Search

Aims: This study was aimed to find the prevalence of potential DDIs in patients and identify factors associated with these interactions. Study design: All patients' medication regimens were screened for potential DDIs through Lexi-Interact® Online application. Place and Duration of Study: This study was conducted for five months in 2017-2018 at the nephrology and kidney transplant ward of Razi hospital, Rasht, Iran. Methodology: Each potential DDI was characterized based on severity, onset, mechanism, risk rating and reliability rating. The patient's comorbidity was assessed with the Charlson comorbidity index. The quality of patients' life was assessed with the Kidney Disease Quality of Life Instrument-SF36TM questionnaire. Results: The study included 191 patients (109 [57.07%] males and 82 [42.93%] females) with a mean age of 58.09 ± 17.76 years. The analysis revealed that 29.4 % of potential DDIs had good and 13.5% had excellent evidence. There was a statistically significant association among the number of prescribed medications (polypharmacy), hospital ward, age, Body Mass Index, education, history of drug addiction, length of hospitalization, dyslipidemia, and hypothyroidism. Conclusion Potential DDIs are common in patients of the nephrology and kidney transplant wards, so proper patient monitoring is essential for minimizing and preventing potential adverse outcomes of DDIs.

Background Dietary diversity score (DDS) is an indicator for assessing nutritional adequacy. Food security is another important measure in nutrition field which can be associated with several cardiovascular risk factors. Considering the importance of nutrition in heart failure (HF) patients, this study was designed to evaluate the DDS and food security of patients with HF. Methods A total of 200 HF patients were enrolled. DDS was evaluated using valid and reliable food frequency questionnaire and was calculated by scoring food intakes as 5 main groups. Household food insecurity access scale was applied to assess food security status. Data were analyzed using descriptive statistics, Chi-square and Kruskal-Wallis tests and multiple logistic regression models. Results The mean age of patients was 65 (standard deviation: 12) years and 59% of patients were male. Median of DDS was 1.96 (range: 0.29 to 6.12). Adjusted odds of greater DDS (> = median of 2) was 2.58 times higher for patients without hypertension than for patients with hypertension (95%CI: 1.31–5.08, P = 0.006). Also, odds of greater DDS were more in ex-smokers’ patients when compared to non-smokers (adjusted odds ratio (AOR): 2.70, 95%CI: 1.27–5.75, P = 0.010), patients with supplement use (AOR: 2.42, 95%CI: 1.16–5.05, P = 0.019), patients with lower total cholesterol level (AOR: 1.01, 95%CI: 1.00–1.02, P = 0.051), and patients with higher ejection fraction (AOR: 1.03, 95%CI: 1.00–1.05, with borderline. P = 0.073). About 57% of patients had experienced degrees of food insecurity as mild (26%), moderate (16%) and severe (15%). On the other hand, women (AOR: 1.90, 95%CI: 0.90–3.71, with borderline P = 0.061) and patients with middle (AOR: 3.48, 95%CI: 1.79–6.76, P P = 0.004) socio-economic status were more likely to be food secure or mild insecure. Also, no relation between DDS and food security was found (r = − 0.08, P = 0.262). Conclusion This study found that HF patients had a low DDS and more than half of the patients were food insecure to some extents.

Background: The role of nutrition is undeniable in controlling hypertension; diet is among the most effective non-pharmaceutical methods. The current study aimed to determine the role of illness perception on diet adherence in patients with hypertension. Materials & Methods: This cross-sectional study examined 268 patients with hypertension. The study sample was selected by convenience sampling method. The study tool consisted of the patients’ individual, social, and clinical factors, illness perception about hypertension, and adherence to the diet. The necessary data were analyzed using multiple logistic regression models. Results: The Mean±SD score of illness perception was measured as 37.09±4.91 out of 56. Adherence to the recommended diet was relatively desirable in the majority of the examined patients (62%). Multiple logistic regression analysis data revealed no significant relationship between the scores of illness perception and dietary adherence (Adjusted OR=1.038, 95%CI: 0.974-1.105, P =0.250). The main predictor of dietary adherence was having hypertension dietary knowledge (OR=2.198, 95%CI: 1.198-4.035, P=0.011). Conclusion: Our study data revealed that increasing awareness among patients with hypertension complications can improve self-care behaviors, including adherence to standard diets. Therefore, emphasis on increasing awareness among these patients and their continued follow-up seems necessar

Acute ischemic stroke treatment has progressed significantly in recent decades, and in most industrialized countries, it ranks among the deadliest diseases. Stroke is essentially caused by a blocka...

Background. Aspirin is an antiplatelet used for the secondary prevention after vascular events. It is also suggested for the primary prevention of vascular events in high risk people, however, despite using standard prophylactic doses, aspirin resistance may result in therapeutic failure and arterial thrombosis. Since the prevalence of aspirin resistance and its associated factors were heterogeneous in different studies, this study was conducted to determine the prevalence and associated factors of aspirin resistance in an Iranian population under aspirin for primary prevention of vascular events. Methods. 264 patients without documented vascular disease with 80 mg daily aspirin consumption for at least one month enrolled in this cross-sectional study. Aspirin resistance was assessed by the measurement of thromboxane B2 in the urine samples using the enzyme-linked immunosorbent assay method. Aspirin resistance was defined as a urine level of thromboxane B2 ≥ 1700 ng/dl. Results. The prevalence of aspirin resistance in this study was 9.8%. Age (OR = 0.935, 95% CI: 0.880-0.993, P = 0.028) and geographical regions (OR = 0.117, 95% CI: 0.014-0.958, P = 0.045) showed independent correlation with aspirin resistance. No significant association observed between aspirin resistance and gender, diabetes mellitus, hypertension, hyperlipidemia, smoking, duration of aspirin use, body mass index, and drug history. Conclusions. Despite the standard daily dose of aspirin for primary prevention of vascular events, some of our patients exhibited aspirin resistance that was directly related to a higher age and geographical region. More studies are required to clarify the beneficial role of aspirin resistance test before planning a preventive strategy in high risk individuals.

There are currently no studies examining healthcare access and utilization by Syrian Americans. A better understanding of the determinants of healthcare utilization among this group could help aid in the design of culturally competent programs. A self-administered survey was distributed at events across Southern California and Jacksonville, Florida from January 2018 to May 2019. Statistical analysis utilized multivariate regressions. Insurance coverage was associated with a preference for speaking Arabic (OR 0.433, p = 0.02) and increased length of residency (OR 1.04, p = 0.02). Routine checkup was associated with female sex (OR 1.97, p = 0.001), age (OR 1.05, p

Background: Patients with Gastrointestinal (GI) cancer experience a range of physical and psychological memorial symptoms after developing cancer and beginning to receive medical care. The present study was conducted to investigate the relationship between self‑compassion and the experience of memorial symptoms in patients with GI cancer. Materials and Methods: This descriptive‑correlational study was conducted in July to August 2019. The study sample included 190 patients admitted to Seyed Al‑Shohada Hospital, with GI cancer who entered the study by convenience sampling. Data were collected using a patient demographic information form, Neff’s Self‑Compassion Scale (SCS), and the Memorial Symptoms Assessment Scale (MSAS) and then analyzed by Pearson correlation coefficient in SPSS‑20. Results: The mean (SD) total score of self‑compassion was 86.67 (16.65) out of 130, and the mean (SD) total score of memorial symptoms was 1.40 (0.64) out of 4 in patients with GI cancer. The most frequently reported physical symptom was lack of energy, with an 86.84% prevalence, and the most frequently reported psychological symptoms included worrying and feeling nervous, with 70.52% prevalence rates. The total score of self‑compassion was inversely correlated with the total score of memorial symptoms, the score of psychological symptoms, and the score of physical symptoms. Furthermore, the total score of the memorial symptoms was inversely correlated with the scores of all the self‑compassion components ( p < 0.001). Conclusions: Cancer patients had memorial symptoms in both physical and psychological domains. These symptoms decrease with an increase in self‑compassion, so compassion‑based educational interventions by nurses can be used to reduce these symptoms.

Patients with gastric cancer are at higher risk for venous thromboembolic events (VTE). Majority of such patients are treated in ambulatory settings where thromboprophylaxis is not routinely offered. In this study, we report on VTE rates and search for predictors that may help identify patients at higher risk to justify VTE-prophylaxis in ambulatory settings. Patients with pathologically-confirmed gastric adenocarcinoma were retrospectively reviewed for VTE detected by imaging studies. Clinical and pathological features known to increase the risk of VTE were studied. Khorana risk assessment model was applied on patients receiving chemotherapy. A total of 671 patients; median age 55 years, were recruited. VTE were diagnosed in 150 (22.4%) patients, including 42 (28.0%) pulmonary embolism and 18 (12.0%) upper extremity deep vein thrombosis (DVT). Majority (> 80%) developed VTE while in ambulatory settings and none had been on thromboprophylaxis. Rate was higher (27.1%) among 365 patients with metastatic compared to 16.7% among 306 patients with nonmetastatic disease, p = 0.001. Patients with metastatic disease who received multiple lines of chemotherapy (n = 85) had significantly higher rate of VTE compared to those who received a single line; 48.2% versus 19.4%, p

Background: Physical activity reduces the risk of Coronary Heart Disease (CHD). The precise mechanism for reducing CHD risk after physical activity has not been determined. The aim of this study was to determine the relationship between physical activity and some biochemical parameters in patients with Acute Coronary Syndrome (ACS). Methods: This cross-sectional study was conducted on patients with ACS referring to Heshmat Medical Center in 2016. Convenient sampling method was used and 280 eligible patients with ACS were included in the study. For data gathering the checklist was used for demographic characteristics of patients and biochemical parameters and the Baecke Questionnaire was used to assess the patients’ physical activity. The data were analyzed in PASW Statistics for Windows, Version 18.0. Chicago: SPSS Inc. using Spearman correlation and multiple regression analyses. The significance level was set at P>0.05. Results: The results showed that 67% of the patients were male and the mean age of the patients was 62.38±12.01 years. The BUN blood urea nitrogen (r=-.121 and -.177) and blood creatinine level (r=-.259 and -.185) had a significant correlation with physical activity in general and at the work hours, (P

Background: Empathy is an important component of the nurse-client relationship and nursing care. The current study aimed to compare nurses' level of empathy with patients in critical care units, psychiatric, and emergency wards. Materials and Methods: The present cross-sectional study was conducted on 112 nurses selected by convenience sampling in three educational hospitals affiliated with Isfahan University of Medical Sciences, Iran from June to September 2017. Data collection tool was a two-part questionnaire consisting of sociodemographic data (such as age, gender, and work experience) and Jefferson Scale of Empathy (JSE) containing 20 items, scored according to Likert scale from totally agree (7 points) to totally disagree (1 point). In total, the maximum score was 140 and the minimum score was 20. Data were analyzed using SPSS version 16 as well as descriptive and analytical statistical tests (multiple regression). Results: The mean (SD) empathy score of nurses working in critical care units, emergency, and psychiatric wards was 87.51 (6.65), 87.59 (4.90), and 90.71 (7.12), respectively. Regarding the regression models, it was observed that only the work experience was a significant predictor for empathy (β = 0.19, p = 0.04). This model predicted 3.50% of variances in the nurses' empathy. Conclusions: Nurses' level of empathy in this study was above average with equal scores in different wards. Therefore, increasing the nurses' level of empathy is essential in interventional studies.

Introduction Chronic, large, and old incisional hernias often lead to surgical complications and major hindrances during emergent laparotomies. The most challenging stages of the laparotomy in such cases occur during opening and fascial closure. Case presentation This article explains the novel surgical technique employed for the complex abdominal closure upon concluding an emergent laparotomy on a 68-year-old female patient. This innovative technique is appropriate for patients with contaminated abdominal cavities and scant fascia who require abdominal operations in cases where biological mesh is not available or is not a viable option. Conclusion This surgical technique can help surgeons restrict abdominal contents and organs (particularly the bowel loops) and prevent migration out of the abdominal cavity during the early post-operative stages, hence, reducing post-surgical complications. The discussed surgical technique ensures that the abdominal fascia defect is limited using skin flaps. This defect later develops into a small hernia sac within a few weeks. Patients then need to have a secondary delayed elective operation on this significantly smaller sized hernia for repair using synthetic mesh., Highlights • In repairing large hernias, if there is no contamination, the best method is to repair with mesh. • In the presence of contamination and small hernia, initial repair seems reasonable. • If there is a large hernia, the use of biological mesh is a good option if possible. • In our country, due to the existence of sanctions in such circumstances, using the proposed method can be a good alternative.

High blood pressure, diabetes, hyperlipidemia and obesity are risk factors for cardiovascular diseases. With regard to the significant role of a healthy diet in the prevention and even treatment of diseases together with the high cost and side effects of drugs, finding foods effective in the treatment of metabolic disorders has been widely considered. This study aimed to evaluate the effect of oxymel – an Iranian traditional syrup with vinegar base – on cardiovascular risk indicators in obese and overweight people. Candidates were selected based on a set of inclusion criteria and were divided into two groups of control and test. The control group received 250 cc of water, while the test group received 250 cc water containing 30 cc of the oxymel for 30 days. Anthropometric and biochemical indicators were measured at the beginning and end of the study. The results showed that there were no significant changes in the body mass index, waist circumference, hip circumference, waist to hip ratio, HDL, LDL, Triglycerides, systolic and diastolic blood pressure, and blood glucose level. However, weight (P = 0.053) and cholesterol (P = 0.083) decreased relatively significantly in the test group compared to the control group. This study shows that consumption of oxymel has positive cardiovascular effects such as lowering the blood cholesterol level and can contribute to weight loss; however, studies with a larger sample size are recommended.

Context: Cleft lip and palate (CLP) is the most common congenital malformations in the face and neck. Given that the inheritance of this disease is multifactorial and both genetic and environmental factors play crucial roles in its creation, studying these factors may be a step toward reducing the prevalence of the disease in future generations. Method: For this study, we looked through several national and international databases, consisting of Scientific Information Database, IranDoc, ScienceDirect, Google Scholar, PubMed, and Scopus. Based on our search method, we found 800 published articles, of which 750 were obtained from the international databases, and the remaining 50 were extracted from the national databases. After data refining, 600 articles with eligible criteria remained for data extraction, and data related to embryological origin, classification and etiology, genes and environmental factors, and complications caused by CLP were collected. Results: The CLP etiology was multifactorial and involved both genetic and environmental risk factors. The primary purpose of this review was to give the reader an overview of studies on multifactorial causes of this congenital disability. The functions of genes are very different, indicating a high level of vulnerability in the cranial and facial growth pathways. Conclusions: These findings have advanced our understanding of genes associated with CLP and genetic polymorphisms involved in orofacial closure defects. The findings can create new clinical and molecular research opportunities.

Although intravenous immunoglobulin (IVIG) is effective therapy for Kawasaki disease, 10-20% of patients have recrudescent fever as a sign of persistent inflammation and require additional treatment. We aimed to compare infliximab with a second infusion of IVIG for treatment of resistant Kawasaki disease.In this multicentre comparative effectiveness trial, patients (aged 4 weeks to 17 years) with IVIG resistant Kawasaki disease and fever at least 36 h after completion of their first IVIG infusion were recruited from 30 hospitals across the USA. Patients were randomly assigned (1:1) to second IVIG (2 g/kg over 8-12 h) or intravenous infliximab (10 mg/kg over 2 h without premedication), by using a randomly permuted block randomisation design with block size of two or four. Patients with fever 24 h to 7 days following completion of first study treatment crossed over to receive the other study treatment. The primary outcome measure was resolution of fever at 24 h after initiation of study treatment with no recurrence of fever attributed to Kawasaki disease within 7 days post-discharge. Secondary outcome measures included duration of fever from enrolment, duration of hospitalisation after randomisation, and changes in markers of inflammation and coronary artery Z score. Efficacy was analysed in participants who received treatment and had available outcome values. Safety was analysed in all randomised patients who did not withdraw consent. This clinical trial is registered with ClinicalTrials.gov, NCT03065244.Between March 1, 2017, and Aug 31, 2020, 105 patients were randomly assigned to treatment and 103 were included in the intention-to-treat population (54 in the infliximab group, 49 in the second IVIG group). Two patients randomised to infliximab did not receive allocated treatment. The primary outcome was met by 40 (77%) of 52 patients in the infliximab group and 25 (51%) of 49 patients in the second IVIG infusion group (odds ratio 0·31, 95% CI 0·13-0·73, p=0·0076). 31 patients with fever beyond 24 h received crossover treatment: nine (17%) in the infliximab group received second IVIG and 22 (45%) in second IVIG group received infliximab (p=0·0024). Three patients randomly assigned to infliximab and two to second IVIG with fever beyond 24h did not receive crossover treatment. Mean fever days from enrolment was 1·5 (SD 1·4) for the infliximab group and 2·5 (2·5) for the second IVIG group (p=0·014). Mean hospital stay was 3·2 days (2·1) for the infliximab group and 4·5 days (2·5) for the second IVIG group (p0·001). There was no difference between treatment groups for markers of inflammation or coronary artery outcome. 24 (44%) of 54 patients in the infliximab group and 33 (67%) of 49 in the second IVIG group had at least one adverse event. A drop in haemoglobin concentration of at least 2g/dL was seen in 19 (33%) of 58 patients who received IVIG as either their first or second study treatment (three of whom required transfusion) and in three (7%) of 43 who received only infliximab (none required transfusion; p=0·0028). Haemolytic anaemia was the only serious adverse events deemed definitely or probably related to study treatment, and was reported in nine (15%) of 58 patients who received IVIG as either their first or second study treatment and none who received infliximab only.Infliximab is a safe, well tolerated, and effective treatment for patients with IVIG resistant Kawasaki disease, and results in shorter duration of fever, reduced need for additional therapy, less severe anaemia, and shorter hospitalisation compared with second IVIG infusion.Patient Centered Outcomes Research Institute.

Jejunogastric intussusception (JGI) is a rare complication of gastrojejunostomy surgery (

Pneumomediastinum is a clinical and radiographic finding that is associated with a wide range of acute processes that allow gas to disseminate through the tissues of mediastinum that often necessitates prompt consideration for thoracic intervention. In some circumstances, pneumomediastinum may arise from processes extrinsic to the thoracic cavity and is a secondary process arising from a primary retropharyngeal or retroperitoneal etiology. Acute emphysematous pyelonephritis is a rare and severe infectious disease of the kidney associated with a very high mortality rate. We report a case of advanced emphysematous pyelonephritis presenting with pneumomediastinum successfully treated with simple nephrectomy in the absence of any direct mediastinal intervention.

Background Omega-3 polyunsaturated fatty acids (n3-PUFAs) may exert beneficial effects on the immune system of patients with viral infections. This paper aimed to examine the effect of n3-PUFA supplementation on inflammatory and biochemical markers in critically ill patients with COVID-19. Methods A double-blind, randomized clinical trial study was conducted on 128 critically ill patients infected with COVID-19 who were randomly assigned to the intervention (fortified formula with n3-PUFA) (n = 42) and control (n = 86) groups. Data on 1 month survival rate, blood glucose, sodium (Na), potassium (K), blood urea nitrogen (BUN), creatinine (Cr), albumin, hematocrit (HCT), calcium (Ca), phosphorus (P), mean arterial pressure (MAP), O2 saturation (O2sat), arterial pH, partial pressure of oxygen (PO2), partial pressure of carbon dioxide (PCO2), bicarbonate (HCO3), base excess (Be), white blood cells (WBCs), Glasgow Coma Scale (GCS), hemoglobin (Hb), platelet (Plt), and the partial thromboplastin time (PTT) were collected at baseline and after 14 days of the intervention. Results The intervention group had significantly higher 1-month survival rate and higher levels of arterial pH, HCO3, and Be and lower levels of BUN, Cr, and K compared with the control group after intervention (all P 2, PCO2, WBCs, GCS, Hb, Plt, PTT, and albumin between two groups. Conclusion Omega-3 supplementation improved the levels of several parameters of respiratory and renal function in critically ill patients with COVID-19. Further clinical studies are warranted. Trial registry Name of the registry: This study was registered in the Iranian Registry of Clinical Trials (IRCT); Trial registration number: IRCT20151226025699N3; Date of registration: 2020.5.20; URL of trial registry record: https://en.irct.ir/trial/48213

Background Although intravenous immunoglobulin (IVIG) is effective therapy for Kawasaki disease (KD), the most common cause of acquired heart disease in children, 10–20% of patients are IVIG-resistant and require additional therapy. This group has an increased risk of coronary artery aneurysms (CAA) and there has been no adequately powered, randomized clinical trial in a multi-ethnic population to determine the optimal therapy for IVIG-resistant patients. Objectives The primary outcome is duration of fever in IVIG-resistant patients randomized to treatment with either infliximab or a second IVIG infusion. Secondary outcomes include comparison of inflammatory markers, duration of hospitalization, and coronary artery outcome. An exploratory aim records parent-reported outcomes including signs, symptoms and treatment experience. Methods The KIDCARE trial is a 30-site randomized Phase III comparative effectiveness trial in KD patients with fever ≥36 h after the completion of their first IVIG treatment. Eligible patients will be randomized to receive either a second dose of IVIG (2 g/kg) or infliximab (10 mg/kg). Subjects with persistent or recrudescent fever at 24 h following completion of the first study treatment will cross-over to the other treatment arm. Subjects will exit the study after their first outpatient visit (5–18 days following last study treatment). The parent-reported outcomes, collected daily during hospitalization and at home, will be compared by study arm. Conclusion This trial will contribute to the management of IVIG-resistant patients by establishing the relative efficacy of a second dose of IVIG compared to infliximab and will provide data regarding the patient/parent experience of these treatments.

Rheumatoid arthritis (RA) is a debilitating autoimmune disease with grave physical, emotional and socioeconomic consequences. Despite advances in targeted biologic and pharmacologic interventions that have recently come to market, many patients with RA continue to have inadequate response to therapies, or intolerable side effects, with resultant progression of their disease. In this review, we detail multiple biomolecular pathways involved in RA disease pathogenesis to elucidate and highlight pathways that have been therapeutic targets in managing this systemic autoimmune disease. Here we present an up-to-date accounting of both emerging and approved pharmacological treatments for RA, detailing their discovery, mechanisms of action, efficacy, and limitations. Finally, we turn to the emerging fields of bioengineering and cell therapy to illuminate possible future targeted therapeutic options that combine material and biological sciences for localized therapeutic action with the potential to greatly reduce side effects seen in systemically applied treatment modalities.

Introduction: Granulomatosis with polyangiitis (GPA) is a kind of anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV), which involves small-to-medium-sized vessels. Besides, GPA usually involves the upper and lower respiratory tract, and also causes necrotizing glomerulonephritis. The involvement of the heart and gastrointestinal (GI) tract in GPA is unusual, and these are atypical places of this vasculitis. Case Presentation: A 14-year-old girl with a newly diagnosed GPA after afflicting with COVID-19 infection presented with ST-elevation Myocardial Infarction (MI), GI perforation, and intracranial hemorrhage. Conclusions: Although GPA is rare in the pediatric population, it might occur in this age group and could involve multiple organ systems.

BACKGROUND: Therapies against severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and its life-threatening respiratory infection coronavirus disease 2019 (COVID-19) have been evaluated, including COVID-19 convalescent plasma (CCP). Multiple large reports of CCP treatment in adults exist. Pediatric data on CCP safety and efficacy are limited. METHODS: Single-center prospective, open-label trial looking at safety, antibody kinetics and outcomes of CCP (10 mL/kg, max 1 unit) treatment for COVID-19 in hospitalized pediatric patients with moderate to severe disease or at high risk for serious illness. RESULTS: Thirteen patients were enrolled. No infusion-related adverse events occurred. No hematological or metabolic adverse events were noted during hospitalization or at 3-weeks. Ten patients had clinical improvement by day 7 (WHO eight-category ordinal severity scale for COVID-19). Following CCP, anti-SARS-CoV-2 anti-nucleocapsid IgG increased significantly at 24 hours and high levels were sustained at 7- and 21-days. Transient IgM response was noted. Twelve patients (92.3%) were discharged home, 9 (75%) by day 7 post-CCP. One remained on invasive ventilatory support 42 days after CCP and was eventually discharged to an intermediate care facility. The single patient death was retrospectively confirmed to have had brain death before CCP. CONCLUSION: CCP was well tolerated in pediatric patients, resulted in rapid antibody increase, and did not appear to interfere with immune responses measured at 21 days. More pediatric data are necessary to establish the efficacy of CCP, but our data suggest benefit in moderate to severe COVID-19 when used early. Other immunological or antiviral interventions may be added as supported by emerging data.

Background Mycobacterium species, specifically M. abscessus and M. chelonae (MABs), are known to contaminate water systems and are uncommon causes of health care–associated infection, but morbidity can be significant and treatment complex. Methods Odontogenic MAB infections occurred in patients following pulpotomy procedures at dental clinic A from 1 January to 6 September 2016. We identified confirmed and probable cases using culture data, imaging, pathology results, and surgical findings. Epidemiologic and clinical data including demographics, symptoms, laboratory findings, treatment regimens, and outcomes were extracted. Results Of 1082 at-risk patients, 71 case patients (22 confirmed; 49 probable) were identified. Median age was 6 years. Median symptom onset was 85 days postpulpotomy. Pain and/or swelling on admission occurred in 79%. On imaging, 49 of 70 had abnormalities of the mandible or maxilla, 13 of 70 had lymphadenopathy, and 19 of 68 had pulmonary nodules. Seventy were hospitalized (average of 8.5 days). Intravenous antibiotics were administered to 32 cases for a median length of 137 days. Clofazimine was administered to 29 patients as part of their multidrug regimen. Antibiotic treatment was associated with many adverse effects. Treated children showed evidence of jaw healing with resolved/improving pulmonary nodules at 1-year follow-up. Conclusions This is the largest outbreak of invasive MAB infections associated with a pediatric dental practice. While infections were indolent, patients suffered medical and surgical consequences of treatment, including permanent tooth loss. Identification of this outbreak led to a change in water standards for pediatric dental procedures in California. Enhanced national dental water quality standards are needed to prevent future outbreaks.

Background: Maternal infection with rubella in the first trimester of pregnancy can result in developmental abnormalities in fetus such as hearing loss, heart abnormalities, impaired vision, and mental retardation. Methods: This Multi-stage prospective/cross sectional study was carried out in three stages in three educational hospitals in Tehran (Rasoul akram, Akbar Abadi and Firoozabadi), during 2011-2012: In first stage, 186 infants at birth day. Rubella antibodies (IgG&IgM) in cord blood was evaluated by Eliza method. In second stage, 89 infants suspected INTRA UTERINE INFECTION and in third stage 165 infants with SNHL were selected . Age matched control group were selected and examined concurrently. Rubella antibodies (IgG&IgM) compared between cases and healthy matched infants. Results: In first stage, significant correlation was found between vaccination history and rubella immunization of mothers (P value = 0.001). None of those with a history of vaccination had positive IgM. In second stage, confirmed CRS (positive IgM) was found in 4.4% of total CRS suspected cases (5 /89). The positive RT–PCR detected in 1.5% of total CRS suspected cases (1/89). Except a positive correlation between abnormal neurologic findings and positive IgM in Confirmed CRS cases, other clinical findings were not related to serologic tests. In third stage, the highest frequency for Positive Rubella-IgM observed in the SNHL cases Conclusion: Active CRS surveillance is recommended strongly even in country with full rubella vaccination. Without active CRS surveillance ;CRS especially, mild infection ( not classic form) such as IUGR(intrauterine growth retardation), hearing loss, heart abnormalities, impaired vision, and mental retardation even in developed country might be missed . The necessity to add a booster vaccine dose to the national vaccination program 8 years after the last vaccination should be evaluated if needed. In addition, follow-up of safety status and studies to evaluate the success of the program may be necessary and is recommended.

Mycobacterium avium subsp. paratuberculosis causes Johne’s disease in cattle and other ruminants. It is one of the most widespread in terms of prevalence and one of the most important diseases in the livestock industry in terms of economic importance. In the latent form of the disease, animals can act as carriers. The main purpose of this study was to evaluate avian tuberculin in a single intradermal comparative tuberculin test (SICTT), histopathology, immunohistochemistry, and molecular methods for diagnosis of infected cows with the latent form of the disease. Twenty-three asymptomatic cows and without post-mortem signs of the disease were selected using the single intradermal comparative tuberculin test and were tested. In this study, avian tuberculin in SICTT was able to in diagnosing the latent form of the disease. The results confirm immunohistochemistry and real-time PCR as a sensitive and reliable diagnostic complementary approach for detecting latent forms of Paratuberculosis.

Background: This community-based study aimed to investigate the psychiatric disorders and their comorbidities according to the kind of psychiatric disorders. Frequency of demographic factors and the prevalence of total psychiatric disorders in term of demographic charactheristics were obtained too. Materials and Methods: The present study focused on 1028 children and adolescent aged 6 to 18 years old across the Razavi Khorasan province by random sampling. The subjects included 496 boys and 532 girls from three age groups (6-9 years, 10-14 years and 15-18 years). Eight clinical psychologists trained to complete the Persian version of K-SADS-PL (Kiddie-SADS present and life time version). This scale measures five diagnostic appendixes of psychiatric disorders. Demographic data of participants were collected too. The data were recorded into the SPSS version 16. The relationship between psychiatric disorders and demographic factors deliberate by descriptive analysis and 95% confidence interval. Results: The total rate of psychiatric disorders among children and adolescent was estimated as 20.5%, elimination disorders with a rate of 12.9% was the most prevalent disorder in the subjects. The lowest prevalence belongs to psychotic disorder and bulimia nervosa (0.1%). Of participants with mood disorders about 71.4% have behavioral disorders too. Anxiety disorders also commonly occurred in person with mood disorders. The comparison of ORs and their 95% confidence interval revealed that there is a significant difference for total psychiatric disorder among boys and girls (OR=0.6 for girls; 95% CI: 0.44-0.82). The rate of total psychiatric disorders in rural and urban areas was 14.9% and 21.1% respectively. Conclusion: With attention to the high prevalence of psychiatric disorders among children and adolescents, it’s necessary that healthcare officials pay more attention to reinforcement of mental health care.[GMJ.2020;9:e1714]

Background Fetal magnetic resonance imaging (MRI) and spectroscopy (MRS) provide a unique opportunity to non-invasively measure markers of neurodevelopment in survivors of twin-twin transfusion syndrome (TTTS). Objective To characterize fetal brain maturation after laser surgery for TTTS by measuring brain volumes and cerebral metabolite concentrations using fetal MRI + MRS. Study design Prospective study of dual surviving fetuses treated with laser surgery for TTTS. At 4-5 postoperative weeks, fetal MRI was used together with novel image analysis to automatically extract major brain tissue volumes. Fetal MRS was used to measure major metabolite concentrations in the fetal brain. Results Twenty-one twin pairs were studied. The average (±SD) gestational age at MRI was 25.89 (±2.37) weeks. Total brain volume (TBV) was lower in the donors, although cerebral volumes were not different between twin pairs. Recipients showed lower proportions of cortical and cerebellar volumes, normalized to TBV and cerebral volumes. MRS data showed that biochemical differences between twin brains were related to discrepancy in their brain volumes. Conclusion Although donors have a smaller TBV compared to recipients, proportionality of brain tissue volumes are preserved in donors. MRS maturational markers of fetal brain development show that recovery in donors persists 4 weeks after surgery.

Objective: Cardiovascular diseases are the main cause of mortality worldwide. Depression is one of the effective factors in the incidence of cardiovascular diseases like coronary artery stenosis. This study aimed to investigate the relationship between depression symptoms and severity of coronary artery disease (CAD) in patients scheduled for angiography. Method: This prospective, cross sectional research was conducted on as many as 401 patients scheduled to undergo angiography at Dr. Heshmat heart hospital as the referral center in the north of Iran in 2016. Before cardiac catheterization, patients' demographic information (age, gender, level of education, and place of residence) and patients’ medical history (history of diabetes mellitus, hypertension, and family history of cardiac disease) were obtained. Also, Beck Depression Questionnaire 2 (BDI II) was completed by a psychologist before angiography. After collecting the data, SPSS v.21 and statistical tests such as Spearman correlation, and Mann-Whitney U regression were used to analyze the data. Results: After controlling for age, sex, and having history of diabetes mellitus, no relation was found between having depression symptoms and more frequency of vessel involvement (OR = 1.35, 95% CI: 0.92 to 1.98, P =0.130) or higher severity of CAD (OR = 1.47, 95% CI: 0.95 to 2.28, P = 0.087). The results were similar for the relation between severity of depression symptoms and CAD extent or CAD severity. Conclusion: The results of this study showed that in patients undergoing angiography, depression symptoms were not related to CAD severity and number of involved vessels. Depression was associated with angina, independently of CAD severity. Our study found no significant correlation between CAD severity and severity of depression. The reason may be that measuring depression at a single time point cannot accurately reveal the impact of this problem on the trend of atherosclerosis over time.

BACKGROUND Previous studies have demonstrated that even small pancreatic cancers are associated with poor survival. The role of facility type on survival in this setting is unknown. STUDY DESIGN The National Cancer Database (NCDB) was utilized. Patients who underwent pancreatoduodenectomy for adenocarcinoma ≤ 2 cm in Academic/Research Cancer Programs (ACPs) were compared to Non-Academic Cancer Programs (NACPs). RESULTS A total of 4672 patients were identified. Surgery at ACPs was associated with a lower rate of positive margins (14% vs 17%,P

Background Kawasaki Disease (KD) and rhino sinusitis are common in young Iranian population. Paranasal sinusitis can cause immunologic reactions and progress to KD. We compared the incidence of rhino sinusitis based on para nasal sinus- computed tomography scans (PNS-CT Scan), in KD cases with control group (head trauma) Methods A prospective, case control study (2013-18)had done in Rasul Akram Hospital in Tehran, Iran.PNS- CT scan finding compared between 43 proven KD and 43 controls (head trauma). The PNS-CTscan changes compared between 2 groups respect to their ages, gender, site and type of sinusitis. Results PNS-CT scan had been performed in 23 cases with proved KD and 43 non KD cases( control) with mean age of 6.48 ± 4.15 years in KD cases without significant difference to controls (p = 0.14.). No significant difference had seen in gender between two groups. (p = 0.14).The paranasal sinusitis had higher prevalence in KD cases in compare with controls: 41.86% (18 / 43) vs 20.9% (9 / 43) respectively (P = 0.036). The mean age of children with sinusitis had not difference between groups (7.44 ± 0.89 vs. 7.88 + 2.44, p = 0.176). Presence of sinusitis in cases and controls were not related to age, sex and site of sinusitis (p = 0.71; 0.80; 0.63 respectively). Conclusion The result of this investigation shows the high prevalence of paranasal sinusitis in KD which suggest the sinusitis as an important factor for developing the KD. Although, the presence of sinus pathology on a PNS- CT scan does not establish the causality between sinusitis and KD, but due to high prevalence of paranasal sinusitis in our pediatric population, we recommend PNS CT-scan for KD cases with prolonged URI ( Upper Respiratory Tract Infection) symptoms more than 2 weeks. In KD cases with confirmed paranasal sinusitis, antibiotic treatment is recommend to prevent relapses and complications of the KD treatment.

Shift work is an inconsistent and atypical work schedule. This study aimed to investigate the influence of shift work on the Quality of Sleep (QOS) and Executive Functions (EF). Thirty shift workers and thirty day workers first completed a demographic questionnaire. They then were tested using the Pittsburgh Sleep Quality Index (PSQI) and EF tests, including the Corsi Block-Tapping Task (CBTT), Berg’s Card Sorting Task (BCST), and the Continuous Performance Task (CPT). Results were subjected to non-parametric Chi-Square Tests, the Mann-Whitney U Test, and Independent T-Tests. Shift workers had significantly poorer sleep quality than day workers, which was shown in PSQI global scale ('p' = 0.001), sleep duration ('p' = 0.042), habitual sleep efficiency ('p' = 0.021), and sleep disturbance ('p' = 0.021). Concerning EF tests, shift workers performed significantly poorer on CBTT ('p' = 0.019) and BCST ('p' = 0.015, 0.047) compared with day workers. Significant differences were also observed between shift workers and day workers in terms of variables of omission errors ('p' = 0.037) and commission errors ('p' = 0.041) on CPT, but no significant difference was found between shift workers and day workers in reaction time ('p' = 0.561). Shift work impaired EF. These findings are related to shift workers’ poorer sleep and its detrimental effects on areas of the brain, which are critical for EF, such as the prefrontal area. Our results suggest the evaluation and implication of practices and policies to assuage the consequences of working in shifts.

Gallbladder cancer has a poor prognosis, and surgery is the only curative treatment. However, lymphadenectomy has been underperformed. We evaluate the trend of lymphadenectomy in the United States and its impact on survival.This is a cohort study of patients who underwent gallbladder cancer surgery between 2004 and 2016. Trend analysis of the rate of lymphadenectomy and the number of lymph nodes (LNs) removed were examined. The impact of lymph node status and different LN staging systems on survival was examined.Of the 4577 patients identified, 69.9% were female, the mean age was 71.0 (±12.4), 87.2% had ≥ T2, and only 50.3% (n = 2302) received lymphadenectomy. Although the rate of lymphadenectomy and the number of LNs removed increased during the study period, both with P 0.0001, the rate of patients who received examination of ≥6 LNs remained low, 13.6% in 2016. Adjusted regression analysis showed that patients without LN examination had worse overall survival than patients with LN positive disease, HR: 1.11 (95% CI: 1.01, 1.22). Concordance index analysis revealed that LN ratio (LNR) and Log odds of positive LN (LODDS) did not improve the ability of the American Joint Commission on Cancer (AJCC) staging in predicting 5-y survival rate.Lack of LN examination is associated with worse survival than LN positive disease. Although the rate of LN examination and number of LNs retrieved have increased from 2004 to 2016, they remained low. LNR and LODDS staging systems added no benefit to AJCC staging ability in predicting a 5-y survival rate.

Objective: To evaluate the relationship between platelet count after primary percutaneous coronary intervention (p-PCI) and left ventricular aneurysm (LVA) in patients with acute anterior ST-elevation myocardial infarction(STEMI). Methodology: This descriptive study was performed on a population of patients with acute anterior STEMI, who had undergone p-PCI. Sampling was carried out by a consecutive survey of patients, who were admitted to the Medical Center in summer and fall of 2018. Blood samples were collected intravenously from all the patients at admission to the emergency department before and after p-PCI. Echocardiographic examinations were routinely performed by a specialist assistant as the co-author 8 to 12 hours after p-PCI and at follow-up (10 to 14 months after acute MI). The TIMI flow was observed immediately after p-PCI. In all the patients undergoing p-PCI, the location of left anterior descending (LAD) artery involvement during coronary arteries angiography was divided into three sections based on LAD artery length. Results: The mean WBC and PMN before p-PCI were statistically higher in the group of patients with LVA compared to individuals without LVA (p

The American College of Cardiology (ACC) in USA and the European Society of Cardiology (ESC) in Europe have issued around 25 practice cardiology guidelines since 2008. The attention and impact of these guidelines have not been investigated yet. In this study, we aim to compare the attention brought up by ACC and ESC guidelines. Guideline documents were defined as documents published by either the ACC or the ESC, where recommendations with a specific level of evidence are clearly indicated. These documents were posted on their respective websites. For each document, we extracted the attention on blogs, news, social media, and other platforms to calculate a total score known as the Altmetric Attention Score (AAS). Then we compared AAS, citations, and other indices between ACC and ESC guideline documents. A total of 26 US and 24 European cardiology guidelines were released between 2008 and 2018. We found a significant difference in the median AAS between American and European guidelines (p = 0.048). The median AAS for European and for American guidelines were 159 (104.25–392.5) and 79 (24–169.75), respectively. The US Contribution to the AAS was significantly higher than the European in both the European guidelines (p

Objectives:The purpose of this study was to evaluate and compare complications caused by VP shunt (based on imaging changes, clinical and laboratory findings) in children with congenital (intrauterine) infections, referred to as TORCH, in contrast to other causes of Shunt insertion in children.Materials and Methods:In this cross-sectional, observational and descriptive study, 68 hospitalized patients in Rasool-Akram Hospital were selected using convenience method during 2 years from 2013 to August, 2016. Clinical examination and organ involvement were determined. Blood sampling, serological and complementary tests were performed to determine the type of infection, cause and duration of shunt insertion, mechanical and infectious complications (meningitis and peritonitis), the course of the disease and finally, mortality and morbidity. All data were collected in questionnaires. Statistical analysis was performed using SPSS-24 version software. The comparison was carried out between two groups of infectious and noninfectious causes. P-value less than 5.5 was considered significant.Results:From total 68 children with VP shunt, 13 patients died (including 8 males and 5 females with a mean age of 69.41 ± 81.57 months-old). The main cause of shunt insertion was infection in 4 patients and tumor, cerebral hemorrhage and myelomeningocele in 9 other children. Shunt-induced meningitis and peritonitis were detected in 92% and 7.7% respectively. The leading causes of shunt insertion In remaining 47 live children (including 27 males and 19 females with a mean age of 63 +83 months) were infectious in 28% and noninfectious in the rest of cases. The shunt mechanical complications were reported in 8.7% (4 patients). Fever was detected in 33% of patients. Positive blood culture and cerebrospinal fluid were reported in 6.8% and 8.5% of patients in that order, but meningitis was detected in 26% (12 cases) and peritonitis in 10.9% (5 cases). Although, there were no significant differences between two groups in terms of mechanical complications such as shunt obstruction, cerebral hemorrhage ;but, a considerable difference was reported in death rate due to shunt insertion between two groups with infectious and noninfectious origin. The risk of shunt-induced meningitis was clearly higher in group with infectious origin. (P-value = 0.05). But peritonitis risk was not different.Conclusion:VP shunt complications were observed in one-quarter of children, but mechanical complications of VP shunt were uncommon (8% in live patients). VP shunt mortality was relatively high (13 patients from total 68), and occurred more often in patients with non-infectious causes of VP shunt, mainly due to meningitis. Shunt meningitis was very common In patients with infectious origin. Shunt infection in patients (meningitis, bacteremia and peritonitis) was common and could increase mortality if not controlled. Prescribing antibiotics is not recommended without initial diagnostic measures (such as spinal fluid puncture, ascites, and proper imaging) because it will result in incomplete and improper treatments.

Background: Recurrent aphthous stomatitis (RAS) is the most common ulcerative oral lesions. Many factors including genetics, stress, lifestyle, gastric diseases and nutritional habits play a major role in the etiology of recurrent aphthous ulcers. The aim of this study was to evaluate the lifestyle of patients with a history of aphthous stomatitis. Methods: This cross-sectional study was conducted on 99 dentistry students with a history of aphthous stomatitis. The control group consisted of 145 dentistry students without any history of the lesion. Demographic information and lifestyle factors including smoking, body mass index, place of living, marital status, regular exercise were recorded. Nutritional habits were evaluated using a modified Food Frequency Questionnaire containing 95 food variables. Independent t-test and Mann Whitney test were used to compare the two groups. Linear regression analysis were used to determine the predictors. Results: There was no significant difference in nutritional habits of study participants. A family history of RAS was more frequently noticed in the case group (43.1%) rather than control group (27.7). Multivariate logistic regression model showed that the most powerful predictors of aphthous lesions were familial history of lesions (OR = 2.4, 95%CI: 1.11-5.13) and food allergy (OR = 4.71, 95%CI: 2.70 to 8.22) respectively. Conclusion: Based on the results of the present study, life style and diet are not associated with aphthous lesions. Considering that aphthous stomatitis is a multifactorial disease, there is a need to study other risk factors and laboratory tests.

BackgroundViral loads (VLs) frequently are followed during treatment of symptomatic congenital cytomegalovirus disease, but their predictive value is unclear.MethodsPost hoc analysis of 2 antiviral studies was performed. Seventy-three subjects were treated for 6 weeks and 47 subjects were treated for 6 months. Whole blood VL was determined by real-time polymerase chain reaction before and during therapy.ResultsHigher baseline VL was associated with central nervous system involvement (3.82 log, range 1–5.65 vs 3.32 log, range 1–5.36; P = .001), thrombocytopenia (3.68 log, range 1–5.65 vs 3.43 log, range 1–5.36; P = .03), and transaminitis at presentation (3.73 log, range 1–5.60 vs 3.39 log, range 1–5.65; P = .009), but with overlap in the amount of virus detected between groups. In subjects treated for 6 months, lower VL at presentation correlated with better hearing outcomes at 12 months, but VL breakpoints predictive of hearing loss were not identified. Sustained viral suppression during 6 months of therapy correlated with better hearing outcomes at 6, 12, and 24 months (P = .01, P = .0007, P = .04), but a majority without viral suppression still had improved hearing.ConclusionsIn infants with symptomatic congenital cytomegalovirus disease, higher whole blood VL before initiation of antiviral therapy has no clinically meaningful predictive value for long-term outcomes.

Introduction A novel Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was identified as the pathogen responsible for a serious, life threatening respiratory infection (COVID-19) initially reported in Wuhan, China which rapidly spread worldwide resulting in global pandemic. Multiple immunological and pharmacological therapies have been evaluated with variable results. Convalescent plasma has been used in previous outbreaks such as Influenza 1918 and 2009, Ebola, MERS and SARS with good efficacy and safety reported. There have been multiple large reports on the safety of COVID-19 convalescent plasma (CCP) for the treatment of this serious infection in the adults; controversy has ensued regarding its efficacy. Pediatric data on CCP use are limited. Methods We conducted a prospective, open label treatment trial using CCP (10 ml/kg up to 1 unit) for the treatment of COVID-19 in pediatric patients with moderate to severe disease or high risk for serious illness. Safety and antibody kinetics and outcome data were collected. Results Eighteen moderate to severe COVID19 pediatric patients were enrolled and received CCP early in their illness (median days of symptoms XX). We observed no infusion related adverse events, no hematological or metabolic adverse events were noted during the hospitalization and at 3 weeks after infusion follow up. Sixteen patients demonstrated significant clinical improvement by day seven post infusion, as measured by the WHO eight-category ordinal severity scale for COVID-19. Presence of SARS-COV-2 anti-nucleocapsid IgG was demonstrated in all CCP specimens, a significant increase in antibodies was demonstrated in CCP recipients 24 hours after receiving CCP. Sustained high levels of anti- SARS-COV-2 anti-nucleocapsid IgG was demonstrated at 7- and 21-days post-transfusion. A transient IgM response not associated with CCP was noted. Eleven (61.1%) patients were discharge to home by day 7 post CCP infusion. One patient remained on invasive ventilatory support 21 days after CCP infusion and was eventually discharged to an intermediate care facility, one patient died retrospectively confirmed to have been brain death before receiving CCP. Conclusion We conclude that CCP was well tolerated in pediatric patients. CCP resulted in rapid increase of antibodies and sustained levels 21 days after infusion suggesting that CCP did not interfere with patients own immune response. More data are necessary to establish efficacy of this intervention in children, but our patients clinical course suggests benefit of CCP. Pediatric patients with moderate to severe COVID-19 may benefit of CCP when used early in the course of illness in conjunction with other immunological or antiviral interventions as needed.

Introduction Utilising epidural analgesia (EA) during major abdominal surgery in combination with general anaesthetic, is a proven approach to decrease anaesthetic requirement in patients with severe comorbidities, enhance recovery and improve pain management. Case presentation Herein we report a case of an 81-years-old female with bilateral lower limb sensory loss, saddle paraesthesia, paraplegia, and incontinence following a thoracic epidural catheterisation required for low anterior resection of rectal adenocarcinoma. The complication was reported by the patient on the third day of post-op. Clinical discussion The magnetic resonance imaging results revealed an extradural extramedullary hyperintense haematoma in the spinal cord at T12-L2 vertebral level. The neurological deficit was addressed urgently with laminectomy; and following implementation of intensive inpatient physiotherapy and rehabilitation regiment the patient restored mild motor function. Conclusion We believe the culprit of the acute focal neurology deficits in this patient could be due to the epidural catheterisation and the post-op local anaesthetic injections. From this case, we anecdotally recommend performing thoracolumbar MRI as part of pre-op workup in patients with long standing back issues or claudication, considering x-ray guided catheterisation in higher risk patients for epidural hematoma, and early and repeated neurological examination and rapid investigation for any mild neurological deficits., Highlights • Epidural anaesthesia is a common practice in colorectal surgery for pain management. • Epidural haematoma formation due to epidural anaesthesia in a colorectal surgical case • Delayed presentation of neurological deficits: bilateral paraesthesia, paraplegia, and incontinence • Identifying at risk patients, proactive thoracolumbar MRI imaging • Recommend X-ray guided epidural catheter insertion and close neurological monitoring

This study investigated the effects of starvation and subsequent refeeding on growth, feed utilization, body composition, hematological indices and some morphological and plasma biochemical parameters of Siberian sturgeon (Acipenser baerii) with average initial weight of 19.32 ± 0.62 g (mean ± SE). The fish were exposed to four feeding regimes: the control group (C) was fed four times daily to apparent satiation throughout the experiment. Fish in the other three treatments were deprived of food for 2, 4, or 8 days followed by 8, 16, or 32 days of refeeding (T1, T2 and T3, respectively) in repeated cycles during an 80 days feeding trial. At the end of the experiment, there were no significant differences in final weight (except for T2 group), growth and feeding performance, whole body composition, hepatosomatic index and digestive somatic index between the deprived and control fish (P > 0.05). Feeding strategies seemed to have a significant effect only on the protein content (P

Introduction: Development of nurse–patient empathic communication in the oncology ward is of great importance for the patients to relieve their psychological stress, however, nursing care of cancer patients is accompanied with high stress and burnout. The present study aimed to define the level of empathy and its association with burnout and some demographic characteristics of oncology nurses. Materials and Methods: This descriptive/correlation study was conducted in a professional cancer treatment center in Isfahan. Through census sampling, 67 oncology nurses were selected. The data collection tools were Jefferson Scale of Nursing Empathy, Maslach Burnout Inventory, and demographic characteristics questionnaire. Results: Mean nurses’ empathy and overall burnout scores were 62.28 out of 100 and 38.8 out of 100, respectively. Score of empathy showed an inverse correlation with overall burnout score (r = −0.189, P = 0.04), depersonalization (r = −0.218, P = 0.02), and personal accomplishment (r = −0.265, P = 0.01). Multiple regression test was used to detect which dimension of burnout was a better predictor for the reduction of empathy score. Results showed that the best predictors were lack of personal accomplishment (P = 0.02), depersonalization (P = 0.04), and emotional exhaustion (P = 0.14), respectively. The most influential demographic factor on empathy was work experience (r = 0.304, P = 0.004). One-way analysis of variance showed that official staff had a higher empathy score (f = 2.39, P = 0.045) and their burnout was lower (f = 2.56, P = 0.04). Conclusions: Results showed a negative relationship between empathy and burnout in oncology nurses. Therefore, nursing support from managers to reduce burnout increases empathic behavior of nurses.

Rheumatoid arthritis (RA) and spondyloarthritis (SpA) are systemic autoimmune diseases, characterized by chronic, systemic inflammatory conditions (1, 2). Even if anti-inflammatory treatment is suc...

Objective As a popular beverage, there has been much interest in studying the effects of tea intake on hypertension (HTN), a particular risk factor for cardiovascular disorders (CVDs). We have thus aimed to isolate the randomized controlled trials investigating the efficacy of black or green tea as a beverage in subjects with elevated blood pressure (BP), or HTN. Methods PubMed, Scopus, Web of Science, and ProQuest dissertations and theses databases were searched from February 1, 1995, up to July 20, 2019, to identify relevant studies. Results The search strategy generated 1119 trials, of which finally five trials fulfilled the criteria for being included in the current study. Three out of 5 articles showed a low risk of bias. According to nine measurements derived from 5 trials on 408 individuals, it was found that regular tea intake resulted in the reduction in SBP (weighted mean difference (WMD): −4.81 mmHg, 95 %CI: −8.40 to −1.58, P = .004) and DBP (WMD:-1.98 mmHg, 95 %CI: −3.77 to −0.20, P = .029); however, excluding the most heterogeneous trials showed that regular tea intake might reduce SBP and DBP by about −3.53 and −0.99 mmHg, respectively. Based on meta-regression findings, we found the longer the duration of tea intake (≥3months), the higher the decrease in both SBP and DBP. Categorized studies, according to the tea type, revealed that the hypotensive effects of green tea were more pronounced compared to black tea. None of the studies reported any side effects. Conclusion These results suggest the positive effects of regular tea intake on BP in subjects with elevated BP or HTN. Hence, it may be applicable to physicians, health care providers, and particularly HTN patients.

Deep brain stimulation (DBS) in psychiatric illnesses has been clinically tested over the past 20 years. The clinical application of DBS to the superolateral branch of the medial forebrain bundle in treatment-resistant depressed patients-one of several targets under investigation-has shown to be promising in a number of uncontrolled open label trials. However, there are remain numerous questions that need to be investigated to understand and optimize the clinical use of DBS in depression, including, for example, the relationship between the symptoms, the biological substrates/projections and the stimulation itself. In the context of precision and customized medicine, the current paper focuses on clinical and experimental research of medial forebrain bundle DBS in depression or in animal models of depression, demonstrating how clinical and scientific progress can work in tandem to test the therapeutic value and investigate the mechanisms of this experimental treatment. As one of the hypotheses is that depression engenders changes in the reward and motivational networks, the review looks at how stimulation of the medial forebrain bundle impacts the dopaminergic system.

BackgroundThe clinical features of Kawasaki disease (KD) overlap with those of other paediatric febrile illnesses. A missed or delayed diagnosis increases the risk of coronary artery damage. Our computer algorithm for KD and febrile illness differentiation had a sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 94.8%, 70.8%, 93.7% and 98.3%, respectively, in a single-centre validation study. We sought to determine the performance of this algorithm with febrile children from multiple institutions across the USA.MethodsWe used our previously published 18-variable panel that includes illness day, the five KD clinical criteria and readily available laboratory values. We applied this two-step algorithm using a linear discriminant analysis-based clinical model followed by a random forest-based algorithm to a cohort of 1059 acute KD and 282 febrile control patients from five children’s hospitals across the USA.ResultsThe algorithm correctly classified 970 of 1059 patients with KD and 163 of 282 febrile controls resulting in a sensitivity of 91.6%, specificity of 57.8% and PPV and NPV of 95.4% and 93.1%, respectively. The algorithm also correctly identified 218 of the 232 KD patients (94.0%) with abnormal echocardiograms.InterpretationThe expectation is that the predictive accuracy of the algorithm will be reduced in a real-world setting in which patients with KD are rare and febrile controls are common. However, the results of the current analysis suggest that this algorithm warrants a prospective, multicentre study to evaluate its potential utility as a physician support tool.