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BackgroundAcute exacerbations of interstitial lung diseases (AE-ILD) have a high mortality rate with no effective medical therapies. Lung transplantation is a potentially life-saving option for patients with AE-ILD, but its role is not well established. The aim of this study is to determine if this therapy during AE-ILD significantly affects post-transplant outcomes in comparison to those transplanted with stable disease.MethodsWe conducted a retrospective study of consecutive patients with AE-ILD admitted to our institution from 2015 to 2018. The comparison group included patients with stable ILD listed for lung transplant during the same period. The primary end-points were in-hospital mortality for patients admitted with AE-ILD and 1-year survival for the transplanted patients.ResultsOf 53 patients admitted for AE-ILD, 28 were treated with medical therapy alone and 25 underwent transplantation. All patients with AE-ILD who underwent transplantation survived to hospital discharge, whereas only 43% of the AE-ILD medically treated did. During the same period, 67 patients with stable ILD underwent transplantation. Survival at 1 year for the transplanted patients was not different for the AE-ILD group versus stable ILD group (96% vs 92.5%). The rates of primary graft dysfunction, post-transplant hospital length-of-stay and acute cellular rejection were similar between the groups.ConclusionPatients with ILD transplanted during AE-ILD had no meaningful difference in overall survival, rate of primary graft dysfunction or acute rejection compared with those transplanted with stable disease. Our results suggest that lung transplantation can be considered as a therapeutic option for selected patients with AE-ILD.

Background: Incidental durotomies (IDs) are frequent complications of spinal surgeries which are mostly posterior or lateral. Anterior IDs are rare; however, they may lead to severe complications. We compared the transthecal approach with the conservative approach for primary closure after durotomy in anterior lumbar dural tear to assess the efficacy of these approaches to decrease postsurgical complications and clinical outcomes. Methods: A total of 21 patients undergoing L2–S1 laminectomy with anterior ID were randomly divided into a transthecal group (n = 9) and a conservative group (n = 12) based on the surgical dural closure technique. Postoperative pseudomeningocele, wound infection, rootlet herniation, pneumocephalus, cerebrospinal fluid (CSF) leakage, headache, meningitis, in addition to surgery duration and length of hospitalization were examined and compared in both groups. Results: The frequency of pseudomeningocele and CSF leakage in patients undergoing the transthecal approach was significantly lower than those undergoing the conservative approach (P = .045 and .008, respectively). Furthermore, although the differences in the frequency of meningitis, pneumocephalus, headache, and wound infection were not statistically significant between the 2 groups, the effect sizes of the comparison were obtained as 49.4, 19.8, 7.1, and 2.6, respectively. This indicated that the differences were clinically significant between the 2 groups. Conclusions: We found that the transthecal approach was significantly more successful in managing CSF leakage as well as its complications and clinical outcomes. However, further clinical trials with bigger sample sizes are needed to substantiate this claim.

Meningioma is associated with the development of vasogenic edema defined as disrupted blood brain barrier. Vitamin D3 through its own nuclear receptor can regulate the expression of many effective agents on the integrity of the blood brain barrier. This study aimed to investigate the association between preoperative serum levels of 25(OH)D and peritumoral brain edema in patients with meningioma. One hundred and twelve patients with meningioma completed the study. Serum 25(OH)D levels assessment and magnetic resonance imaging (MRI) were done for all patients at the beginning of the study. The percentage of edema index (EI) was used to estimate the extent of peritumoral brain edema through preoperative MRI. The median serum level of 25(OH)D in the patients with the percentage of EI100% was significantly higher than those with100% (65.58 vs. 37.33

End-stage lung disease and advanced cardiac conditions are frequently seen together and represent a clinical dilemma. Even though both issues may be amenable to surgical management, combining lung transplant with surgical valve repair is rarely done and theoretically associated with increased morbidity and mortality risks, especially in elderly patients. Here, we describe 2 patients presenting with end-stage lung disease and significant aortic stenosis who were successfully bridged to lung transplant via transcatheter aortic valve replacement. Patient 1 was a 66-year-old man who underwent a double lung transplant 56 days after transcatheter aortic valve replacement. Patient 2 was a 70-year-old man who underwent a single right lung transplant 103 days after transcatheter aortic valve replacement. Both patients had uneventful postoperative courses and are alive at the 1-year time point with excellent performance status. This report suggests that transcatheter aortic valve replacement may favorably impact lung transplant candidacy for patients with end-stage lung disease in the setting of severe aortic stenosis, likely representing a better alternative to concomitant aortic valve replacement and lung transplant in elderly patients.

Excessive accumulation of cerebrospinal fluid within the brain ventricles is called hydrocephalus, which results in increased intracranial pressure preventing brain growth or causing damage to intracranial structures due to raised intracranial pressure. One of the most common treatment options for this pathology includes the placement of a ventriculoperitoneal shunt to drain the excess fluid. The location of catheterization is traditionally considered as an important factor affecting shunt survival. In this study, we aimed to systematically review all available documents to determine the advantage and superiority of frontal or occipital shunt entry points as the two main approaches. A database search was performed in PubMed, Scopus, Embase, Web of Science, Medline, Ovid, and Google Scholar using "ventriculoperitoneal", "shunt placement", and "hydrocephalus" as the main key terms. Resultant articles were screened for relevancy based on predefined inclusion and exclusion criteria by two authors independently. After excluding irrelevant documents, the data of 11 related articles consisting of 3947 patients were extracted and qualitative data synthesis and pooled analysis were performed. The results of the included studies showed that although the outcomes of a higher percentage of the total review population were in favor of frontal shunt placement, there was no significant superiority for neither of these two approaches after pooled analysis of available failure rates. Findings have shown that each approach has benefits and drawbacks, and there may be other factors such as age and valve design besides the position of shunt placement that may affect the survival rate. Also, the accuracy of shunt placement as an independent factor affects the failure rate and can be improved with various image-guidance methods to minimize shunt failure.

The prognostic role of procedural complexity when discontinuing aspirin in patients on oral anticoagulation undergoing percutaneous coronary intervention (PCI) has never been studied.Ischaemic events were compared in 256 consecutive patients according to procedural complexity and aspirin on discharge. PCI complexity was defined according to the high-risk features for ischaemic events in the current guidelines RESULTS: Forty percent patients had stable presentation. In patients with complex PCI, ischaemic events were significantly higher when discharged without aspirin (adjusted HR 3.66, (95% CI 1.07 to 12.47), P = 0.038). This was driven from both target vessel failure and de-novo coronary lesions. Ischaemic events were comparable between patients with complex PCI on aspirin and those who underwent non-complex PCI.Procedural complexity in patients with indication for oral anticoagulation undergoing PCI should be factored in when deciding optimal antithrombotic therapies. Aspirin discontinuation in patients with high-risk PCI features should be discouraged.

NMOSD is a disease shown to be highly associated with other diseases such as autoimmune diseases. There are a few reports of this association with cancer. So, this systematic review aimed to obtain a broad understanding on the cancers associated in NMOSD, including the source of common perceptions and assumptions in this regard. Methods in this study, we systematically searched the PubMed, EMBASE, SCOPUS, Web of Sciences, Proquest, Ovid, conference proceedings, and reference lists of the retrieved articles. All NMOSD cases who met the last version of criteria for its diagnosis, which reported the patients with a history of cancer before or after the onset of neurological symptoms without time limitations, and those who were referred as paraneoplastic neuromyelitis optica in articles published in English language (both the abstract & full text), were assessed. Finally, each study was critically appraised. Results Only 47 studies met the inclusion criteria, so they were assessed for qualitative synthesis. Considering the Euro network criteria, only 62 cases met this issue. The mean age of 52.21 ± 17.14 and 52.16 ± 17.21 was reported for cancer and NMOSD cases with female predominance (79%), respectively. The most reported organ in the cancer population were genitourinary (n = 14, 22.3%), breast (n = 12, 19.4%), lung (n = 12, 19.3%), gastrointestinal (n = 7, 11.3%), and hematology (n = 6, 9.7%), respectively. Conclusion In older NMOSD patients without suspicious symptoms, we recommend paying more attention to lung, breast and genitourinary (especially ovary) cancer screening. Also, cancer resection had positive effect on the attack numbers after receiving treatment and NMOSD recovery.

Multiple sclerosis (MS) is one of the most important demyelinating diseases that affects the central nervous system. Its treatment often involves a long-term disease modifying therapy. According to some studies, the prevalence of autoimmune disorders, such as autoimmune hepatitis (AIH) and ulcerative colitis (UC) is higher in MS patients than in the normal population. There are also few studies that have reported the onset of UC after rituximab therapy. The present study presents a report of a 31-years old female patient suffering from aggressive multiple sclerosis, which developed into autoimmune hepatitis during the MS therapy. Thereafter, she received rituximab for the treating both MS and AIH. One week after the third cycle of rituximab (6 doses of 1000 mg), she experienced abdominal pain, fever, and severe bloody diarrhea; finally, she was diagnosed with ulcerative colitis (UC). It seems that the administration of certain immunomodulators or immunosuppressive drugs may have a main role in the exacerbation of some autoimmune diseases.

Background: Type II Diabetes Mellitus (T2DM) is a considerable problem of global health, and finding new therapies for treating the disease continues. Recently, attention has been focused on vitamin D as a potential lowering agent of T2DM’s risk factors and its complications. The present work was conducted to determine the effect of vitamin D supplements on serum lipids, uric acid, C-Reactive Protein (CRP) and also Homeostatic Model Assessment of Insulin Resistance (HOMA-IR). Materials and Methods: Sixty patients with T2DM as well as deficiency of vitamin D and referred to Rasoul-e-Akram Hospital in 2017 were selected by convenience sampling method. To begin the study, patients’ demographic information was required, so a questionnaire including age, waist circumference, sex, height, blood pressure and weight was provided. Patients with vitamin D3 0.05. Conclusions: Deficiency of vitamin D should be treated and prevented, but administration of this high-dose vitamin D supplements for prevention or improvement of T2DM has not been recommended yet. Our study showed a correlation between the vitamin D intake and decreased level of FBS and Uric Acid in diabetic patients.

Introduction\ud \ud Patients with cancer who develop small bowel obstruction are at high risk of malnutrition and morbidity following compromise of gastrointestinal tract continuity. This study aimed to characterise current management and outcomes following malignant small bowel obstruction.\ud \ud \ud \ud Methods\ud \ud A prospective, multicentre cohort study of patients with small bowel obstruction who presented to UK hospitals between 16th January and 13th March 2017. Patients who presented with small bowel obstruction due to primary tumours of the intestine (excluding left-sided colonic tumours) or disseminated intra-abdominal malignancy were included. Outcomes included 30-day mortality and in-hospital complications. Cox-proportional hazards models were used to generate adjusted effects estimates, which are presented as hazard ratios (HR) alongside the corresponding 95% confidence interval (95% CI). The threshold for statistical significance was set at the level of P ≤ 0.05 a-priori.\ud \ud \ud \ud Results\ud \ud 205 patients with malignant small bowel obstruction presented to emergency surgery services during the study period. Of these patients, 50 had obstruction due to right sided colon cancer, 143 due to disseminated intraabdominal malignancy, 10 had primary tumours of the small bowel and 2 patients had gastrointestinal stromal tumours. In total 100 out of 205 patients underwent a surgical intervention for obstruction. 30-day in-hospital mortality rate was 11.3% for those with primary tumours and 19.6% for those with disseminated malignancy. Severe risk of malnutrition was an independent predictor for poor mortality in this cohort (adjusted HR 16.18, 95% CI 1.86 to 140.84, p = 0.012). Patients with right-sided colon cancer had high rates of morbidity.\ud \ud \ud \ud Conclusions\ud \ud Mortality rates were high in patients with disseminated malignancy and in those with right sided colon cancer. Further research should identify optimal management strategy to reduce morbidity for these patient groups.

Background: Workload is defined as the amount of work assigned to employees. The imbalance of efforts and rewards may cause occupational stress. The present study aimed to assess the impact of workload-related factors on the effort-reward imbalance in various working groups at a gas refinery complex. Methods: This cross-sectional study was conducted on 274 employees in five working groups in 2018. Data were collected using a demographic questionnaire, NASA TLX, need for recovery scale, and effort-reward imbalance (ERI) questionnaire. Data analysis was performed in SPSS version 22. Results: In total, 97 participants (34.3%) had the ERI score of more than one, and the imbalance was higher in the service workers. The ERI score was significantly correlated with the mental workload in the staff (P = 0.034) and engineering personnel (P = 0.045). A significant association was observed between the need for recovery and ERI score in the staff, engineering personnel, and middle managers (P < 0.05). Conclusion: The ERI score reduced with the reduction of workload-related factors through improving the workplace conditions, hiring sufficient employees, and proper rewards. Therefore, special attention must be paid to the needs of various working groups in order to enhance their working conditions.

Some studies indicated night shift work can be associated with the higher risk of metabolic syndrome (MetS). However, the effect of both rotating and extended night shift work (12-hr rotating night) on MetS has not well-known. We aimed to examine and clarify the association among petrochemical workers.We recruited 1575 eligible workers in this study. According to shift work schedules the participants were divided into following groups: 12-hr fixed day and 12-hr rotating night. Biochemical data, including fasting blood sugar and lipid panel (TC, TG, LDL, and HDL) were determined by blood tests. Demographic data was obtained by interview at the time of blood pressure and anthropometric indices measurements. The National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) was applied to identify subjects with MetS. The Logistic regression models were used to predict risk of MetS and its components between study groups.The prevalence of MetS was showed 18.4% (290/1575). We found a significant difference between study groups in the prevalence of MetS (p 0.05). The odds ratios (ORs) and 95% confidence intervals (CIs) in the 12-hr rotating night group in comparison to the 12-hr fixed day shift group according to unadjusted and full adjusted logistic regression models were estimated 1.26 (0.96, 1.65) and 1.34 (1.01, 1.76), respectively. Among MetS components, we observed the significant higher risk in TG and HDL (P 0.05).This study suggests 12-hr rotating night shift as the high-risk group for MetS. More studies needed to confirm our findings.

Objective To determine the effect of vitamin D supplementation on postoperative pain and analgesic requirement in brain tumor surgery. Methods A total of 60 patients with vitamin D serum levels ≤20 ng/dL were randomly assigned to 2 groups equally. The study group (n = 30) received intramuscular injection of 300,000 IU vitamin D before surgery. Results Preoperative serum level of vitamin D was 15.9 ± 3.8 ng/dL and 14.5 ± 3.6 ng/dL in the study and control groups, respectively (P = 0.13). Serum level of vitamin D on day 5 of surgery was 22.5 ± 4.3 and 13.7 ± 3.8 in the study and control groups, respectively (P 4 on the first postoperative day, which decreased with time. The median (interquartile range) of the visual analogue scale score during the 3 postoperative days was 3 (5), 3 (5), 1 (3), and 5 (7), 2 (5), 1 (3) in the study and control groups, respectively, with no significant difference. There was no difference in analgesic consumption between the 2 groups. Analysis through the generalized estimating equation model indicated that patients who had received vitamin D for a longer time before the operative time had an insignificantly less pain score. Conclusions On the basis of the study results, one half of our patients reported moderate-to-severe pain scores on the first day after surgery. The pain in the study group was insignificantly less than that in the control group, but it seems that chronic high level of vitamin D may lead to promising results.

Background:Cardiovascular disease has been associated with multiple risk factors such as dyslipidemia. However, the focus has recently shifted towards some novel risk factorsi.e. infection from periodontitis.Given this background, we aimed to assess the effect of periodontal therapy on some CVD risk factors including Total Cholesterol (TC), Low-Density Lipoprotein(LDL), High-Density Lipoprotein(HDL), Triglycerides(TG) and C-Reactive Protein (CRP). Fasting Blood Sugar (FBS) level has also been measured.Methods:Thirty patients (12 male and 18 female) who had severe periodontitis were tested for different blood parameters; namely Total Cholesterol (TC), Low-Density Lipoprotein (LDL), High-Density Lipoprotein(HDL), Triglycerides (TGs), C-Reactive Protein (CRP) and Fasting Blood Sugar (FBS). Enzymatic colorimetric methods were applied to measure all the parameters’ values except for CRP. The first stage of periodontal treatment comprised oral hygiene instruction as well as scaling and root planing. After 1 month, at the next stage, open flap debridement surgery was performed on all 4 quadrants of the mouth. The blood parameters were reassessed and compared with the baseline values after 3 months. Two patients (female) failed to participate in the follow-ups. The Pearson's and Spearman's correlation coefficients were calculated to determine whether changes in laboratory variables are associated with age and average probing depth or not.Results:All the assessed parameters related to 28 patients showed mean reduction which proved to be significant for CRP (p=0.011) and cholesterol (p=0.035). Among all parameters, only CRP level was found to have a significant positive correlation with pocket depth. Other blood parameters' relationship with age and probing depth proved to be insignificant.Conclusion:Considering the results, periodontal treatment may significantly lower lipid profile serum levels and some inflammatory factors.

This systematic review and meta-analysis aimed to determine whether adjunctive use of antimicrobial photodynamic therapy (a-PDT) in peri-implant diseases improves clinical outcomes in smokers. An electronic search was performed in MEDLINE (through PubMed), Scopus, Cochrane Library, Embase, Web of Science and Google Scholar. The primary outcome measures were bleeding on probing (BOP) and pocket depth (PD). Plaque index (PI) was the secondary outcome. Four RCTs, (188 participants) comprised of 118 cigarette smokers, 38 E-cig smokers and 32 water pipe smokers with follow-up periods ranged from 6 weeks to 6 months were recruited. All trials applied diode laser in one session with wavelengths ranged from 660 to 670 nm. There was a significant difference between mechanical debridement (MD)+a-PDT and MD alone groups in PD (WMD = -1.26 mm, 95% CI: -2.19 to -0.32, P = 0.01) and PI (WMD = -10.60%, 95% CI: -14.46 to -6.74, P

Current NICE guidance recommends CT coronary angiography (CTCA) as first line for investigation of new onset stable chest pain, however; CTCA is not yet readily available in all UK centres. DSE remains recommended in current ESC guidance and provides a readily available, low cost alternative (1). Indeed, a negative test has been demonstrated to have an excellent negative predictive value in the region of >98% (2). Aim We sought to evaluate the rate of cardiac events within two years of a negative DSE. Methods We performed a retrospective data interrogation of all DSE’s performed in the Mater Hospital Cardiac Investigations Department between 2017 and 2019. MACE was evaluated at two years. Data were extracted using local electronic healthcare records. Statistical analysis performed using SPSS software. Results 302 DSE’s were performed during the study period. The mean age was 64.1±10.4years with 41.7% male. Of the population, 16.2% had a prior history of IHD with 19.2% being diabetic. All tests were requested by the Cardiology team on an outpatient. 15 patients had a positive test. At two years the negative predictive value of a negative DSE was 98.3%. A positive test had a sensitivity for predicting coronary artery disease of 86.7% with a false positive rate of approximately of 13.3%. The overall complication rate was low at 0.7%. Using a combined endpoint of time to ACS or revascularisation; there was a significant difference (p Conclusion DSE is a safe test with a high sensitivity for detecting coronary artery disease. Furthermore, compared to a positive test, a negative test has a strong negative predictive value for cardiac events at two years. Conflict of Interest none

This is a case report of a 31-year-old woman with past medical history of hereditary angioedema (HAE) who developed acute right ventricular dysfunction. The patient presented to the emergency department with complaints of acute abdominal pain and swelling. Her electrocardiogram demonstrated sinus tachycardia and T wave inversion in leads V1-V3, otherwise without findings suggestive of ischemia. Troponin was elevated at 1.83 ng/mL. A transthoracic echocardiogram showed normal left ventricular function with ejection fraction of 65-70%, but the right ventricle (RV) was dilated and severely hypokinetic and there was moderate tricuspid regurgitation. Patient was managed symptomatically for her HAE exacerbation. Her abdominal swelling resolved, troponins continued to trend down, and she was discharged home after three days. A follow up echocardiogram done six months later demonstrated normal RV function.

Summary Background Lung transplantation is a life-saving treatment for patients with end-stage lung disease; however, it is infrequently considered for patients with acute respiratory distress syndrome (ARDS) attributable to infectious causes. We aimed to describe the course of disease and early post-transplantation outcomes in critically ill patients with COVID-19 who failed to show lung recovery despite optimal medical management and were deemed to be at imminent risk of dying due to pulmonary complications. Methods We established a multi-institutional case series that included the first consecutive transplants for severe COVID-19-associated ARDS known to us in the USA, Italy, Austria, and India. De-identified data from participating centres—including information relating to patient demographics and pre-COVID-19 characteristics, pretransplantation disease course, perioperative challenges, pathology of explanted lungs, and post-transplantation outcomes—were collected by Northwestern University (Chicago, IL, USA) and analysed. Findings Between May 1 and Sept 30, 2020, 12 patients with COVID-19-associated ARDS underwent bilateral lung transplantation at six high-volume transplant centres in the USA (eight recipients at three centres), Italy (two recipients at one centre), Austria (one recipient), and India (one recipient). The median age of recipients was 48 years (IQR 41–51); three of the 12 patients were female. Chest imaging before transplantation showed severe lung damage that did not improve despite prolonged mechanical ventilation and extracorporeal membrane oxygenation. The lung transplant procedure was technically challenging, with severe pleural adhesions, hilar lymphadenopathy, and increased intraoperative transfusion requirements. Pathology of the explanted lungs showed extensive, ongoing acute lung injury with features of lung fibrosis. There was no recurrence of SARS-CoV-2 in the allografts. All patients with COVID-19 could be weaned off extracorporeal support and showed short-term survival similar to that of transplant recipients without COVID-19. Interpretation The findings from our report show that lung transplantation is the only option for survival in some patients with severe, unresolving COVID-19-associated ARDS, and that the procedure can be done successfully, with good early post-transplantation outcomes, in carefully selected patients. Funding National Institutes of Health. Video Abstract Early outcomes after lung transplantation for severe COVID-19

Background Abdominal wall hernia is a common surgical condition. Patients may present in an emergency with bowel obstruction, incarceration or strangulation. Small bowel obstruction (SBO) is a serious surgical condition associated with significant morbidity. The aim of this study was to describe current management and outcomes of patients with obstructed hernia in the UK as identified in the National Audit of Small Bowel Obstruction (NASBO). Methods NASBO collated data on adults treated for SBO at 131 UK hospitals between January and March 2017. Those with obstruction due to abdominal wall hernia were included in this study. Demographics, co‐morbidity, imaging, operative treatment, and in‐hospital outcomes were recorded. Modelling for factors associated with mortality and complications was undertaken using Cox proportional hazards and multivariable regression modelling. Results NASBO included 2341 patients, of whom 415 (17·7 per cent) had SBO due to hernia. Surgery was performed in 312 (75·2 per cent) of the 415 patients; small bowel resection was required in 198 (63·5 per cent) of these operations. Non‐operative management was reported in 35 (54 per cent) of 65 patients with a parastomal hernia and in 34 (32·1 per cent) of 106 patients with an incisional hernia. The in‐hospital mortality rate was 9·4 per cent (39 of 415), and was highest in patients with a groin hernia (11·1 per cent, 17 of 153). Complications were common, including lower respiratory tract infection in 16·3 per cent of patients with a groin hernia. Increased age was associated with an increased risk of death (hazard ratio 1·05, 95 per cent c.i. 1·01 to 1·10; P = 0·009) and complications (odds ratio 1·05, 95 per cent c.i. 1·02 to 1·09; P = 0·001). Conclusion NASBO has highlighted poor outcomes for patients with SBO due to hernia, highlighting the need for quality improvement initiatives in this group., This study shows that small bowel obstruction due to abdominal wall hernia is common, typically involves a co‐morbid group of patients and has poor outcomes, including high mortality rates. High mortality from this problem

The theory of platelet role in cancer progression was recently introduced. We investigated the association of extravasated platelets in colorectal cancer with clinicopathological features, and also the expression of epithelial-mesenchymal transition (EMT) markers. We retrospectively analyzed data from 33 patients with colorectal cancer who underwent surgery between 2013-2016. In formalin-fixed paraffin-embedded tissues, we evaluated the expression of a platelet-specific marker of CD42b and EMT markers using immunohistochemistry. The associations among the expression of the platelet‑specific marker in specimens, EMT, and clinicopathological futures were analyzed. The presence of platelets was observed in 15 out of 33 primary colorectal tumors (45%). According to multivariate analysis, CD42b expression was not correlated with clinical characteristics. Platelet-positive tumor cells did not show EMT marker expression. These data suggest that extravasated platelets may not have a central role in determining patient characteristics and clinical futures.

Objectives Day case tonsillectomy compared with inpatient tonsillectomy has increasingly become a trend for many patients undergoing elective surgeries. Unjustified stays of tonsillectomy can be avoided by day case surgery, which consequently reduces treatment costs. The aim of this study was therefore to determine the cost and effectiveness of day case tonsillectomy compared with inpatient tonsillectomy. Methods This cost-effectiveness study was performed on 300 patients from May 2017 to April 2018. Patients were randomly divided into 2 groups: day case (n = 150) and inpatient (n = 150). Consequences used in model included incidence of bleeding, blood transfusion, and reoperation frequency within 2 weeks after surgery and also the patients’ pain during 24 hours after surgery. Costs were collected from societal perspective, so the costs included direct medical and nonmedical costs as well as indirect costs. One-way sensitivity analysis was conducted to measure the uncertainty effects of the parameters. The collected data were analyzed using software TreeAge and Excel 2016. Results Day case tonsillectomy was more cost-effective than inpatient. Mean total costs in day case and inpatient were $915.1 and $1227.9, respectively. Besides, the mean effectiveness was 0.921 and 0.914 percent, respectively. Also, 1-way sensitivity analysis proved the robustness of the results of study. Conclusions Day case tonsillectomy is a cost-effective strategy and can be suggested as a good alternative for a wide range of patients after tonsillectomy. Supporting day case surgery for tonsillectomy cases can significantly reduce the financial burden.

Context: The most common type of brain tumors are gliomas, among which glioblastoma multiforme is the most life-threatening. In spite of the existing treatments, malignant gliomas often do not respond to treatment. Objectives: The aim of this study was to investigate the antitumor activity of vitamin D3 in malignant gliomas through the study of in vitro and in vivo articles. Data Sources: The electronic databases, including PubMed, ScienceDirect, Web of Science, Google Scholar, and the Cochrane Central Register of Clinical Trials (last updated April 12th, 2019) were searched, using medical subject headings (MeSH) keywords “vitamin D AND brain malignancy”. Data Extraction: There was no limitation on the date and language of the articles. A review of all the found articles at the level of titles and abstracts was made to find eligible articles. Our work is in accordance with the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. The quality of the articles was judged in accordance with the GRADE tool for in vitro studies and CIRCLEs RoB tool for in vivo studies. Results: Totally, 88 articles were identified and after careful examination, 16 eligible articles meeting the inclusion criteria were selected. These studies showed that vitamin D3 and its analogs suppress self-renewal ability, cell viability and/or cell growth, migration rate, and invasive capacity; in addition, they induce autophagy and cell death. They also reduce tumor size in animal models. Evidence was mainly of moderate to high quality. Conclusions: Based on the in vitro and in vivo evidence of this systematic review, vitamin D3, compared to the control group, induced cell death and reduced cell growth, invasion, and migratory capacity in gliomas cell culture. As well as, vitamin D analogs were able to show the same effects without the hypercalcemic effect in vivo. We suggest performing future high-quality studies with the aim of shedding light on the relevant mechanisms and the effects of vitamin D3 derivatives and its analogs on health status and clinical outcomes in patients with malignant gliomas.

Childbirth consists of a three-stage period beginning with uterine, contractions, and ending in the expulsion of the placenta. The aim of this study was the effect of intramuscular hyoscine and hyoscine-promethazine on the duration of labor in nulliparous pregnant women. This study was a triple-blind clinical trial on 213 nulliparous pregnant women who had referred to Amiralmomenin hospital in Zanjan, Iran. Selection of samples was random and done with using 3, 6(1:1:1) of blocking ratio. This study had three groups. The first group received 20 mg hyoscine (group A), the second group 3 cc sterile water (group B), and the third group 20 mg hyoscine and 25 mg promethazine (group C). Data collection tools included a demographic questionnaire, checklist of data, and partograph chart. The mean of the first stage of labor in hyoscine group was 88.95 ± 51.07 min, hyoscine-promethazine 100.05 ± 65.88 min, and control group 170.37 ± 106.87 min. There was significant correlation between A and C and B and C groups (P

Background: Several studies in the recent decade have supported a relationship between different types of infections and CHD (Coronary Heart Disease); however, such a relationship is not definitely proven. Helicobacter pylori is one of the most common infections in human. The role of inflammation in the pathogens of CAD (Coronary Artery Disease) has been widely discussed; although, the mechanism is not clearly known yet. Methods: In this systematic review and meta-analysis all case-control articles on the relationship between Helicobacter pylori and CHD published from 31st June 2000 to 31st June 2016 indexed in Scopus, PubMed, Google Scholar, Science Direct, and Iranian databases Magiran, Iran Medex, Irandoc, and SID were included. The articles were searched using the following keywords in Farsi and English. The extracted data was imported into Microsoft Excel and analyzed in Stata 12. Results: Thirty case-control studies conducted in different regions of Iran (15 provinces) have been published from 2001 to 2015 included in this study. A general estimate of OR (Odds Ratio) for the association of Helicobacter pylori and heart diseases in Iran was 2.351 (95 CI: (1.715, 3.221)). Conclusion: According to the observed association between Helicobacter pylori and heart diseases in the resent study, most of the hosts of the bacterium are afflicted with the infection in their childhood. Therefore, personal hygiene promotion and preventive programs for Iranian children may have a considerable role in reducing the risk of the infection and cardiovascular diseases, consequently.

IL-8 is a chemokine which plays an essential role in tumorigenesis, specifically in tumor growth, angiogenesis and invasion. Recent studies have determined that IL-8 +781C/T polymorphism correlates with some human cancers. The purpose of current study was to clarify the association of interleukin-8 polymorphism (+781 C/T) with the risk of ovarian cancer. In this case-control study, 150 samples including 50 specimens of ovarian tissue from female patients and 100 blood samples of cancer-free females were recruited. All studied individuals were from Kermanshah province, Iran, with ethnic background of Kurdish. After DNA extraction, the polymorphism of interleukin-8 (+781 C/T) was assessed by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) test. Our results showed that the frequencies of CC, CT and TT genotypes in healthy individuals were 8, 70 and 22% respectively. In contrast, in ovarian cancer patients, frequencies were found as CC (13%), CT (57%) and TT (30%) genotypes. Based on our obtained results, there was a significant positive correlation (P

Purpose Belatacept reduces calcineurin inhibitor (CNI) nephrotoxicity in kidney transplant recipients. However, its use in lung transplantation is extremely limited and it remains unclear whether it can provide a safe and effective renal sparing immunosuppression in patients with chronic kidney disease. Methods This is a prospective cohort study of patients who were started on Belatacept with lower CNI goals post lung transplantation at our institution between 2018 and 2020. Institutional IRB approval was obtained. Patients aged 18 years or older were included and multiorgan recipients were excluded. Continuous data was reported as median and categorical data as proportions. Paired data analyses that include Wilcoxan signed rank test and McNemar's test were performed. Results 85 patients satisfied the inclusion and exclusion criteria. Median time to initiation of Belatacept after transplantation was 293 days, interquartile range (IQR) (148-611). The cohort was followed for a median of 311 days IQR (182-465). 28 patients (33%) stopped the infusion with the majority due to infectious complications. There was a median of 1ml increase in GFR (p=0.68). The FEV1 increased a median of 40ml during the same duration (p=0.0034). Conclusion In this large cohort, Belatacept provided an effective renal sparing immunosuppression. There was no decline in graft function with stabilization of GFR. There was a tendency towards a higher rate of opportunistic infections and cancers; however, this did not achieve statistical significance.

Purpose Due to donor/recipient size matching challenges, lung transplant candidates height may pose a significant disadvantage for receiving a transplant, resulting in longer wait times and increased waitlist mortality. We hypothesize that a proactive approach focused on donor lung size reduction improves access to transplantation with equivalent post-operative outcomes. Methods We retrospectively reviewed our experience with transplant candidates listed from Jan 2010 to May 2019. Since January 2016, our program considers surgical downsizing of donor lungs via non-anatomical reduction or lobar transplantation whenever LAS prioritization recommends matching to a shorter stature candidate and downsizing is anatomically feasible. We compared this cohort of patients (recent era) to those from our early era in which size reduction was not proactively performed (Jan 2010- Dec 2015). We excluded pediatric, redo and multiorgan transplants. Our primary endpoint was waitlist mortality or removal due to clinical deterioration. Secondary endpoints were time to transplant and post-operative outcomes. Results We included 410 patients with 226 in the early era and 184 in the recent era. Age (mean 54.46 vs 57.87) and LAS (mean 44.73 vs 44.18) were comparable between both groups. Donor characteristics were similar between periods. The number of patients with surgically downsized grafts was significantly higher in the current period compared to the early period (n=62; 34.4% vs n=20; 8.9%; p Conclusion Removal of size restrictions through proactive surgical downsizing improved access to transplantation. Despite more technically demanding, this change in practice has not impacted postoperative outcomes. The significant decreases in waitlist mortality and wait times suggest that this approach is able to address a significant disparity in our field.

Introduction Neuromyelitis Optica (NMO) is an autoimmune inflammatory demyelinating disease of the central nervous system (CNS) which predominantly involves optic nerves and spinal cord. Since the introduction of Neuromyelitis Optica Spectrum Disorders (NMOSD) as a separate entity, there have been many reports on its association with other disorders including systemic and organ-specific autoimmune diseases. Here, we reviewed other immune-mediated diseases associated with NMOSD and tried to categorize them. Methods The present review was conducted using the PUBMED database based on papers from 1976 (i.e., since the first NMO comorbidity with SLE was reported) to 2017. We included all articles published in English. The keywords utilized included Neuromyelitis optica, Neuromyelitis Optica Spectrum Disorders, Devic's disease, in combination with comorbidity or comorbidities. Results Diseases with immune-based pathogenesis are the most frequently reported co-morbidities associated with NMOSD, most of which are antibody-mediated diseases. According to literature, Sjogren's Syndrome (SS) and Systemic Lupus Erythematosus (SLE) are the most frequently reported diseases associated with NMOSD among systemic autoimmune diseases. Further, myasthenia gravis in neurological and autoimmune thyroid diseases in non-neurological organ-specific autoimmune diseases are the most reported comorbidities associated with NMOSD in the literature. Conclusions NMOSD may be associated with a variety of different types of autoimmune diseases. Therefore, systemic or laboratory signs which are not typical for NMOSD should be properly investigated to exclude other associated comorbidities. These comorbidities may affect the treatment strategy and may improve the patients' care and management.

Background: Hospital-acquired infections (HAIs) are a global problem in hospitals and significant causes of mortality and morbidity regardless of advances in supportive care, antimicrobial therapy and prevention. The study aimed to determine a comprehensive estimate of the HAIs prevalence, influential factors, and types of these infections in Iran. Methods: A systematic literature review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using the online databases; Medline, EMBASE, Scopus, Cochrane, SID, Magiran, and Medlib from January 1995 to September 2020 using a combination of medical subject heading terms (‘Nosocomial infection [Mesh] OR ‘’ Hospital infection [Mesh] OR Hospital Acquired Infection[Mesh] OR Healthcare-associated infection ‘’AND (‘Iran’ [Mesh]) among observational and interventional studies. SPSS version 25 and STATA version 11 were used for data analysis. Results: A total of 66 (cross-sectional, cohort, and case-control) observational studies were identified. More of the studies had been done before 2014(43 papers or 65%). Based on the random-effects model, the overall prevalence of HAIs in Iran was 0.111 [95% CI: 0.105 - 0.116] with a high, statistically significant heterogeneity (I2= 99.9%). The infection rate was 0.157 and 0.089 before and after the Iranian Health Transformation Plan (HTP), respectively. HAIs rates reported more in the South and West of Iran rather than other regions (0.231 and 0.164) (p= 0.001). Escherichia coli and klebsiella infections were reported in 53 and 52 papers (0.239 and 0.180, respectively). In addition, respiratory and urinary infections were reported 0.296 and 0.286 in 51 and 38 papers, respectively. Conclusion: The prevalence of HAIs in Iran is relatively high. Preventing and decreasing hospital nosocomial infections can considerably affect reducing mortality and health-related costs. This should be taken into consideration by health policymakers for pathology and revision of some previous programs and standards as well as the development of appropriate and evidence-based control and education programs to reduce this health problem.

Background It remains unclear whether radial access (RA), compared with femoral access (FA), mitigates the risk of acute kidney injury (AKI). Objectives The authors assessed the incidence of AKI in patients with acute coronary syndrome (ACS) enrolled in the MATRIX-Access (Minimizing Adverse Haemorrhagic Events by Transradial Access Site and Systemic Implementation of Angiox) trial. Methods Among 8,404 patients, 194 (2.3%) were excluded due to missing creatinine values, no or an incomplete coronary angiogram, or previous dialysis. The primary AKI-MATRIX endpoint was AKI, defined as an absolute (>0.5 mg/dl) or a relative (>25%) increase in serum creatinine (sCr). Results AKI occurred in 634 patients (15.4%) with RA and 712 patients (17.4%) with FA (odds ratio [OR]: 0.87; 95% confidence interval [CI]: 0.77 to 0.98; p = 0.0181). A >25% sCr increase was noted in 633 patients (15.4%) with RA and 710 patients (17.3%) with FA (OR: 0.87; 95% CI: 0.77 to 0.98; p = 0.0195), whereas a >0.5 mg/dl absolute sCr increase occurred in 175 patients (4.3%) with RA versus 223 patients (5.4%) with FA (OR: 0.77; 95% CI: 0.63 to 0.95; p = 0.0131). By implementing the Kidney Disease Improving Global Outcomes criteria, AKI was 3-fold less prevalent and trended lower with RA (OR: 0.85; 95% CI: 0.70 to 1.03; p = 0.090), with stage 3 AKI occurring in 28 patients (0.68%) with RA versus 46 patients (1.12%) with FA (p = 0.0367). Post-intervention dialysis was needed in 6 patients (0.15%) with RA and 14 patients (0.34%) with FA (p = 0.0814). Stratified analyses suggested greater benefit with RA than FA in patients at greater risk for AKI. Conclusions In ACS patients who underwent invasive management, RA was associated with a reduced risk of AKI compared with FA. (Minimizing Adverse Haemorrhagic Events by TRansradial Access Site and Systemic Implementation of angioX [MATRIX]; NCT01433627 )

ObjectiveThe main objective in this systematic review was to analyse herbal medicine interventions for anxiety and depression to detect possible benefits of herbal medicines in peri- and postmenopa...

Introduction The combination of single antiplatelet and oral anticoagulation therapy demonstrated similar ischaemic efficacy when compared to triple therapy in patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI).1,2 Importantly, a significant proportion of the included patients had bare-metal stents, up to one third, in these trials. 1,2 This may question the applicability of the reported data when tackling complex PCI in the real-world patients. We sought to investigate the incidence of ischaemic events in patients with AF undergoing PCI according to the complexity of PCI procedure and the used antithrombotic treatment. Methods 1895 consecutive patients undergoing PCI with bioabsorbable polymer drug eluting stent were screened for eligibility. Major adverse cardiovascular events (MACE) were defined as composite of death, myocardial infarction, stroke, and unplanned revascularization. Complex PCI was defined as two stents bifurcation strategy, 3 treated vessels, or > 3 stents implanted in the same procedure as previously described.3 Four groups were compared accordingly: Group 1 (dual treatment and complex PCI), Group 2 (dual treatment and non-complex PCI), Group 3 (triple therapy and complex PCI), and Group 4 (triple therapy and non-complex PCI). Results 256 (13.5%) patients had indication for oral anticoagulation, with 33 excluded patients been commenced on 1–3 months DAPT followed by oral anticoagulation. Mean age was 75 ±9 and 77% male. 40.2% patients had stable angina presentation. Average CHA2DS2-VASc and HAS-BLED scores were 3.7 ±1.3 and 1.7 ±0.7, respectively. In the whole group, one year ischaemic events was 9.4%. There were no differences among four groups in gender, hypertension, smoking history, ejection fraction, the nature of presentation (stable versus acute), CHA2DS2-VASc or HAS-BLED scores. On the other hand, there were significant variations among four groups in terms of age (78 ±7, 76 ±9, 72 ±10, 72 ±10, P= 0.008) and diabetes status (9%, 35%, 29%, 22%, P= 0.036), respectively. There was a significant difference in the incidence of MACE among four groups, with dual treated-patients and complex anatomy having the highest rate of MACE (26%, 9%, 13%, 4%, Log rank P= 0.012) (figure). The difference was mainly driven from more frequent unplanned revascularisations (13%, 4%, 4%, 0%, P= 0.033) with no difference in death, myocardial infarction or stroke. Patients with complex anatomy receiving dual treatments had at least 7 times more likelihood of sustaining MACE within the first year following PCI [hazard ratio (HR) 7.36, 95% CI 1.84 to 29.5, P= 0.005]. This risk stayed significant even after adjusting to other variables including age and diabetes status (HR 5.87, 95% CI 1.41 to 24.46, P= 0.015). Conclusion Despite a remarkable low incidence of ischaemic events in patients with AF undergoing PCI using bioabsorbable polymer DES, there is a marked heterogeneity in their future cardiovascular risk. Coronary anatomy and complexity of PCI procedure may play a role in risk stratifying patients with AF to tailor antithrombotic treatment to reduce their risk. Conflict of Interest None

Purpose Although lung transplantation (LT) remains the definitive therapy for end-stage respiratory disease, limited long-term survival rates highlight the need for improved post-transplant care. Given the high risk for postoperative dysphagia, we aimed to determine the prevalence, risk factors and associated outcomes of dysphagia in postoperative LT patients. Methods A retrospective review of consecutive adult patients undergoing LT and postoperative videofluoroscopic evaluation of swallowing (VFSS) at our institution between 11/2017 and 6/2020 was conducted. Relevant outcomes were extracted from electronic medical records (EPIC) and entered into a central database (REDCap). VFSS notes were examined and Penetration Aspiration Scale (PAS) scores extracted. Descriptives, t-tests, one-way ANOVA's, chi-squares and odds ratios were derived in SPSS. Results 205 LT recipients met inclusion criteria and were included. Mean age was 58.63 years and 50.7% were male. Postoperatively, 18% demonstrated safe swallowing (n=37), 39% demonstrated laryngeal penetration (n=79), and 43% demonstrated tracheal aspiration (n=89). Aspiration response profiles included: 50% no cough response (n=41), 31.7% ejection of aspirate material (n=26), and 18.3% ineffective cough response (n=15). Postoperative aspiration in LT patients was associated with: 1) peri-transplant venous-venous extracorporeal membrane oxygenation (OR: 2.0, X2 =3.7, p=.05); 2) cardiopulmonary bypass (n=40; OR: 2.3, X2=5.7, p=.02); 3) ≥ 3 intubations (OR: 7.5, X2 =5.2, p=.02); 4) tracheostomy (OR: 4.8, X2 =8.3, p=.004); and 4) longer intubation duration (70 vs. 44 hours, p=.002). LT patients who aspirated waited an average of 240 hours longer to resume a regular diet (p=0.004) and demonstrated a 2.4 and 2.0 higher odds of pneumonia and discharge to a acute rehab, respectively. One-year mortality rate was 2.9% (n=6), with 100% of deaths classified as unsafe swallowers. Conclusion Dysphagia was highly prevalent and associated with inferior patient outcomes. The observation that ∼70% of aspirators could not clear tracheal aspirate may explain, in part, the increased odds for development of pneumonia. Mortality data suggest that presence of dysphagia may impact survival and should be further examined in ongoing prospective studies.

Purpose The COVID-19 pandemic has infected millions of people across the world and caused several thousands of deaths. Given advances in extracorporeal life support technology, ECMO for COVID-19 acute respiratory distress syndrome (ARDS) has proven to be successful in sustaining life, however, has left a significant number of patients fully depended on devices and incapable of being weaned. Lung transplantation, as a well-established therapy for end-stage lung disease, has been considered for some patients with COVID-19 ARDS in the absence of lung recovery and the presence of findings suggestive of end-stage lung disease. Methods This is an International collaborative effort to assess the role of lung transplantation in COVID-19 ARDS. There is worldwide representation with centers from US (3), Europe (2) and Asia (1). Patients with COVID-19 ARDS supported on ECMO and/or mechanical ventilation who were deemed unweanable and developed features of end-stage lung disease were evaluated for lung transplantation. We followed ISHLT conventional recipient selection criteria recommendations and a 2 negative COVID-19 PCRs from bronchoalveaolar lavage or viral culture depending on medical urgency. Endpoints We will present demographics, intraoperative challenges, primary graft dysfunction, postoperative complications, survival and functional outcomes of patients with COVID-19 ARDS who underwent lung transplantation. Additionally, referral patterns, reasons for listing denial and waitlist outcomes will be presented. So far, this collaborative group has transplanted 17 patients. There have been no deaths on the waitlist, there was one post-transplant mortality at day 61. Ten patients have been discharged from the hospital and are doing well. Six patients are recovering well however less than 30 days post-transplantation and remain admitted.

Background Cancer is one of the main public health issues in the world. Breast cancer is one of the most common types of cancer among women. It is also the second cause of mortality in women. The association between the use of oral contraceptive pills and breast cancer is controversial and a main issue in public health. Some findings have shown that taking these pills does not have a significant effect in increasing the risk of breast cancer, while others have confirmed the carcinogenic effect of these products. These contradictory findings necessitated this meta-analysis, through of all correlated studies in Iran. Methods All published studies were considered from June 2000 until June 2015, using reliable Latin databases like PubMed, Google Scholar, Google search, Scopus, and Science Direct, and Persian database like SID, Irandoc, IranMedex, and Magiran. Finally, 26 papers were selected: 24 studies were case control while two were population based studies. A total of 26 papers with 46,260 participants were assessed since 2001. Results Overall estimate of OR for the effect of oral contraceptive pills on breast cancer is 1.521 (CI = 1.25-1.85), which shows that the intervention group had more chance (52%) compared to the control group (P = 0.001). Using these pills increased the risk of breast cancer up to 1.52 times. Conclusions Because of directly increasing levels of estrogen and the role of estrogen in gaining weight indirectly, oral contraceptive pills can stimulate the occurrence of breast cancer. More studies should be conducted for controlling the period of pill use.

Context Recently, new anti-epileptic drugs are marketed to be used as an add-on to the traditional drugs in children with refractory epilepsy. Levetiracetam is a second-generation of new anti-epileptic drugs with unknown precise mechanism of action in brain and synaptic vesicle in children with drug resistant epilepsy. Herein, the efficacy and safety of add-on levetiracetam in children with refractory epilepsy is reviewed. Evidence Acquisition A literature review was performed on efficacy and safety of add-on Levetiracetam in children with refractory epilepsy using international databases with the following terms: levetiracetam, refractory epilepsy, drug resistant epilepsy, seizures/epilepsy, children/pediatric. All articles related to add-on levetiracetam in children with refractory epilepsy written in English and published from 2000 to 2015 were included. The title and abstracts of 542 articles were assessed, of which, 488 were excluded. The full texts of the other 54 articles were assessed for relevance. Results Of the nine eligible articles, 1036 patients aged ≤ 18 years were identified. Male patients (52%) were more prominent than female ones. Five articles reported that levetiracetam therapy appeared more effective against localization-related than generalized epilepsy. The dosage of levetiracetam ranged from 6 to 70 mg/kg/day, with a mean of 43.2 mg/kg/day based on the mean doses reported by four of nine reviewed articles. The mean duration of follow-up was 39 weeks (ranging from 8 - 144 weeks). Administration of levetiracetam was effective in 42.24% of the patients (responders with >50% decrease in seizure frequency), of whom 11.8% had become seizure free. The mean number of anti-epileptic drugs tried before introducing levetiracetam treatment was 4.4 (ranging 1 - 20). The most frequent side effects were psychological and behavioral changes (11.1%), followed by agitation (9.2%) and sleep disturbances (6.7%). Conclusions The current review demonstrated that levetiracetam, as an add-on therapy, is an effective and well-tolerated anti-epileptic drug, associated with reversible and no serious side effects, to control seizure frequency of childhood refractory epilepsy.

Background and Purpose: Social support is considered as a facilitator of health behaviors in women. This study aimed to evaluate and compare the status of social support and its associated dimensions in pregnant and non-pregnant women. Methods: This analytical study was conducted on 310 pregnant and non-pregnant women referring to the health-care centers of Zarqan city in Shiraz, Iran in 2011. Participants were selected via convenience sampling. Data collection tools included demographic questionnaire and Social Support Appraisals (SS-A) scale. Data analysis was performed in SPSS V.16 using descriptive (frequency, percentage, mean, and standard deviation) and inferential statistics (Chi-square, T-test, and Pearson's and Spearman's correlation-coefficient). Results: In non-pregnant women, mean of the total social support was 40.08±2.80, and mean scores of support from friends, spouse, family and others were 12.08±1.33, 14.02±1.56, 14.53±0.96 and 13.54±1.09 respectively. Among pregnant women these values were 39.52±2.85, 11.72±1.59, 14.54±1.12, 14.38±1.06 and 13.4Ш.18, respectively. The total support and support from friends were significantly higher in non-pregnant women compared to pregnant women (P = 0.05 and P = 0.03, respectively). On the other hand, support from the spouse was significantly higher in pregnant women compared to non-pregnant women (P = 0.01). Moreover, a significant correlation was observed between the total scores of social support and employment status of spouse among pregnant women (P

Purpose Gastroparesis (GP) is prevalent after lung transplant (Ltx) (50-68%). GP has been associated with symptoms and delayed absorption of medications. Of particular concern after Ltx, GP can predispose to gastroesophageal reflux disease considered the main culprit for chronic allograft dysfunction. Therefore, early diagnosis and treatment is recommended in Ltx patients. Pharmacologic intervention for GP is not efficacious to improve gastric emptying and can induce potential serious side effects. Transcutaneous electric stimulation (TES) has been proposed to improve motility in various gastrointestinal motility disorders Methods We tested the hypothesis that TES may improve gastric emptying in Ltx patients. A 4-hour solid-phase gastric emptying study was done for worsening lung function before and after TES. Surveillance gastric emptying study (GEE) was done 2-12 weeks after TES. Five patients (4 female, age 48 ± 8), interval post-transplant (1-10 years), underwent TES as rescue therapy for moderate to severe GP (gastric retention >25% at 4 hours) that failed standard pharmacologic and dietary interventions. TES was delivered in continuous square wave, pulse rate 120 Hz, pulse width 220 µs, and pulse intensity to the maximum tolerated level without pain or muscle twitching. Two cutaneous electrodes were placed between T6 and T10 spinal levels (gastric autonomic segment) over the spine. Patients were instructed to use TES for 30 min after meals and for 30 min at bedtime Results Following TES, the percentage of gastric retention at 4 hours improved in the majority of patients (42 median, 25-73 min-max before TES; 20 median 7-43 min-max) after TES, p=0.01; figure 1). Three patients reported GP symptoms. Only one patient reported no significant improvement in the severity of symptoms Conclusion TES appears to modulate symptom perception and significantly improves gastric emptying in Ltx patients with moderate to severe gastroparesis

Purpose 1) Determine the incidence of postoperative swallowing impairment in patients undergoing lung transplantation, 2) identify potential demographic or surgical dysphagia risk factors, and 3) examine associated outcomes with aspiration. Methods A retrospective chart review was conducted in 122 consecutive individuals undergoing lung transplantation (LT) and a routine postoperative modified barium swallowing (MBS) exam. Demographic and health-related outcome data were extracted and MBS films assessed using the validated Penetration Aspiration Scale (PAS) by an expert rater. Results Dysphagia Incidence: 27.3% of LT patients demonstrated safe swallowing (PAS:1-2), 43.8% had laryngeal penetration during swallowing (PAS:3-5), while tracheal aspiration occurred in 28.7% (n=35) of patients (PAS:6-8). Thus, 72.5% (n=87) of LT patients demonstrated unsafe swallowing. Of the aspirators, 51% demonstrated no cough response to tracheal aspirate. Risk Factors: Body Mass Index (BMI) was significantly lower in aspirators versus non-aspirators (p=0.03) with a negative correlation noted between PAS score and BMI (r=-0.23, p=0.01). A linear by linear association for prevalence of aspiration by weight class was also noted (p=0.04). No relationships were noted for age, race, gender, or operative time with aspiration status (p>0.05). Outcomes Associated with Dysphagia: Compared to non-aspirators, LT patients who aspirated waited 138 hours longer to resume an oral diet (249 vs. 111, p=0.05), spent 192 hours longer in the intensive care unit (359 vs. 167, p Conclusion Dysphagia is highly prevalent in LT patients and associated with significant morbidity. These data highlight the need for close monitoring of the LT patient and further suggest a key role for implementation of instrumental assessment techniques for accurate and timely detection of dysphagia.

Alpha-1 antitrypsin deficiency (AATD) is a largely monogenetic disorder associated with a high risk for the development of chronic obstructive pulmonary disease (COPD) and cirrhosis. Intravenous alpha-1 antitrypsin (AAT) therapy has been available for the treatment of individuals with AATD and COPD since the late 1980s. Initial Food and Drug Administration (FDA) approval was granted based on biochemical efficacy. Following its approval, the FDA, scientific community and third-party payers encouraged manufacturers of AAT therapy to determine its clinical efficacy. This task has proved challenging because AATD is a rare, orphan disorder comprised of individuals who are geographically dispersed and infrequently identified. In addition, robust clinical trial outcomes have been lacking until recently. This review provides an update on the evidence for the clinical efficacy of intravenous AAT therapy for patients with AATD-related emphysema.

Background: One of the most common infections in women, especially during the reproductive age, is vulvovaginal candidiasis, which can cause physical and psychological distress for patients. According to different reports, Candida albicans is the main etiological agent of this infection. However, non-Candida albicans species have arisen recently. Therefore, it seems that in VVC, the pattern of Candida species, have changed. Objectives: In the current study, the researchers determined the frequency of different species of Candida in the Iranian female population. Methods: Five hundred and fifty-nine patients suspected of VVC, participated in this study. Wet swabs were used for collecting the samples. Vaginal swabs were examined microscopically and treated for fungal culture. Candida species identification was done by polymerase chain reaction (PCR)-Sequencing with universal fungal primers (ITS1 and ITS4). Results: Out of 559 patients, 46 (8.2%) samples were positive for VVC. The age group of 30 to 39 years old with 20 (44.7%) patients had the highest frequency. Itching concomitant with abnormal discharge and vaginal irritation (59.6%) were the most prevalent symptoms in the patients. The most frequent identified species of Candida were Candida albicans (67.7%), Candida glabrata (25.8%), and Candida kefyr (3.2%), respectively. In addition, only one (2.1%) case showed recurrent vulvovaginal candidiasis (RVVC). Conclusions: The results of the present study demonstrated that in patients with VVC, Candida albicans species are more frequent than other candida species. In order to achieve appropriate treatment, clinical and laboratory findings must be considered together.

Background The objective of this study was to compare the lifestyles and sexual satisfaction of patients who received Narcotics Anonymous with patients who received methadone maintenance therapy. Methods In this cross-sectional study, 50 patients who received Narcotics Anonymous were compared with 50 patients who underwent methadone maintenance treatment (MMT). The participants were chosen from the city of Ghazvin (Iran) in 2016 and they completed the lifestyle questionnaire and Larson sexual satisfaction questionnaire. Results The results of multivariate analysis of variance showed significant differences between the 2 groups in the components of lifestyle so that the MMT group achieved higher scores in the subscale of weight control and nutrition, disease prevention, mental health, social health, drug prevention, accident prevention, and environmental health (P < 0.05). However, the difference between the 2 groups in components of health, exercise and fitness, and mental health was not significant. Furthermore, independent t-test results showed that the 2 groups have no significant difference in sexual satisfaction (P = 0.000). Conclusions The findings indicated the higher effectiveness of methadone maintenance therapy in MMT group compared to Narcotics Anonymous. It can be stated that the lifestyle was partly modified due to the avoidance of substance abuse in methadone maintenance treatment.

Introduction: Allgrove’s syndrome (AS) is a rare cause of adrenal insufficiency inherited in an autosomal recessive pattern. Usually the disease is manifested during the first decade of life with severe hypoglycaemia, which can lead to sudden death. Case Presentation: Here we described two cases of Allgrove’s syndrome; the first case was an 8-year-old male admitted to hospital for evaluation of seizure and gait abnormality and the second case was a 4-year-old boy admitted for evaluation of hyperpigmentation of his skin and buccal mucosa for eight months, also we made a review of literature. Conclusions: Alacrima is considered to be the earliest clinical manifestation of Triple A syndrome and early recognition of glucocorticoid deficiency would prevent hypoglycaemic convulsions, neurological sequelae and death. A carful replacement of glucocorticoids is critical to avoid adrenal crisis and allow normal growth and development.