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Background: Burns are the second most common etiology of injury death in children under 5 years old and are the most common cause of death in a home accident. Materials & Methods: This study was performed to investigate the epidemiology of childhood burn in children under 16 years old referred to Velayat Burn Center, Rasht City, Iran, from 2013 to 2018. Data were collected from electronic hospital records of burn patients aged under 16 years of age. Results: Out of 717 patients, 44.5% were girls, and 55.5% were boys (sex ratio=1.2). The highest frequency of burns (56.1%) was reported in the 1-5 years age group. The most common cause of burn was scalds (76%), and the most common burn severity was second-degree burns (46.7%). The Mean±SD duration of hospitalization was 3.07±4.15 days, and the hospital stay was significantly associated with the cause of the burn, Burned Body Surface Area (BBSA), and burn severity. The highest frequency was reported on Saturdays, i.e., (the first working day in Iran) (22.7%), between 6 and 12 o’clock (42.8%). Conclusion: This study found that children in 1-5 years old were the most susceptible age group for burn injuries and scalds were the most common cause of the burn. The male to female ratio was 1.2, and the majority of burns occurred in the winter.

Background: Hearing impairment is the most common disabilities that have negative impact on the quality of life of affected children and their families. The aim of this study was to: assess parents' perception level of quality of life of their elementary school children with hearing impairment using hearing aids. Subjects and method: Study design: A descriptive study design was utilized in this study. Study settings: This study was conducted in audiology out-patient clinic of the School Health Insurance Hospital at Tanta City. Study subjects: A convenient sampling of 150 of elementary school students who diagnosed with hearing impairment using hearing aids and their parents which constitute 150 were included in the study. Tool of data collection: one tool was used by the researcher to collect the necessary data. Tool I: A structured interview schedule: this tool included five parts: Part (1): Socio-demographic characteristics of the students and their parents. Part (2): History of hearing impairment and using hearing aids. Part (3): History of the academic achievement of the students. Part (4): Children using hearing devices quality of life. Part (5): Pediatric Quality of Life Inventory. Results: about half (47.3%) of the child's performance after fitting of hearing aids was fair, while less than half (42.7%) of them had good, less than two thirds (61.3%) of the studied school children' parents had a fair score regarding quality of life and nearly one fifth (20.0% and 18.7% respectively) of the studied school children' parents had a good and poor score. Also there was a highly significant positive correlation between levels of pediatric quality of life inventory of the studied school children and the levels of the studied school children parents of their children using hearing device quality of life as (p=0.000) and (r=0.407). Conclusion: It can be concluded that, less than two thirds of studied school children parents had a fair score according to their children using hearing devices quality of life. Recommendations: It was recommended that, written instructions about hearing aids in the form of booklets or brochures should be provided to each child with hearing impairment using hearing aids and their parents in order to encourage them in effective adherence to the plan of care.

Background and objectives With global efforts to develop and deliver a COVID-19 vaccine rapidly, vaccine hesitancy stands as a barrier to these efforts. We aimed to estimate the proportion of Syrian adult population intending to be vaccinated against COVID-19 and, principally, to assess the demographic and attitudinal factors associated with it in order to approach suitable solutions. Methods An anonymous online questionnaire was conducted between 23rd December 2020 and 5th January 2021 in various provinces in Syria. A total of 3402 adults were sampled to reflect the population demographic factors. Attitudinal factors included Covid-19 fears, risks, and beliefs on the origin. Vaccination hesitancy and knowledge were also measured. The intention to get vaccinated against COVID-19 was the primary endpoint. Results According to their statements, 1222 participants (35.92%) will consent to get vaccinated against COVID-19. Our findings indicate that male gender, younger age, rural residence, not having children, smoking, fear about COVID-19, individual perceived severity, believing in the natural origin of the coronavirus, and high vaccination knowledge were positive predictors of embracing COVID-19 vaccine when it is available. Conclusion COVID-19 vaccine acceptance rate is considerably poor across Syrian population compared to populations in developed countries. Vaccine hesitancy is closely bound to the fear of side effects and doubts about vaccine efficacy. Factors such as conspiracy beliefs and myths about the vaccine lower vaccine uptake. Thus, interventional educational campaigns are increasingly required to overcome misinformation and avert low vaccination acceptance rates.

Objectives: Diabetes is the most common metabolic disease in primary health care. The prevalence and severity of diabetes can be influenced through lifestyle modification. This study was aimed to identify the prevalence of sleep disorders as a modifiable lifestyle factor among diabetic patients. Materials and Methods: This cross-sectional study was conducted on 190 patients with type 2 diabetes mellitus who referred to the Internal Medicine Clinic of the Ghaem Hospital, Mashhad, Iran from 2016 to 2017. A demographic questionnaire and the Pittsburgh Sleep Quality Assessment questionnaire (with sleep disorder defined as scores higher than 5) was filled for each subject. Blood tests including haemoglobin A1 C (Hb A1C), fasting blood sugar (FBS) and 2 hour post prandial glucose as well as the assessment of blood pressure and body mass index (BMI) were performed for all patients. Data were analysed using the statistical package for social sciences (SPSS) version 16. Results: Age of the patients (with male to female ratio being 71/119s) was 56.31 ± 7.37 years. BMI of more than 25 kg/m2was observed in 145 (76.3%) of patients. Mean Pittsburgh Sleep Quality Assessment score was 7.48 ± 4.11. Fifty-one (26.8%) patients were good sleepers and 139 (73.2%) were poor sleepers. There was a significant relationship between sleep disorder and age (p=0.019) and female gender (p=0.017), but no other variables which included level of education, occupation, HbA1 C, FBS, 2-hour post prandial glucose, systolic and diastolic blood pressure. Discussion: Sleep disorders are common among type 2 diabetic patients especially women. It is recommended that sleep disorders should be screened in diabetic patients. Treatment and prevention of sleep disorders through sleep hygiene education including recommendation to have normal nocturnal sleep should be focused by practitioners in type 2 diabetic patients, especially women. Appropriate measures should be taken to manage sleep disorders by weight control in this population.

Background and Objectives: Cancer is one of the most common chronic diseases that affects the spiritual health of patients. Therefore, interventions are needed to improve the spiritual health of patients. Therefore, the purpose of this study was to determine the effect of group hope therapy on the spiritual health of cancer patients. Materials and Methods: This quasi-experimental study was performed from December to March 2015 in Gonabad city. The study population was all cancer patients and the research environment was cancer clinic. Forty patients were selected by simple random sampling method and randomly divided into experimental (n=20) and control (n=20) groups. After completing demographic and spiritual health Paloutzian & Ellison questionnaires, Hope group therapy sessions were performed in 8 sessions of 90 minutes once a week in the experimental group; but the control group received only routine care. The spiritual health questionnaire was completed again at the end of the last session. Data were analyzed using independent t-test, paired-t test and covariance analysis. Results: According to the results of the study, the two groups didnchr('39')t have any significantly difference in terms of demographic variables (p>0.05). The mean score of spiritual health after the intervention showed a significant difference between the experimental and control groups (p

Visitation is one of the most critical needs of patients in intensive care units (ICUs). Clinicians should enable a more flexible visitation policy to prevent the adverse effects of a restricted approach.This study aimed at investigating the relationship between increasing visitation time and patients' physiological parameters in intensive units. Additionally, nurses' beliefs and attitudes towards visiting is examined in this research.Parallel randomized clinical trial.This study was conducted in four general medical ICUs in Iran. In total, 60 patients and 57 nurses participated in this study. The patients' physiological parameters were measured at particular times in both groups. Moreover, the nurses responded to the questionnaire on beliefs and attitudes towards visitation in intensive units before and after the intervention.Among all the physiological parameters, systolic and diastolic blood pressure and heart rate had a significant decrease within the normal range 10 and 30 minutes after visiting in the intervention group (P .05), and nurses' beliefs and attitudes score were at the middle of the survey scoring range (0-120). However, no significant difference was found between nurses' belief and attitude score and intervention in any groups (P .05).The findings indicate that increasing visitation times can lead to a positive effect on the stability and balance of patients' physiological parameters.A more flexible visiting policy can provide a therapeutic environment where not only patients' physiological disorders are minimised as much as possible but also a higher level of patients' health and satisfaction are reached.

Background The magnitude of the problem of substance use in Egypt has been growing lately. Substance use disorders have been associated with depression and suicide, as well as impulsivity and specific personality traits. Suicide is closely linked to the substances use. Therefore it is very important to confirm the factors that affect the possibility of suicide. Aim of the Work This study aimed at evaluating suicide risk and its correlation with each of personality disorders and severity of addiction in a sample of 72 tramadol addicts from outpatient clinic of Institute of psychaitry Ain Shams University hospitals. Patients and Methods This is a descriptive Cross sectional study conducted in outpatient clinic of Institute of psychaitry Ain Shams University hospital. The present study aimed at analyzing the demographic data of 72 tramadol addicts, over six months period from January 2018 to August 2019. The severity of the addiction problem among those patients was assessed using Addiction Severity Index (ASI), suicidal probability was assessed using suicide probability scale (SPS), Structured Clinical Interview for DSM-VI Axis II (SCID-II) for assessing personality disorders and Structured Clinical Interview for DSM-IV Axis I Disorders (SCID I). Results The results showed that 32 (44.44%) of the patients had a risk of suicide probability. Also there was a statistically significant difference between risk of suicidal probability and personality disorders especially antisocial personality. It was found that the need for more power for work and pleasurable effects were the most risk factors for tramadol addiction. Conclusion Suicide probability was found to be (44.44%) among the studied tramadol addicts. The risk of suicide probability among them was found to be significant in each of the following: antisocial personality disorder, longer duration of addiction, being single and positive family history of addiction. Attention should be paid to include the assessment of suicidal risk as part of routine assessment of addicts.

Background The number of patients with a history of melanoma who are waiting a solid organ transplantation (SOT) is increasing. Few recommendations exist on the timing to transplantation after melanoma diagnosis. The aim of this study was to assess the melanoma recurrence-free survival after pretransplant melanoma (PTM). Methods We conducted a multicenter ambispective observational study. Organ transplant recipients (OTR) with a history of PTM and complete AJCC staging were included. Results Thirty-seven patients (predominantly men with a renal allograft) were included. Five melanomas were in situ, 21 stage IA, 4 stage IB, 5 stage II and 2 stage IIIB. The median post-transplantation follow-up time was 4 years. 62% of patients were followed more than 2 years. Recurrence-free survival since melanoma reached 89.9%, but varied significantly according to AJCC staging (p=0.0129). Three patients presented a recurrence. Conclusion Despite the rather limited sample size and a wide range of follow-up, our findings concerning the recurrence-free survival appear reassuring for in situ and stage IA PTM; accordingly we suggest that a waiting time to transplantation is not mandatory in patients with in situ or stage IA PTM, especially whenever SOT I s urgently needed. Caution is however needed for patients with higher stage.

Purpose To find a possible association between patients’ cooperation, perceived pain, and ocular dominance in patients who undergo photorefractive keratectomy (PRK). Methods One hundred-one eligible candidates for PRK refractive surgery were recruited. Preoperative exams were performed for all patients, and the dominant eye was specified. The surgeon was unaware about which eye was dominant. After surgery, the surgeon completed a cooperation score form for each patient. Ocular cyclotorsion, cooperation, and perceived pain scores were compared between the first-second eye surgeries and between dominant-non-dominant eyes surgeries. Results The dominant eye was the right eye in 68 patients and the left eye in 33 patients. First, eye surgery was performed on the dominant eye in 56 patients and on the non-dominant eye in 45 patients. Cooperation score and perceived pain were not significantly different between the first and second eye surgeries (P = 0.902 and P = 0.223, respectively), but cyclotorsion was more in the second eye (P = 0.031). Cooperation score, pain score, and cyclotorsion were not significantly different between dominant and non-dominant eye surgeries (P = 0.538, P = 0.581, and P = 0.193, respectively). Also, there was no correlation between cooperation score and duration of the surgery for the first or second eye (P = 0.12 and P = 0.78). Conclusion During PRK surgery, the patients’ cooperation and perceived pain did not seem to be associated with eye laterality or dominancy.

Background Obesity is associated with an increased risk of insulin resistance and type 2 diabetes mellitus (T2DM). However, some obese individuals maintain their insulin sensitivity and exhibit a lower risk of associated comorbidities. The underlying metabolic pathways differentiating obese insulin sensitive (OIS) and obese insulin resistant (OIR) individuals remain unclear. Methods In this study, 107 subjects underwent untargeted metabolomics of serum samples using the Metabolon platform. Thirty-two subjects were lean controls whilst 75 subjects were obese including 20 OIS, 41 OIR, and 14 T2DM individuals. Results Our results showed that phospholipid metabolites including choline, glycerophosphoethanolamine and glycerophosphorylcholine were significantly altered from OIS when compared with OIR and T2DM individuals. Furthermore, our data confirmed changes in metabolic markers of liver disease, vascular disease and T2DM, such as 3-hydroxymyristate, dimethylarginine and 1,5-anhydroglucitol, respectively. Conclusion This pilot data has identified phospholipid metabolites as potential novel biomarkers of obesity-associated insulin sensitivity and confirmed the association of known metabolites with increased risk of obesity-associated insulin resistance, with possible diagnostic and therapeutic applications. Further studies are warranted to confirm these associations in prospective cohorts and to investigate their functionality.

Background Primary cardiac tumors are rare, and approximately 90% of them are benign. Myxoma is the most common type of these tumors occurring in the left atrium in 75–85% of cases. The tumor can cause the left atrio-ventricular valve obstruction and embolization phenomenon. Case presentation We reported a case of 54-year-old man with complaints of dyspenea and amnesia. In our patient, transthoracic echocardiography revealed a mass of 28*63 mm attached to the upper intra-atrial septum, which was prolapsing through the mitral valve into the left ventricle during diastole, being indicative of the left atrial myxoma. On examination, he was alert and conversant, and no pathological abnormality was observed in the examination of cardiovascular, gastrointestinal, respiratory, hepatic, renal and nervous systems. After myxoma diagnosis, the tumor was removed under cardiac surgery and discharged under good conditions. In the telephone follow-up after discharge, the patient recovered and did not report the disease and surgery complications. Conclusions Patients with cardiac myxoma are usually asymptomatic, but they may have manifestations related to the embolism phenomenon or intracardiac obstruction. Therefore, myxoma may represent an emergency. Surgery should be performed as soon as possible. If surgery is delayed, the patient may suffer from serious and irreversible complications, such as stroke and cardiac arrest.

Background: Patients with coronary artery diseases (CAD) use a wide spectrum of medications; hence, strategies are needed to increase their adherence. In this line, identifying factors associated with medication self-efficacy can be useful. Objectives: The current study aimed to investigate medication self-efficacy and its related factors in patients with CAD in the north-east of Iran. Methods: In this cross-sectional study, 104 patients with CAD hospitalized in one of the largest teaching hospitals in the north-east of Iran are studied. Participants were selected by convenience sampling method. Data were collected using Demographic and clinical information form, Information Satisfaction questionnaire (ISQ), and Self-Efficacy for Appropriate Medication Use scales (SEAMS). Data were analyzed by SPSS version 22 using descriptive statistics and multiple regression test. Results: The mean age of patients was 52.3 ± 8.8 years. The mean medication self-efficacy score was 24.9 ± 9.5 (out of 39). Multiple regression showed a linear and significant association between information satisfaction, income, medications used in the last month, information about the nature of the disease, doctors as a preferred source of information, nurses, family members, internet and social networks as the most information sources used by patients, with medication self-efficacy (R = 0.907, P < 0.001). These variables could explain 82.2% of the self-efficacy variance. Conclusions: Based on the result, it can be argued that in designing and implementing educational interventions aimed to promote medication self-efficacy in patients with CAD, individuals with lower income and under long-term medication treatment should receive more support. Educational programs should emphasize more on explaining the nature of the disease to the patients, and physicians should be more involved in educating patients.

Objective: Vitamin D may be associated to the modulation of signaling cascade in the central nervous system. We aimed to evaluate the effect of high dose vitamin D supplementation on neuropsychological function in female adolescents. Methods: We evaluated the effects of 9 weeks of vitamin D supplementation [50000 IU of vitamin D3 (cholecalciferol)/weekly] on cognitive ability and sleep disorders among 940 adolescent girls. Results: Oral vitamin D supplementation upgraded cognitive abilities tasks including memory, inhibitory control and selective attention, decision making, planning, sustained attention and cognitive flexibility in healthy adolescent girls (p

Objective: Visual snow (VS) is a distressing, life-impacting condition with persistent visual phenomena. VS patients show cerebral hypermetabolism within the visual cortex, resulting in altered neuronal excitability. We hypothesized to see disease-dependent alterations in functional connectivity and gray matter volume (GMV) in regions associated with visual perception. Methods: Nineteen patients with VS and 16 sex- and age-matched controls were recruited. Functional magnetic resonance imaging (fMRI) was applied to examine resting-state functional connectivity (rsFC). Volume changes were assessed by means of voxel-based morphometry (VBM). Finally, we assessed associations between MRI indices and clinical parameters. Results: Patients with VS showed hyperconnectivity between extrastriate visual and inferior temporal brain regions and also between prefrontal and parietal (angular cortex) brain regions (p < 0.05, corrected for age and migraine occurrence). In addition, patients showed increased GMV in the right lingual gyrus (p < 0.05 corrected). Symptom duration positively correlated with GMV in both lingual gyri (p < 0.01 corrected). Conclusion: This study found VS to be associated with both functional and structural changes in the early and higher visual cortex, as well as the temporal cortex. These brain regions are involved in visual processing, memory, spatial attention, and cognitive control. We conclude that VS is not just confined to the visual system and that both functional and structural changes arise in VS patients, be it as an epiphenomenon or a direct contributor to the pathomechanism of VS. These in vivo neuroimaging biomarkers may hold potential as objective outcome measures of this so far purely subjective condition., Frontiers in Human Neuroscience, 14, ISSN:1662-5161

Objective Biologics are indicated in rheumatoid arthritis (RA) in case of persistent high disease activity despite conventional disease-modifying anti-rheumatic drugs (cDMARDs) or patients with contraindications to cDMARDs or poor prognostic factors. The purpose of this study was to compare the prescription rates of biologics in Kuwaiti and non-Kuwaiti patients and to assess whether this had an impact on disease activity and quality of life in RA patients. Methods Data were extracted from the Kuwait Registry for Rheumatic Diseases. Adult patients who satisfied the ACR classification criteria for RA from four major hospitals in Kuwait were evaluated from February 2013 through May 2018. The treatment agents, disease activity, and quality of life of Kuwaiti patients were compared with non-Kuwaiti patients. Results A total of 1651 RA patients were included; 806 (48.8%) were Kuwaiti patients. Among Kuwaiti patients, 62.5% were on biologic drugs in comparison with 14% of non-Kuwaiti patients. In comparison with non-Kuwaiti patients, Kuwaiti patients had significantly lower numbers of swollen joints (p p = 0.02) and less steroid use (p p p p Conclusion In the setting of easy accessibility to treatment for Kuwaiti patients, biologics were prescribed by rheumatologists at a higher rate than for non-Kuwaitis. This may explain the lower disease activity and the lower rate of steroid use in Kuwaiti patients than non-Kuwaitis. Key points • Significant discrepancies in the rates of prescribing biologic therapies between KP and NKP in Kuwait were observed. • Several treatment outcomes were significantly better in the KP group than in the NKP group even after adjustment of confounding factors. • The poor access to biologic therapies was suggested to limit the effectiveness of RA treatments in the NKP group.

BackgroundPregnant women with gestational diabetes mellitus (GDM) or type 2 diabetes mellitus (T2DM) are at increased risks of pre-term labor, hypertension and preeclampsia. In this study, metabolic profiling of blood samples collected from GDM, T2DM and control pregnant women was undertaken to identify potential diagnostic biomarkers in GDM/T2DM and compared to pregnancy outcome.MethodsSixty-seven pregnant women (21 controls, 32 GDM, 14 T2DM) in their second trimester underwent targeted metabolomics of plasma samples using tandem mass spectrometry with the Biocrates MxP®Quant 500 Kit. Linear regression models were used to identify the metabolic signature of GDM and T2DM, followed by generalized linear model (GLMNET) and Receiver Operating Characteristic (ROC) analysis to determine best predictors of GDM, T2DM and pre-term labor.ResultsThe gestational age at delivery was 2 weeks earlier in T2DM compared to GDM and controls and correlated negatively with maternal HbA1C and systolic blood pressure and positively with serum albumin. Linear regression models revealed elevated glutamate and branched chain amino acids in GDM + T2DM group compared to controls. Regression models also revealed association of lower levels of triacylglycerols and diacylglycerols containing oleic and linoleic fatty acids with pre-term delivery. A generalized linear model ROC analyses revealed that that glutamate is the best predictors of GDM compared to controls (area under curve; AUC = 0.81). The model also revealed that phosphatidylcholine diacyl C40:2, arachidonic acid, glycochenodeoxycholic acid, and phosphatidylcholine acyl-alkyl C34:3 are the best predictors of GDM + T2DM compared to controls (AUC = 0.90). The model also revealed that the triacylglycerols C17:2/36:4 and C18:1/34:1 are the best predictors of pre-term delivery (≤ 37 weeks) (AUC = 0.84).ConclusionsThis study highlights the metabolite alterations in women in their second trimester with diabetes mellitus and identifies predictive indicators of pre-term delivery. Future studies to confirm these associations in other cohorts and investigate their functional relevance and potential utilization for targeted therapies are warranted.

BACKGROUND AND OBJECTIVES Insufficient skills among health personnel, including midwives, can lead to failure in evaluating and providing sexual health counseling services to clients. Thus, the purpose of this study was to compare the effect of 2 interactive educational workshops with or without standardized patients (SPs) on midwifery students' clinical skills in providing sexual health counseling at Mashhad University of Medical Sciences, Mashhad, Iran, in 2014 to 2015. RESEARCH METHODS In this randomized controlled trial, 62 midwifery students were selected through convenient sampling method and then randomly divided into 2 groups who received 1 of 2 interactive educational workshops, with or without SPs in 10-hour educational programs. The students' skills in providing sexual health counseling were evaluated before and 2 weeks after the education through an Objective Structured Clinical Examination composed of 5 stations using validated checklists. The data were then analyzed using the SPSS Software (Version 16) through descriptive statistics as well as independent t test, paired t test, Mann-Whitney U, χ, and Fisher exact tests. The level of significance was considered by P < 0.05. RESULTS There was no significant difference between the mean scores of students' clinical skills in providing sexual health counseling services in the group educated with or without SPs (22.4 ± 7.0 and 23.0 ± 9.4, P = 0.77). However, 2 weeks after the interventions, the mean scores were 75.8 ± 11.2 and 47.0 ± 8.9, respectively, meaning a significant difference between the study groups (P < 0.0001). CONCLUSIONS Although both teaching methods could promote clinical skills among the midwifery students, the effect of interactive workshop with SPs was much significantly stronger.

Congenital erythropoietic porphyria (CEP or Gunther disease) is a very rare subtype of porphyria with a prevalence of

INTRODUCTION: Midwifery screening is one of the duties of midwives according to national guidelines. It is possible to increase midwives' knowledge and practice through effective education. The aim of this study was to compare the effect of standardized patient-based education and feedback lecture on midwives' knowledge and practice in screening counseling for fetal malformations. METHODS: This quasi-experimental, two-group study (standardized patient-based training and feedback lecture) was performed on 67 midwives (licensed by the office) in Mashhad in 2018. Midwives' knowledge and practice before and 2 weeks after training (a 4-h training program) were assessed by the Objective Structured Clinical Examination and a questionnaire. The data were analyzed by the SPSS software version 16 using Mann–Whitney, Chi-square, Wilcoxon and independent t-test while P < 0.05 considered as a significant level. RESULTS: Before intervention, the total score of knowledge and practice showed no statistically significant difference between the two groups (P > 0.05). After intervention, knowledge score in feedback lecture group was statistically significantly higher than that of standard patient group (P < 0.001). In addition, there was no statistically significant difference in performance scores between the two groups after intervention (P = 0.761). CONCLUSION: Both educational methods can increase midwives' knowledge and practice in fetal screening counseling. However, in raising midwives' awareness, feedback lecture group was more effective than standard patient group.

PURPOSE The study aims to define the effect of different dose strategies on ophthalmic complications in patients with Graves' disease (GD). METHODS All the patients with GD and no or inactive ophthalmopathy (clinical activity score; CAS < 3) underwent Snellen chart examination, measurement of proptosis, thyroid volume, and radioactive iodine uptake, and randomized into 1 of 3 groups. In group 1, all the patients received fixed low dose (FLD) of 259 MBq of I, whereas in group 2, all the patients received fixed high dose (FHD) of 555 MBq, and in group 3, calculated dose (CD) was administered to deliver 5.55 MBq/g (thyroid weight) of I. All examinations were repeated 6 months after treatment. The measurement of thyroid function tests and clinical examination were repeated after 12 months. RESULTS We studied 92 patients (58 female and 34 male) with mean age of 38.2 ± 12.0 years. Overall, 29, 32, and 31 patients were studied in FLD, FHD, and CD groups, respectively. The patients in CD received a mean activity of 240.5 MBq. The 3 groups were not significantly different regarding age, sex ratio, radioactive iodine uptake, smoking, visual acuity, and proptosis. The response rate 12 months after radioactive iodine therapy was 66.7%, 94.4%, and 92.9% in FLD, FHD, and CD groups, respectively (P = 0.05). Overall, CAS was increased significantly after treatment. Delta proptosis and delta CAS were increased significantly in FHD group compared with other groups (P < 0.05). The highest increment in proptosis was seen in FHD group. CONCLUSIONS The administration of 5.55 MBq/g of I has fewer ophthalmic complications compared with high fixed dose model and is more effective than low fixed dose strategy.

INTRODUCTION: There are various ways to relieve physical injuries, but less attention has been dedicated to the treatment of psychological injuries in burned children. AIM: The present study was conducted to investigate the effects of art therapy using painting and music on reducing anxiety and depression in burned children. MATERIALS AND METHODS: This study was a three-group randomized clinical trial with a pre-test-post-test design that was performed on 60 children aged 6–12 years. The patients were admitted to the Burn Center of Imam Reza Hospital, Mashhad, Iran, within 2018 were selected using convenience sampling method and randomly divided into three groups, namely, two intervention (subjected to art and music) and one control group. Ten 45-min-long art therapy sessions were conducted every day. Anxiety was measured with parent-version of the Spence Children’s Anxiety Scale, and depression was measured using Maria Kovacs Children’s Depression Inventory Questionnaire. The control group only benefited from the routine services of the center. RESULTS: Before the intervention, the total mean scores of anxiety in the burned children in the painting, music, and control groups were measured at 90.4 ± 5.4, 84.8 ± 6.8, and 77.4 ± 13.8, respectively. However, the total mean scores of anxiety after the intervention in the burned children in the painting, music, and control groups were estimated at 53.3 ± 4.4, 45.9 ± 8.4, and 72.4 ± 12.9, respectively (p < 0.001). Furthermore, the mean of depression total score before the intervention was measured at 38.7 ± 3.4, 32.8 ± 5.4, and 28.9 ± 5.4, for painting, music, and control groups, respectively (p < 0.001). Moreover, the total mean score of depression after the intervention in the painting, music, and control groups was obtained as 29.9 ± 4.0, 19.3 ± 3.8, and 25.2 ± 4.9, respectively (p < 0.001). CONCLUSION: Art therapy using painting and music led to the reduction of anxiety and depression in children with burns; therefore, it is recommended to use the technique for this population.

Psychological birth trauma has persistent adverse effects on the performance and health of women during and after childbirth. Therefore, Interventions to prevent and mitigate psychological birth trauma are of paramount importance.The present study aimed to investigate the effects of counseling based on Gamble's approach on psychological birth trauma in primiparous women.This randomized clinical trial was conducted on 60 primiparous women referring to the health centers in Mashhad, Iran in 2018. In the intervention group, counseling was provided by an obstetrician based on Gamble's strategy to each participant in three sessions before delivery and one session postpartum. The participants in the control group only received routine prenatal care. Data were collected using demographic and obstetrics characteristics questionnaire and psychological birth trauma questionnaire. The data were analyzed using SPSS, version 21 and chi-square and independent t-test.The mean age of the women in the intervention and control groups was 23.3 ± 3.9 and 24.4 ± 4.4, and the mean prenatal age upon delivery was 40.8 ± 5.7 and 39.8 ± 1.2 weeks respectively. The mean score of psychological birth trauma in the intervention (counseling) and control groups was 37.2 ± 10.4 and 47.6 ± 16.3, respectively, which was significantly lower in the intervention group (According to the results, counseling based on Gamble's approach could reduce psychological birth trauma in primiparous women. Therefore, this effective, simple, cost-effective, and harmless approach could be employed to reduce intrapartum and postpartum maternal traumas and prevent adverse events for the mother and the newborn.

Objective: Our aim was to study fertility issues, attitudes towards reproductive techniques and fertility preservation options in women of reproductive age with endometriosis.Study design: In 2018 we conducted a web-based survey on fertility issues in women aged 18-40 years with endometriosis. Participants were recruited via advertisements on social media and local endometriosis support groups. Participants completed a self-developed online questionnaire evaluating the following dimensions: sociodemographic, medical data, parental project, knowledge and attitudes toward endometriosis and fertility, means used to access information, and reproductive choices.Results: The majority of women (96 %) worried about the impact of endometriosis on their fertility. Approximately half of them (52 %) reported having received sufficient information concerning the effect of endometriosis on fertility from their doctor, whereas 31 % had discussed fertility issues with their doctor but desired further information. In contrast, only a minority (27 %) of women considered themselves well-informed on fertility preservation options. Information given by specialists on endometriosis and reproduction was considered most useful. Information mediated through patient support groups was also highly rated, whereas information given by the general gynecologist was less highly rated. The majority of women would consider assisted reproductive techniques (74 %) or adoption (70 %) in case of infertility. Interestingly, 72 % of women would undergo oocyte vitrification for fertility preservation, whereas only 37 % would resort to oocyte donation.Conclusion: This is the first survey to address the topic of fertility issues from the patient's perspective in women with endometriosis. The vast majority of women attach great importance to a discussion about fertility possibilities and only a minority of women consider themselves well-informed. Our results highlight the importance of addressing the issue of fertility in women with endometriosis. Special attention should be given to information and counselling about fertility preservation options since most women consider their knowledge on the topic insufficient. Knowledge and attitudes to counsel endometriosis patients on fertility issues and fertility preservation options should be included in the training curricula of gynecologists. Adequate information on reproductive aging, risk factors for infertility, and reproductive choices, including oocyte vitrification, should be incorporated into follow-up visits for endometriosis patients.

ContextNonalcoholic fatty liver disease (NAFLD) is associated with insulin resistance (IR) and predicts type 2 diabetes. Currently, it is uncertain whether NAFLD may directly cause IR or vice versa.ObjectiveTo test the hypothesis that NAFLD is causally related to IR.Design and MethodsWe performed a Mendelian randomization (MR) in 904 obese children/adolescents using an NAFLD-related genetic risk score (GRS) as an instrumental variable. We assessed NAFLD by ultrasonography and IR by homeostasis model assessment (HOMA-IR). We also interrogated the MAGIC Consortium dataset of 46 186 adults to assess the association between PNPLA3 rs738409 (ie, the most robust NAFLD-related polymorphism) and HOMA-IR, and we performed a 2-sample MR with 2 large datasets to test reverse causation (HOMA-IR increasing the risk of NAFLD).ResultsNonalcoholic fatty liver disease prevalence increased by 20% for every increase in the GRS (β-coefficient = 0.20, P < 0.001), and NAFLD was associated with ln-HOMA-IR (β-coefficient = 0.28, P < 0.001). Thus, the expected increase in ln-HOMA-IR for every increase in the GRS (expected β-coefficient) was 0.056 (0.28*0.20) in the case of complete NAFLD-HOMA-IR causal association, and 0.042 in the case of 75% causality. In our cohort, the GRS did not predict ln-HOMA-IR (β-coefficient = 0.007, P = 0.75). In the MAGIC cohort, the PNPLA3 rs738409 did not associate with ln-HOMA-IR. The 2-sample MR failed to show a causal association between ln-HOMA-IR and NAFLD.ConclusionsOur study shows that genetically-influenced NAFLD does not increase HOMA-IR, and genetically-influenced HOMA-IR does not increase the risk of NAFLD. Shared pathogenic pathways or NAFLD subtypes not “captured” by our MR design might underpin the association between NAFLD and HOMA-IR.

Background:Patients undergoing cardiothoracic surgery require the placement of at least one chest drain. Chest Drain Removal (CDR) has been considered to be a painful event in patient’s postoperative recuperation.Objective:This study aimed to evaluate the impact of using ice on quality of pain associated with CDR in adult patients undergoing cardiac surgeryMaterials and Methods:This randomized, observer-blind, crossover trial was done on 51 post-cardiac surgery patients who had two chest drains in the Mashhad Heart Center in Iran. The patients were assigned to ice, placebo, and control groups. Ice and placebo bags were used over the region around the chest drains for 20 minutes prior to CDR. The quality of pain was assessedviaShort-Form McGill Pain Questionnaire (SF-MPQ) before and after CRT. The data were analyzed through the SPSS software using ANOVA, Kruskal-Wallis, and Chi-square tests.Results:The study findings revealed that the three groups were not significantly different regarding pain quality before CDR (p=0.24). However, the ice bag group (4.6±4.4) was significantly different from the placebo (8.1±6.9) and control groups (7.1±5.3) concerning the pain quality score immediately after CDR (pConclusion:The results indicated that ice bag application could be used as an effective, safe, and inexpensive non-pharmacological intervention to reduce patients’ pain and increase their comfort during CDR.

Letrozole is an aromatase inhibitor, used to treat postmenopausal women with hormone receptor-positive or unknown advanced breast cancer. It is prohibited in sport because it is used together with androgen anabolizing steroids to avoid their adverse effects. In the case of an adverse analytical finding, it may be important to distinguish between repetitive use due to voluntary administration and occasional use, possibly due to involuntary intake. With the objective to identify the dose capable of producing a positive hair test, and to apply these results to the scenarios of inadvertent letrozole ingestion by an athlete, this study investigates the urinary excretion and incorporation into hair of single doses of letrozole. Seven subjects were recruited for an excretion study of letrozole and its metabolite bis(4-cyanophenyl) methanol (M1) in urine, after the consumption of 0.62 mg, 1.25 mg, and 2.5 mg of letrozole, and to investigate the incorporation in hair after ingestion of 0.62 mg and 2.5 mg of letrozole. Urine and hair samples were also obtained from two women in chronic therapy. Urinary concentrations of letrozole and its metabolite M1 were lower in subjects administered once with 0.62 mg, 1.25 mg, or 2.5 mg letrozole than in women in regular therapy with 2.5 mg/day. In hair collected after a single dosage, concentrations of 16-60 pg/mg were detected while in women in chronic therapy concentrations were higher than 160 pg/mg all along the hair shaft. Hair analysis turned to be a promising possibility for the discrimination of letrozole repetitive use vs occasional/inadvertent administration.

Background Many children of preschool age present with recurrent wheezing. Most of them outgrow their symptoms, while some have early-onset asthma. Aim of this prospective preliminary study was to apply a metabolomic approach to see whether biochemical-metabolic urinary profiles can have a role in the early identification of the children with asthma. Methods Preschool children with recurrent wheezing were recruited and followed up for 3 years, after which they were classified as cases of transient wheezing or early-onset asthma. A urine sample was collected at recruitment and analyzed using a metabolomic approach based on UPLC mass spectrometry. Results Among 34 children aged 4.0 ± 1.1 years recruited, at the end of the 3-year follow-up, 16 were classified as having transient wheezing and 16 as cases of early-onset asthma. Through a joint multivariate and univariate statistical analyses, we identified a subset of metabolomic variables that enabled the 2 groups to be clearly distinguished. The model built using the identified variables showed an AUC = 0.99 and an AUC = 0.88 on sevenfold full cross-validation (P = .002). Conclusions Metabolomic urinary profile can discriminate preschoolers with recurrent wheezing who will outgrow their symptoms from those who have early-onset asthma. These results may pave the way to the characterization of early non-invasive biomarkers capable of predicting asthma development.

Objective: To determine the diagnostic value of mean apparent diffusion coefficient (ADC) measures to distinguish between benign (grade I) and atypical (grade II) cranial meningiomas. Patients and methods: Forty-seven patients (10 men and 37 women) with cranial meningiomas were included in the study and underwent MRI examination including diffusion-weighted imaging (DWI). Signal characteristics on conventional MR and diffusion-weighted images were evaluated. The intratumoral mean ADC values were obtained and correlated with the final histopathological findings of the excised tumors. The optimum cutoff value of mean ADC measurements to differentiate between grade I and II was determined using the generated receiver operating characteristic (ROC) Results: Thirty-six meningiomas were benign (WHO grade I), while 11 were atypical (grade II). No grade III meningiomas were encountered during the study period. At standard MRI sequences, only the enhancement pattern had produced a significant statistical correlation with the tumoural grade (p = 0.001). Tumoural margins, peritumoural edema, and the DWI signal showed none statistical relationship (p = 0.105, 0.11 and 0.219 respectively). Intratumoral mean ADC values were significantly lower in grade II meningiomas (p

Importance Citalopram is a common antidepressant widely used and STAR*D study has indicated that most, more than 60%, of patients who receive it, do not benefit from their first antidepressant. Objective To identify whether citalopram is effective for patients with particular medical history. Design We used stratification to balance case/control study design. Setting We used the National Institute of Mental Health's STAR*D data, collected from 41 specialty and primary medical care settings spanning across a seven year time period. Participants The data included .mental and physical diagnoses of 4041 patients with major depression. Intervention(s) (for clinical trials) or exposure(s) (for observational studies) Patients comorbidities were balanced using Stratified Covariate Balancing method. This algorithm uses Markov Blanket of both treatment and outcome to identify which comorbidities can be ignored. It uses stratification to remove confounding introduced by the covariates in the Markov Blanket of treatment and outcome. Main outcome(s) and measure(s) A patient's remission was judged by weather there was a 50% reduction in the Hamilton Rating Scale for Depression. Results Patients exposed to neurological disorders were less likely to experience remission than controls without neurological disorder (odds=0.74, chi-square=, alpha Conclusions and relevance Patients exposed to PTSD or neurological disorders were less likely to experience remission from depression. These data suggest that citalopram should not be a first line agent prescribed for patients with these disorders.

Objective: Obesity-associated impaired fat accumulation in the visceral adipose tissue can lead to ectopic fat deposition and increased risk of insulin resistance and type 2 diabetes mellitus (T2DM). This study investigated whether impaired adipogenesis of omental (OM) adipose tissues and elevated 4-hydroxynonenal (4-HNE) accumulation contribute to this process, and if combined metformin and insulin treatment in T2DM patients could rescue this phenotype. Methods: OM adipose tissues were obtained from forty clinically well characterized obese individuals during weight reduction surgery. Levels of 4-HNE protein adducts, adipocyte size and number of macrophages were determined within these tissues by immunohistochemistry. Adipogenic capacity and gene expression profiles were assessed in preadipocytes derived from these tissues in relation to insulin resistance and in response to 4-HNE, metformin or combined metformin and insulin treatment. Results: Preadipocytes isolated from insulin resistant (IR) and T2DM individuals exhibited lower adipogenesis, marked by upregulation of anti-adipogenic genes, compared to preadipocytes derived from insulin sensitive (IS) individuals. Impaired adipogenesis was also associated with increased 4-HNE levels, smaller adipocytes and greater macrophage presence in the adipose tissues. Within the T2DM group, preadipocytes from combined metformin and insulin treated subset showed better in vitro adipogenesis compared to metformin alone, which was associated with less presence of macrophages and 4-HNE in the adipose tissues. Treatment of preadipocytes in vitro with 4-HNE reduced their adipogenesis and increased proliferation, even in the presence of metformin, which was partially rescued by the presence of insulin. Conclusion: This study reveals involvement of 4-HNE in the impaired OM adipogenesis-associated with insulin resistance and T2DM and provides a proof of concept that this impairment can be reversed by the synergistic action of insulin and metformin. Further studies are needed to evaluate involvement of 4-HNE in metabolically impaired abdominal adipogenesis and to confirm benefits of combined metformin-insulin therapy in T2DM patients. Keywords: Obesity, Insulin resistance, T2DM, Omental fat, Adipogenesis, 4-hydroxynonenal, Metformin, Insulin

Although vitamin D deficiency is known to be a risk factor for some psychological disorders, there have been few studies on the effects of vitamin D supplementation on their symptoms. Depression and aggression are common mental disorders and are associated with disability and disease burden. We aimed to evaluate the effectiveness of high-dose vitamin D supplementation on depression and aggression scores in adolescent girls. Nine hundred forty adolescent girls received vitamin D3 at a dose of 50,000 IU/week for 9 weeks. Anthropometric parameters and blood pressure were measured using standard protocols at the baseline and at the end of the study. Depression score was evaluated using the Beck Depression Inventory-II and aggression was evaluated using the Buss-Perry Aggression Questionnaire at baseline and at the end of the study. Comparison among the four categories of depression score (normal, mild, moderate, and severe) revealed no significant differences in demographic and anthropometric parameters at baseline. After 9 weeks of vitamin D supplementation, there was a significant reduction on mild, moderate, and severe depression score. However, vitamin D supplementation had no significant effect on aggression score. Our results suggest that supplementation with vitamin D may improve depressive symptoms among adolescent girls, as assessed by questionnaire, but not aggression score. Formal, larger, randomized controlled studies are required to confirm this effect on cases with different degrees of depression.

Background: The outbreak of gestational diabetes has a significant increase during 14 recent years. This disease has complications for mother and her baby. Screening is an opportunity for preventing of gestational diabetes it's complications.Objective: The aim of this research was to determine the most important risk factors of gestational diabetes mellitus (GDM) in Iran according to the expert's views by Group Analytical Hierarchy Process.Materials and Methods: In this cross-sectional study, papers related to the prevalence and risk factors of GDM in Iran from 1992-2015 were reviewed. By studying texts and Upto Date databases, 10 risk factors of gestational diabetes were collected. Among these 10 items, the risk factors that have become significant based on studying literature in Iran were selected for analysis. GAHP questionnaire distributed among all experts.Results: 8 risk factors of gestational diabetes were significant in Iran. The analysis of experts' views showed that "History of GDM or disorder in glucose tolerance in pregnancy" is the most important risk factor for developings GDM (40.7%). The second and third most important risk factors were "History of macrosomia (infant birth (weight > 4.1 Kg)" (20.2%) and" History of diabetes in first degree relatives " (10.7%).Conclusion: Correct knowledge of prevalence of gestational diabetes and its risk factors is necessary for effective planning. SuggestSuggesting screening based on the importance of these risk factors can reduce the cost and stress in pregnant women. Also, it makes faster patient identifying faster.

Background: The aim of this study was to assess the effects of functional training (FT) on pain, function, and performance in elite male taekwondo players with CMLBP. Method: 27 elite male taekwondo players (mean ± standard deviation: age 24.4 ± 4.9 years, body mass 75.7 ± 15.1 kg, height 181.4 ± 7.8 cm) were allocated to two experimental (n = 15) and control (n = 12) groups. The eight-week FT was divided into four distinct phases for the subjects of the experimental group. Variables of pain and function were assessed by Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI), respectively. The movement time of Ap Douliou Chagi kick (MTAK) and speed of Ap Douliou Chagi kick (SAK) was used for the variable of performance. Results: Considering the results of pretest before the implementation of the scores protocol, after FT intervention, VAS (p = 0.004), ODI (p = 0.005), MTAK on the right leg (p = 0.029) and the left leg (p = 0.013) decreased and SAK on both legs (p = 0.000) increased significantly in comparison with the control group. Conclusion: It is assumed that FT can reduce the pain intensity and improve the function and performance in taekwondo players.

Gastrointestinal Stromal Tumors (GIST) present different types of mutations that may or may not be sensitive to specific target therapy. The laboratory procedure required to prepare histological sections traditionally demands multiple steps, making the process prone to contamination by exogenous genetic material (DNA). An eventual contamination of the biological sample with exogenous DNA may jeopardize subsequent analysis of mutations. The Short Tandem Repeat (STR) technique is frequently used in forensic science fields and presents a potential application in surgical pathology, especially in situations of suspected sample exchange. In the present study, the objective is to verify the possible contamination by exogenous DNA in gastric GIST samples and to evaluate if the presence of contamination can interfere in the detection of the mutations of interest. We assessed eight gastric GISTs by the Sanger sequencing and STR sequence analyses. Seven samples presented more than one profile, a result interpreted as contamination. Our results indicate that exogenous DNA contamination occurred in most of the samples studied and that this was more frequent in samples obtained from the slides than those obtained from the block. The presence of contamination did not inhibit the detection of the mutations of interest for a specific target therapy. Furthermore, the histologic block revealed to be more advantageously when compared to the slide for molecular pathology diagnosis.

BackgroundAlthough vitamin D deficiency is associated with several inflammatory conditions, there have been few studies on the effects of vitamin D supplementation on markers of oxidative stress (OS) and inflammation. The aim of the current study was to evaluate the effects of high-dose vitamin D supplementation on heat shock protein 27 antibody (anti-Hsp27) titers in adolescent girls.MethodsFive hundred and fifty adolescent girls received vitamin D3 at a dose of 50,000 IU/week for 9 weeks. Demographic, clinical and biochemical markers including serum fasting blood glucose (FBG), lipid profile and anti-Hsp27 titers as well as hematological parameters including white blood cell (WBC) count and red blood cell (RBC) distribution width (RDW) were determined in all the subjects at baseline and at the end of the study.ResultsSerum vitamin D significantly increased from 6.4 (4.2–9.6) ng/mL to 35.6 (25.8–47.5) ng/mL (p ConclusionsHigh-dose vitamin D supplementation was found to reduce antibody titers to Hsp27. Further randomized placebo-controlled trials are warranted to determine the long-term effect of vitamin D administration on the inflammatory process especially that associated with chronic disease.

Introduction: Angioplasty is widely used as a selective treatment for acute coronary syndromes. The complications of this procedure often lead to an increase in the length of the patients’ stay and hospital costs. Therefore, this study aimed to determine the effect of using sand and ice bags on hematoma and hemorrhage after percutaneous coronary intervention (PCI). Methods: In this randomized clinical trial, study was completed with participation of 60 patients with femoral angioplasty candidate, referring to Imam Reza hospital in Mashhad, were randomly divided into control and intervention groups. In the control group, a sand bag was placed on the location for up to 4 hours. In the intervention group, the ice bag and the sand bag were used simultaneously for 15 minutes, and then for 45 minutes, with the pressure of the sand bag only. This cycle was repeated four times. Hemorrhage (volume and weight) and hematoma (area and lump) were checked four times. The data were analyzed using SPSS software version 22. Results: The rate of hemorrhage after intervention was significantly reduced in the intervention group compared to the control group. Although the incidence of hematoma in the intervention group decreased from control to 20% to 6.7%, but the statistical test was not significant. Conclusion: According to the results of the present study, the simultaneous sand-ice bag application can reduce post-PCI’ hemorrhage (and hematoma rate, though insignificantly) through compression and vasoconstriction.

Objective Gestational diabetes mellitus (GDM) is a common endocrine complication in pregnancy. There are few risk factors that clearly correlate with GDM. Fibroblast growth factor 21 (FGF21) is a metabolic hormone that can regulate glucose metabolism. It has been recognized that serum levels of FGF21 are significantly increased in diabetes and insulin resistance states. The objective of this study was to determine the serum FGF21 levels in women with GDM compared with non-GDM women and its correlation with insulin resistance. Methods Thirty GDM patients and 60 healthy pregnant controls that matched for maternal and gestational age were selected. Women with previous history of GDM, hypertension, polycystic ovary syndrome, renal or liver failure and drug consumption with effects on glucose or insulin levels were excluded. FGF21 was determined and correlated with biochemical parameters of glucose metabolism and insulin resistance. Results FGF21 concentration was significantly higher in GDM (264.5±196.2 ng/L) as compared with control groups (59.1±36.5ng/L). Correlation of FGF21 with insulin resistance was not significant. A cut-off 82.07 ng/L of FGF21 had sensitivity of 100% and specificity of 85% for prediction of GDM. Conclusion FGF21 is increased in GDM and it is independent of insulin resistance. We suggest that FGF21 resistance could be directly involved in pathophysiology of GDM.

Ad dress for Cor res pon den ce/Ya z›fl ma Ad re si: Seyed Mehran Homam MD, Islamic Azad University Faculty of Medicine, Mashhad branch, Department of Neurology, Mashhad, Iran Phone: +989153137889 E-mail: mmazloomfarsibaf@yahoo.com Re cei ved/Ge lifl Ta ri hi: 04.02.2016 Ac cep ted/Ka bul Ta ri hi: 04.07.2016 ©Turkish Journal of Neurology, Published by Galenos Publishing House. This article is distributed under the terms of the “Creative Commons Attribution NonCommercial 4.0 International Licence (CC BY-NC 4.0)”. Objective: To evaluate the cognitive status and sleep quality and their association in patients with Parkinson’s disease (PD). Materials and Methods: In this analytical cross-sectional study, 120 patients with PD were selected from 22-Bahman and 17-Shahrivar hospitals. Demographic information was recorded on a form and Parkinson’s severity was determined using the Hoehn and Yahr scale (HY). Pittsburgh Sleep Quality Index (PSQI) and Epworth sleepiness scale (ESS) were used for the assessment of sleep quality and excessive daytime sleepiness, respectively. Cognitive status was assessed using the Montreal Cognitive Assessment questionnaire. Results: The mean age of patients with PD was 65.9±11.7 years, and 67.5% were men. Cognitive impairment was found in 113 (94.2%) patients, poor sleep quality in 87 (72.5%), and excessive daytime sleepiness in 27 (22.5%) patients. The mean PSQI and ESS scores were 9.03±4.70 and 7.38±3.73, respectively. There was a significant association between cognitive status and sleep quality, as well as daytime sleepiness (independent sample t-test, p

Ketamine (KT) is used to induce and maintain general anaesthesia in combination with sedative drugs in human and animals. Because of its dissociative and hallucinogenic effects, KT has become a recreational drug in a variety of social settings and may be included in the panel of drugs of abuse that are controlled in driving under the influence (DUI) ascertainment. In a local driving license re-granting protocol, a case where a veterinary physician was found positive to KT and nor-ketamine (NK) in hair suggested the possibility of a professional exposure in a veterinary setting and prompted an experimental study. Male (7) and female (4) veterinary physicians were recruited on a voluntary base. Detailed information was collected on their habits, use of drugs, professional practice, frequency and mode of using KT injections. Hands and skin were examined. Head hair and pubic hair were collected. Two naive subjects, starting their professional practice at a local veterinary clinic, were recruited and their hair (head, pubic, axillary, thoracic hair, and beard) and urine were collected before and after usual clinic activity. Hair were cut according to their length, washed, pulverized and 25 mg were extracted and analyzed by liquid chromatography coupled to high accuracy, high resolution mass spectrometry. All the hair samples from the veterinary physicians turned to be positive for KT, at a concentration varying from 0.010 to 0.840 ng/mg in head hair and from 0.040 to 2.04 ng/mg in pubic hair; NK ranged from not detected to 0.080 ng/mg in head hair, from not detected to 0.100 in pubic hair; when KT was ≥0.100, NK was always detected. For the two naive subjects, hair from different body sites were negative before they started their activity, and positive one month later; some urine samples resulted positive and confirmed systemic exposure to KT. The possibility of unaware exposure to KT was demonstrated. The site of absorption is skin, independently from the presence of skin injuries due to hand contact with KT injection solutions and/or animal body fluids by veterinary physicians during clinical activities and animal handling. Possible adverse systemic effects by unaware KT exposure need to be studied and concerns have arisen as to healthy and safe workplace policies. Comparison with a population of subjects undergoing driving license re-granting evidenced a larger range of concentration in this latter setting (0.050–10.0 ng/mg for KT, not detected to 0.100 ng/mg for NK).

Background Early and regular developmental screening can improve children's development through early intervention but is insufficiently used. Most developmental problems are readily evident at the 18-month well-baby visit. This trial's purpose is to: (1) compare identification rates of developmental problems by GPs/family physicians using four evidence-based tools with non-evidence based screening, and (2) ascertain whether the four tools can be completed in 10-min pre-visit on a computer. Methods We compared two approaches to early identification via random assignment of 54 families to either: ‘usual care’ (informal judgment including ad-hoc milestones, n = 25); or (2) ‘Evidence-based’ care (use of four validated, accurate screening tools, n = 29), including: the Parents' Evaluation of Developmental Status (PEDS), the PEDS-Developmental Milestones (PEDS-DM), the Modified Checklist for Autism in Toddlers (M-CHAT) and PHQ9 (maternal depression). Results In the ‘usual care’ group four (16%) and in the evidence-based tools group 18 (62%) were identified as having a possible developmental problem. In the evidence-based tools group three infants were to be recalled at 24 months for language checks (no specialist referrals made). In the ‘usual care’ group four problems were identified: one child was referred for speech therapy, two to return to check language at 24 months and a mother to discuss depression. All forms were completed on-line within 10 min. Conclusions Despite higher early detection rates in the evidence-based care group, there were no differences in referral rates between evidence-based and usual-care groups. This suggests that clinicians: (1) override evidence-based screening results with informal judgment; and/or (2) need assistance understanding test results and making referrals. Possible solutions are improve the quality of information obtained from the screening process, improved training of physicians, improved support for individual practices and acceptance by the regional health authority for overall responsibility for screening and creation of a comprehensive network.

La rinoplastica è una procedura chirurgica molto comune e al tempo stesso di elevata complessità. Uno degli aspetti più discussi di tale chirurgia sono gli insoddisfacenti esiti funzionali dovuti spesso ad un eccessivo restringimento dell’area della valvola nasale. Alcune procedure, come la turbinoplastica inferiore, possono favorire la prevenzione di tali problematiche ostruttive. L’intento del presente studio è quello di indagare gli effetti della turbinoplastica inferiore sulla resistenza nasale e sull’ostruzione respiratoria. In 50 pazienti è stata effettuata un’analisi preoperatoria e sei mesi dopo rinoplastica con turbinoplastica inferiore mediante rinomanometria anteriore attiva. Nessuno dei pazienti ha lamentato sintomatologia ostruttiva nasale nel preoperatorio o nel corso del postoperatorio. In accordo con i dati rinomanometrici sia le resistenze inspiratorie che quelle espiratorie hanno presentato valori migliori nel postoperatorio, ma solo le resistenze espiratorie hanno presentato una significatività statistica (p = 0,034). Le differenze in termini di flusso nasale fra maschi, femmine e differenti gruppi di età non sono state significative (p > 0,05). In conclusione dai dati del nostro studio emerge che la rinosettoplastica, associate a turbinoplastica parziale non ha un impatto negativo sulla funzionalità nasale ed in particolare sul flusso aereo attraverso le cavità nasali.

Objective: Data on rheumatoid arthritis (RA) in Kuwait and The Middle East is scarce. Available data from Western countries may not be representative of the region. We describe RA patients in Kuwait and compare them with other RA populations and with Kuwaiti general population. Methods: Adult RA patients from Kuwait Registry for Rheumatic Diseases (KRRD), the first RA Original Research Article Al-Herz et al.; BJMMR, 14(9): 1-11, 2016; Article no.BJMMR.24673 2 registry in The Middle East, were studied from February 2013 through February 2015. Demographic, clinical and serologic data were compared with other RA populations and with Kuwaiti general population. Results: 835 patients were enrolled, 62.3% female. Mean age 50.6±12 years and disease duration 6.1±6 years. RA was diagnosed at a mean age of 44.9±12 years. 17.1% had family history of autoimmune rheumatic diseases. 3.1% had rheumatoid nodules. Rheumatoid factor (RF) and anticitrullinated peptide (ACPA) were detected in 75.6% and 57.8%, respectively. Both were positive in 49% (r=0.287, p=0.001). ANA was positive in 19.1%. Both ACPA and a combination of positive RF and ACPA were more in males (p=0.017, 0.004 respectively), whereas ANA was more in females (p=0.01). One third of male patients were smokers versus 1.9% of females. Smoking was correlated to RF (p=0.009) and ACPA (p=0,002). Difference in ACPA between genders was statistically explained by the predominance of smoking in males. Comorbidities included diabetes mellitus (DM) (20.8%), hypertension (20.2%), hyperlipidemia (10.5%) and coronary artery disease (CAD) (3.1%). 4 cases of cancer were reported. Conclusion: RA population in Kuwait includes less women than other RA populations but more than Kuwaiti general population. Family history is more common. A higher positive ACPA in males was explained by smoking difference. Hypertension and hyperlipidemia were less reported than in both Kuwaiti general population and other RA populations. CAD was similar to other RA populations. DM was more reported, reflecting its high background prevalence in Kuwait.

Background: Preterm birth is increasing as a major cause of perinatal complications and mortality in Iran. The present study aimed to investigate the effect of prenatal self-care based on Orem's theory on preterm birth occurrence in women at risk for preterm birth. Materials and Methods: The present clinical trial was conducted on 176 pregnant women at 24–26 weeks at risk for preterm birth in Mashhad, Iran, from December 2015 to October 2016. A multistage sampling method was used in this study. The intervention group (88 pregnant women) received individual self-care education but the control group (88 pregnant women) received only common prenatal care. Results: There was a statistically significant difference between intervention and control groups in terms of preterm birth occurrence (6.80% vs 20.50%) (χ2 = 6.90, df = 1,p = 0.008). The incidence of preterm birth in the intervention group was approximately three times higher than that in the control group. Conclusions: Given that educational interventions could reduce the incidence of preterm birth, it is suggested that the women at risk for preterm birth are trained for prenatal self-care.

International audience; Background Kidney transplant recipients have an impaired ability to dilute urine but seldom develop baseline hyponatremia before ESRD. Although hyponatremia is a risk factor for adverse events in CKD and in kidney transplant recipients, it remains unclear whether subtler alterations in osmoregulation performance are associated with outcome. Methods We studied a single-center prospective cohort of 1258 kidney transplant recipients who underwent a water-loading test 3 months after transplant to determine osmoregulation performance. Measured GFR (mGFR) was performed at the same visit. A group of 164 healthy candidates for kidney donation served as controls. We further evaluated the association of osmoregulation performance with transplantation outcomes and subsequent kidney function. Results Unlike controls, most kidney transplant recipients failed to maintain plasma sodium during water loading (plasma sodium slope of −0.6±0.4 mmol/L per hour in transplant recipients versus −0.12±0.3 mmol/L per hour in controls; P

Background Cardiovascular disease is the most common cause of mortality and morbidity in diabetic patients. Insulin resistance has been shown to be reduced by the secretion of irisin from muscle and adipose tissues. This study was aimed at determining the relationship between serum irisin levels and angiographically defined coronary artery disease (CAD) in type II diabetic patients. Methods In this case-control study, 30 diabetic subjects with angiographically defined CAD were compared with 30 age- and sex-matched diabetic subjects without CAD in terms of clinical and laboratory parameters including serum irisin levels. Results Serum levels of Irisin were significantly higher in the diabetic group without CAD compared with the group with CAD (P = 0.048). Serum irisin levels showed a significant positive correlation with BMI (r = 0.374, P = 0.004) and fasting insulin (r = 0.303, P = 0.021), and a significant negative correlation with diabetes duration (r = −0.384, P = 0.002). Based on the results of the binary logistic regression model, circulating levels of irisin were associated with the presence of CAD in diabetes (p = 0.038) after adjusting for potential confounders. Conclusion Serum irisin levels were lower in the diabetic patients with cardiovascular complication compared with the uncomplicated diabetic patients. Therefore, additional larger scale studies are needed to determine the role of irisin in monitoring CAD in diabetic patients.

Background: Diabetes Mellitus is one of the most common medical disorders in pregnancy. The possibility of vitamin D deficiency as a pathogenesis for impaired glucose tolerance tests show a probable role of vitamin D in insulin secretion and reduction of insulin resistance. This study was assigned to evaluate relation between serum vitamin D level and insulin resistance in Gestational Diabetes Mellitus (GDM). Methods: This cross sectional study was done throughout one year between 2015-2016 in GDM patients (age, 20-40 years). After history taking and physical examination, the laboratory tests including : Fasting Blood Sugar (FBS), Glucose Tolerance Test (GTT), calcium, phosphorous, parathormone, 25(OH) vitamin D, insulin, HbA1C, TG, LDL, HDL were performed for all patients. Insulin resistance was calculated according to HOMA-IR formula. Vitamin D level was compared between patients with and without insulin resistance. Results: This research was performed in 93 GDM patients with average age (30.3 ± 5.6). Thirty eight patients with insulin resistance and 55 patients without insulin resistance were detected. The prevalence of vitamin D deficiency was 91.4% in all patients. There was no significant difference in vitamin D levels between insulin resistant and non insulin resistant group (P-value=0.51). : In all variable parameters, only FBS and triglyceride level in insulin resistant group were more than non insulin resistant group (P-value : Obtained results showed not significant relationship between vitamin D deficiency and insulin resistance in GDM patients.

Background An association between serum uric acid (UA) and disease activity in rheumatoid arthritis (RA) patients has not been well studied. Objectives We describe RA patients with high and normal UA and study its association with RA activity. Methods Adult RA patients from The Kuwait Registry for Rheumatic Diseases (KRRD) who satisfied the ACR classification criteria for RA from four major hospitals were studied from February 2013 through April 2017. Patients with recorded UA were identified. Visits with documented UA levels were included. UA of ≥357 µmol/L (6 mg/dL) was considered high. Statistical correlations were made. Results A total of 564 RA patients with 2710 hospital visits and available UA were identified, 353 (62.6%) females. Mean age 50.8±11.5 years and disease duration 10.5±2.9 years. Mean DAS28 was 2.9±1.2 and mean HAQ-DI 0.77±0.67. Rheumatoid factor (RF) was positive in 431/564 (76.4%) and anti-cyclic citrullinated peptide antibodies (ACPA) in 374/564 (66.3%). Mean UA was 271±78 µmol/L with 12.7% readings being high. There were more males among patients with high UA than with normal UA(56% vs 36%,p UA was negatively correlated with DAS28(p Conclusions RA patients with a higher UA had a lower disease activity despite using similar antirheumatic drugs. Reasons behind such association need to be further studied. Disclosure of Interest None declared