, Kurdistan Region). Postoperative Doppler ultrasound was performed for recipients and donors immediately after surgery and then daily until discharge. Results: The donor age (28.5 ± 6.9) year, male/ female 19/ 21, intensive care unit stay (1.2 ± 0.43), floor stay (5.2 ± 1.4) days, their portal vein velocity (43.5 ± 18.4 ml/sec), hepatic artery resistive index (0.6 ± 0.09) and triphasic/ continuous venous outflow 30/10, their postoperative day one and at the discharge total serum bilirubin were (2.8 ± 1.8) and (2 ± 1.4), their postoperative day one and at the discharge international normalization ratio were (1.7 ± 0.5) and (1.2 ± 0.2) respectively. The recipient age (48.5 ± 11.3), male/female 27/13, intensive care unit stay (4.75 ± 3.9), floor stay (7.7 ± 3.7) days, portal vein velocity (63.96 ± 24.65 ml/sec), hepatic artery peak systolic velocity (74.76 ± 32.85) hepatic artery resistive index (0.7 ± 0.15), and triphasic/continuous venous outflow 27/13. Conclusions: Middle hepatic vein incorporation in live donor liver graft is safe with a favorable outcome for recipient and donor, doppler US is one the important tool for evaluation and follow up of donor and recipient for detection of vascular complications and assessment of venous outflow and graft function. In addition, early discharge of the donor is a reasonable option.

Background Studies show that having some symptoms seems to be associated with more severe disease and poor prognosis. Therefore, knowing who is more susceptible to symptomatic COVID-19 disease is important to provide targeted preventive and management practice. The aim of the study was to assess factors associated with the development of symptomatic disease among COVID-19 patients admitted to Millennium COVID-19 Care Center in Ethiopia. Methods A case-control study was conducted from August to September 2020 among a randomly selected 730 COVID-19 patients (337 Asymptomatic and 393 Symptomatic patients). Chi-square test and independent t-test were used to detect the presence of a statistically significant difference in the characteristics of the cases (symptomatic) and controls (asymptomatic), where p-value of P-values were used for testing significance and interpretation of results. Results The result of the multivariable binary logistic regression shows that age group (AOR = 1.89, 95% CI = 1.25, 2.87, p-value = 0.002 for 30–39 years; AOR = 1.69, 95% CI = 1.06, 2.73, p-value = 0.028 for 40–49 years and AOR = 4.42, 95% CI = 2.75, 7.12, p-value = 0.0001 for ≥50 years), sex (AOR = 1.76, 95% CI = 1.26, 2.45, p-value = 0.001) and history of diabetes mellitus (AOR = 3.90, 95% CI = 1.92, 7.94, p-value = 0.0001) were found to be significant factors that determine the development of symptomatic disease in COVID-19 patients. Conclusions Developing a symptomatic COVID-19 disease was found to be associated with exposures of old age, male sex, and being diabetic. Therefore, patients with the above factors should be given enough attention in the prevention and management process, including inpatient management, to pick symptoms earlier and to manage accordingly so that these patients can have a favorable treatment outcome.

Background The association of genetic polymorphisms at Axis inhibition protein 2 (AXIN2) gene and susceptibility to different cancer has attracted much interest. The present study aimed to evaluate the association between AXIN2 rs2240308 C>T, rs1133683 C>T, rs7224837 A>G polymorphisms with susceptibility to breast cancer. Methods A polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) assay was designed to genotype the AXIN2 rs2240308 C>T, rs1133683 C>T, rs7224837 A>G polymorphisms among 150 breast cancer patients and 150 healthy subjects. Results The frequencies of these genetic variants were in agreement with Hardy-Weinberg equilibrium in healthy controls (p>0.05). The frequencies of AXIN2 rs2240308 C>T, rs1133683 C>T, rs7224837 A>G genotypes were similar in breast cancer patients and controls. There was no a significant association between the AXIN2 SNP and risk of breast cancer. Conclusion The impact of AXIN2 polymorphisms in the breast cancer development remains unclear. Our results indicated that AXIN2 rs2240308, rs7224837 and rs1133683 polymorphisms did not contribute to increased risk of breast cancer. More studies with larger sample sizes and diverse ethnicities are warranted to verify our finding.

Breast cancer early diagnosis increases treatment chances, and self-examination is one of the commonest screening methods employed by women. The case of a 24-year-old Iranian woman with a history of mild mental retardation and chest pain was reported. A large lump was detected in the breast during visitation to the surgical clinic. The parents stated the lump was noticed due to a shape change in the clothes covering the patient's chest area. Therefore, the patient had mastectomy surgery after a biopsy and a malignant breast lump was confirmed. The registration and identification of people with mental disorder histories or various mental retardation degrees in each region's health centers to periodically assess their breast health tend to reduce the risk of late breast cancer detection in women.

Labor pain (LP), as a physiological process, is known as one of the most severe pains. Aromatherapy is one of the methods to reduce LP in the first phase of labor. It is an important approach for enjoyable birth and decreases the severity of pain in today’s society. Accordingly, this study aimed to systematically review the relieving effect of aromatherapy in LP and Apgar score. We used international databases such as EMBASE, Web of Science, Scopus, Google Scholar, PubMed, Cochrane Library, ProQuest, and clinicaltrials.gov to conduct a systematic search for all relevant articles. Cochran’s Q-test and I2 statistic were applied to assess heterogeneity, a random-effects model was used to estimate the unstandardized mean difference (UMD), and a meta-regression method was utilized to investigate the factors affecting heterogeneity between studies. A total of 27 studies were included in the meta-analysis (sample size: 2,566). Overall, aromatherapy leads to relieving LP during delivery (UMD: 1.75; 95% CI: 1.13–2.37). Based on cervix dilation, aromatherapy significantly affects LP when cervix dilation is 8–10 cm (UMD: 6.18; 95% CI: 4.51–7.85) and 0–4 cm (UMD: 5.31; 95% CI: 3.74–6.87); but it had no effects on 1- and 5-min Apgar scores. No publication bias was observed (P=0.113). Mother’s age, publication year, sample size, and cervix dilation had no significant effects on heterogeneity (P>0.05). Aromatherapy had a positive impact on relieving LP, and the greatest and least effect was witnessed in dilatation of 8–10 cm and 0–4 cm, respectively. Moreover, it had no effects on 1- and 5-min Apgar scores.

Abdi Birhanu,1 Tariku Dingeta,2 Moti Tolera2 1School of Medicine, College of Health and Medical Science, Haramaya University, Harar, Ethiopia; 2School of Public Health, College of Health and Medical Science, Haramaya University, Harar, EthiopiaCorrespondence: Abdi BirhanuSchool of Medicine, College of Health and Medical Science, Haramaya University, PO Box: 235, Harar, EthiopiaTel +251917094058Email abdiibiree@gmail.comIntroduction: Despite the world has made efforts, the reduction of acquired immunodeficiency syndrome (AIDS) related mortality by giving antiretroviral therapy (ART), still HIV/AIDS is killing people while they are on ART. However, the current progress and associated factors of mortality among ART-taking patients are hardly available. Therefore, this study was aimed to determine predictors of mortality among HIV-infected adult patients after starting antiretroviral therapy in Harar Hospitals, Harari region, Ethiopia.Methods: A facility-based retrospective cohort study was employed with randomly selected 610 medical records of HIV patients on antiretroviral therapy (ART). Adjusted hazard ratio (AHR) with 95% confidence interval (CI) was used to identify predictors of mortality using multivariate Cox proportional hazard model.Results: Among 610 medical records analyzed with a total of 1410.7 follow-up years, 67 (11%) deaths were found giving an overall mortality rate of 4.75 per 100 person-years. The independent predictor of mortality identified was ambulatory/bedridden functional status (AHR=2.48; 95% CI: 1.43– 4.28), taking other than Tenofovir-based regimen (AHR=2.5,95% CI; 1.04– 5.94), not taking isoniazid preventive therapy (IPT) (AHR=2.8; 95% CI: 1.61,4.71), hemoglobin < 11g/dl (AHR=3.33,95% CI 1.94– 5.69), and poor adherence to ART (AHR= 3.62, 95% CI: 1.87– 7.0).Conclusion: This study demonstrated that poor ART adherence, not taking IPT, and initiating ART with a non-Tenofovir-based regimen and low hemoglobin count were significantly associated with the risk of death. For this reason, addressing these all significant predictors is essential to prevent early death.Keywords: predictors, mortality, HIV, ART, adult, Ethiopia

Spinal cord neurological disorders associated with Hashimotos disease are rare and very rarely described.Thediagnosis is based on a set of arguments with the performance of an exhaustive assessment in order to eliminate other possible causes of medullary neurological damage. In this case, we report a 21 years old man, who was admitted for a spinal cord syndrome with D12-L1 sensory level and was diagnosed with acute transverse myelitis associated with Hashimotos thyroiditis. The evolution was favorable with regression of the symptomatology after bolus of corticoids followed by oral corticotherapy.

Background: Schistosomiasis remains a major public health problem in Kenya. Environmental factors are critical in creating a medium for growth and spread of schistosomiasis vectors. The study investigated the environmental factors influencing prevention and control of schistosomiasis infection in Mwea West Sub County, Kirinyaga County-Kenya. Methods: A multi stage sampling was used to identify four hundred and sixty-five (465) household. Analytical descriptive cross-sectional design that utilised quantitative data collection method was used. Data was collected using a pretested structured questionnaire and analysed using Chi square tests or Fisher’s exact tests where applicable. Results: Study results indicated a significant association p

Merga Sheleme,1 Tilahun Alemayehu Nigatu,2 Teka Gebremariam,2 Tesema Etefa,2 Abdi Birhanu1 1School of Medicine, College of Health and Medical Science, Haramaya University, Harar, Ethiopia; 2Department of Biomedical Sciences, College of Medical Sciences, Institute of Health Sciences, Jimma University, Jimma, EthiopiaCorrespondence: Merga ShelemeSchool of Medicine, College of Health and Medical Science, Haramaya University, P.O. Box, 235, Harar, EthiopiaTel +251920963059Email mergasheleme2014@gmail.comBackground: Knowledge of the normal variation in AF size may be helpful to cue early diagnosis of congenital hypothyroidism, hyperthyroidism, cardiac disease, meningitis, degree of dehydration or provide a clue to disorders of neural and skeletal development. However, the data is scarce. Therefore, this study was aimed to determine AF size and associated factors among term neonates on the first day of life born in Jimma University Medical Center (JUMC), Southwest Ethiopia.Methodology: An institution-based cross-sectional study design was used to consecutively sample term and health newborns. Descriptive statistics, one-way ANOVA, independent samples t-test and correlation were implemented. Finally, multiple Linear regressions were used to see the association of the dependent and independent variables at 95% confidence interval. The significance level was declared at < 0.05 p-value.Results: The mean AF size of the study population was 3.018 cm with standard deviation (±SD) of 0.909 cm (range 0.4– 5.50cm). A multiple linear regression analysis revealed that neonatal birth weight (B=0.001, 95% CI: 0.000– 0.001, p=0.000), crown heel length (B=0.048, 95% CI, 0.018– 0.078, p=0.002), labor duration (B= − 0.028, p=0.001, 95% CI: − 0.45; − 0.012), and gender of the neonates (B=− 0.275, 95% CI: − .441; − .109, p=0.001) were statistically significantly associated with AF size. In a multiple linear regression analysis AF size was explained by independent variables by 54.3%.Conclusions: AF size of the study population was 3.018 cm with a standard deviation (±SD) of 0.909 cm. Birth weight, crown heel length, duration of labor, and gender of the neonate were significantly associated with AF size.Keywords: anterior fontanel, associated factors, linear regression, term neonate, Ethiopia

Diabetes type 2 (T2D) had caused the loss of millions of lives all over the world. About 50% of the patients with T2D die because of cardiovascular disease (CVD), primarily myocardial infarction and stroke. Many of the leading risk factors for CVD coexist and act synergistically to increase cardiovascular events. The purpose of this descriptive cross-sectional study was to determine the prevalence, patterns, and certain predictive factors in the complications of T2D patients attending diabetic clinics at Mnazi Mmoja hospital. A total of 138 respondents made up of 58 females and 80 males within the age brackets of 30-40, 41-50, 51 – 60, and 61 above were recruited for this study. Data were analysed and interpreted based on certain predictive factors and variables, including smoking, alcohol, excessive salt intake, lipid intake, sedentary lifestyle, family history of diabetes, and hypertension, on how they relate to the development of complications of type 2 diabetes. Pearson Chi-Square test was used to compare the levels of significances. Probability values of less or equal to 0.05 were accepted to be significant. The combination of salt intake, sedentary lifestyle, family history of diabetes, and lipid intake was the commonest risk factor for developing complications of T2D. However, alcohol and cigarette smoking had the most negligible impact on developing complications in T2D. The result also shows the patients between the age bracket of 30 and 40 have more risk factors for developing complications. The result showed no gender difference in the number of risk factors. There was a statistically significant association between some of the risk factors (smoking, alcohol, sedentary lifestyle, and salt intake) and the gender of respondents (p

Acute kidney injury (AKI) and malnutrition are two complications commonly reported in severe forms of COVID-19, their combined effect on short-term mortality is, however, not yet investigated. The objective of this study is to determine both their individual and combined effects on short-term prognosis.This is a prospective, uni-centric study, including 247 severe COVID-19 patients, admitted between April 25th and June 20th, 2020, at the University Hospital of Blida. AKI was defined according to the KDIGO-2012 guidelines. Nutritional status was assessed using the Controlling Nutritional Status (CONUT) score. The association with in-hospital mortality was assessed using the Kaplan-Meier method and proportional Cox regression.Among the 247 severely affected COVID-19 patients included in this study, 34.4% developed AKI, 30.4 and 1.2%, respectively, had moderate and severe CONUT scores, 17.7% worsened and progressed to a critical state and 26.7% did not survive. Both AKI and CONUT score were significantly associated with mortality in a dose-response manner (pLog-Rank

Highlights • We summarized the most important errors which may happen during nucleic acid tests for detection of SARS-CoV-2. • We explored the errors in three different analytic phases. • We showed that most important sources of error occurred during pre-analytic phase., The COVID-19 pandemic remains a significant problem involving health systems worldwide. Accurate and early detection of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection is critical for minimizing spread and initiating treatment. Among test methods, real-time reverse-transcriptase polymerase-chain-reaction (rRT-PCR) is considered the gold standard. Although this test has high specificity and relatively high sensitivity, the occurrence of falsely negative results in symptomatic patients and/or having a positive CT scan remains a challenge. Sources of error can be pre-analytical (sampling, storage and processing), analytical (RNA extraction, cDNA synthesis and amplification) and post-analytical (interpretation and analysis and test reporting). These potential sources of error and efforts to mitigate are reviewed in this article with an emphasis on the analytical phase.

Background This study was aimed to examine the effects of vitamin K2 supplementation on atherogenic status, assessed by insulin resistance (IR)-related indexes, in patients with type 2 diabetes mellitus (T2DM). Methods In this double-blind, controlled trial, 68 patients with T2DM on the oral glucose-lowering medications were randomly allocated into two groups receiving daily intakes of 360 μg MK-7 or placebo for 12 weeks. Eight different IR-related indexes were calculated at the baseline and end of the trial. Results At the end of the study, atherogenic coefficient (mean ± SD: − 0.21 ± 0.45 vs. 0.02 ± 0.43; p = 0.043), triglyceride-glucose index (8.88 ± 0.55 vs. 9.23 ± 0.69; p = 0.029), and atherogenic index of plasma (0.37 ± 0.27 vs. 0.51 ± 0.24; p = 0.031) were significantly lower in the vitamin K2 group, compared to the placebo. However, after accounting for their baseline values, the differences were no more significant. No significant differences were observed in Castelli’s Ӏ and ӀӀ risk indexes, the ratio of triglycerides to high-density lipoprotein cholesterol, lipoprotein combine index, and the metabolic score for insulin resistance index between the two groups at the end of the study. Conclusions Daily intakes of 360 μg vitamin K2 in the form of MK-7 for 12 weeks could not improve the IR-related indexes of Cardiovascular Diseases risk. Trial registration The trial was registered on Iranian Registry of Clinical Trials registry (Trial ID. IRCT20190824044592N1) on 22 December 2019. The record can be found at https://en.irct.ir/trial/41728.

Diabetes mellitus is a chronic non communicable disease. Characterized by an increase in blood sugar levels, the result is that the pancreas cannot produce or the body cannot use insulin. Foot exercise in diabetes mellitus is a leg movement exercise that aims to improve blood circulation in the legs and detect the severity of vascularity in the legs. The research objective was to assess the effect of foot exercise on the value of the Ankle Brachial Index (ABI) in diabetes mellitus patients at Grandmed Lubuk Pakam Hospital. Quasi experimental research design pretest and posttest without control. The study was conducted from October to December 2020 at Grandmed Lubuk Pakam Hospital with 43 respondents, the samples were taken using consecutive sampling technique. The intervention was carried out twice a day. Consistent exercise can increase the supply of oxygen in the blood to the peripheral tissues in the legs. The results of the research from the univariate analysis found that male gender were 23 respondents (53.5%), aged > 55 years were 21 respondents (48.8%), the use of blood sugar drugs was 39 respondents (90.7). While the bivariate results using the Wilcoxon test, it was found that there was a significant effect between the average ABI value before the intervention 0.84 and 0.95 after intervention, p = 0.000. The results of the study concluded that there was an effect of foot exercise on the value of the ankle brachial index (ABI) in diabetes mellitus sufferers, where leg blood flow was getting better after foot exercise.

Background: This study aimed to compare the effectiveness and safety of radioiodine (RAI) and long-term methimazole (MMI) in the treatment of subclinical hyperthyroidism (SH) in the elderly. Method...

Musa Kumbi Ketero, Abduljewad Hussen Muhammed, Adem Abdulkadir Abdi Department of Public Health, Goba Referral Hospital, Madda Walabu University, Goba, EthiopiaCorrespondence: Adem Abdulkadir Abdi Tel +251920323417Email ademabdi8@gmail.comBackground: The Integrated Management of Newborn and Childhood Illness (IMNCI) strategy includes both preventive and curative interventions to improve practices in health facilities, the health system and at home. The quality of these interventions has been very rarely subjected to scientific inquiry in Ethiopia. This study assessed quality of IMNCI services in health centers of Jimma, South West Ethiopia, 2014.Methods: A facility based cross-sectional study was conducted from March 2– 15, 2014 in the health centers of Jimma among 411 care takers exit interview and total of 60 consultation sessions were observed using checklist and participants enrolled through convenient sampling technique. Descriptive statistics were used and factor analysis was employed to create measurement scales for satisfaction of caretakers. Factor scores were used in linear regression analyses to determine presence of statistically significant association between explanatory variables and the outcome variable at P value < 0.05.Results: The response rate for the exit interview was 411 (97.4%). The mean score of overall caretakers satisfaction was 63.4. Specifically 23.4%, 33.6%, and 19.2% of the respondents were dissatisfied with waiting time, amount of explanation they received about the problem or treatment, and availability of medicines, respectively. Availability of prescribed medications (95% CI: 0.577 to 0.047), receiving first dose of medication at health facility (95% CI: 0.087, 0.552), receiving laboratory services (95% CI:0.455,0.056) were among factors that significantly associated with the caretakers’ satisfaction score.Conclusion and Recommendations: Perceived mean of caretakers’ satisfaction at the health centers of Jimma town was low as compared to national standards and long waiting time while providing services. Availability of prescribed medications, receiving first dose of medication and receiving laboratory services were factors associated with patients’ satisfaction. Respective health centers need to ensure availability of medications and supplies and professionals need to pay special attention on medical services like laboratory services, medication and decrease waiting time while providing health services.Keywords: Integrated Management of Newborn and Childhood Illnesses, quality, satisfaction, Jimma

Introduction Chronic functional constipation (CFC) is the most prevalent type of constipation. Considering the proven effect of pelvic floor muscles dysfunction in these patients’ symptom and the fascial connection between pelvic floor and abdominal and lumbopelvic muscles, this study aimed to examine the possible relationship between this muscles and CFC. Method We conveniently selected 100 patients with CFC and 100 healthy participants based on the Rome IV criteria. Two groups were asked to complete the international physical activity questionnaire and food frequency questionnaire. Then both groups were assessed for the presence of trigger points in more prevalent pain sites for each muscle by pressure algometer with 50% of their caught pressure pain threshold. Results There were no statistical differences between two groups in the intake of calories, carbohydrates, proteins, sugar, fiber, vegetables, and wheat products. Patients had a higher consumption of fat and dairy products. for the physical activity level, a statistical difference showed that patients were less physically active. The comparison of the presence and the number of trigger points for each muscle in patients and control groups indicated more than 50% impairment, and there was a significant difference between two groups. Conclusions This study revealed that the relationship between myofascial trigger points of abdominal and lumbopelvic muscles and constipation. In addition to that, it seems that a sedentary life may influence CFC patients’ condition. Moreover, it seems that the results of the dietary condition in patients could be because of conscious consumption of some certain foods.

Objective: Disabled people experience worse situation in respect of the stress, health, and socio-demographic indicators than healthy people. Little knowledge is available about the way in which this disadvantage is patterned by employment status and occupation type, especially in employees with physical disabilities. Few studies have investigated the potential effect of employment status and occupation type on general health and occupational stress in physically disabled employees. This study investigated the role of employment status and occupation type and demographic factors in predicting general health and also, examined the relations between occupational stress and general health while adjusting for demographic factors among employees with physical disabilities in vocational centers of the State Welfare Organization in Tehran City, Iran. Materials & Methods: This was a descriptive-analytical study with a cross-sectional design. The study was performed among 273 people with physical disabilities employed in the productive workrooms of vocational rehabilitation centers of Tehran, which were selected via convenience sampling. Data collection tools were Occupational Stress Index (OSI) developed by Belkic (1991) based upon cognitive ergonomics concept to measure the five key potential work-related stressors, Goldberg’s 28-item General Health Questionnaires (GHQ-28) (1979) to detect psychiatric illness as well as current psychological state in the past month and self-administered demographic form. Data analysis was conducted in SPSS software, using the independent t-test, one-way ANOVA and multiple linear regression. Results: The Mean±SD age of the physically disabled employees was 33.65 (3.76) years. Most of them were aged 30 to 39 years. (55.2%), men (60.4%), married (60.4%), with part-time employment (67%) and engaged in productive affairs (30%). The relationship between general health and occupational stress with gender and marital status was found to be significant (P