Showing papers in "Journal of medicine and life in 2015"

Hepatic hemangioma -review-.

Abstract: Hepatic hemangiomas are benign tumors of the liver consisting of clusters of blood-filled cavities, lined by endothelial cells, fed by the hepatic artery. The vast majority of HH are asymptomatic, most often being discovered incidentally during imaging investigations for various unrelated pathologies. Typical hemangiomas, the so-called capillary hemangiomas, range from a few mm to 3 cm, do not increase in size over time and therefore are unlikely to generate future symptomatology. Small (mm-3 cm) and medium (3 cm-10 cm) hemangiomas are well-defined lesions, requiring no active treatment beside regular follow-ups. However, the so-called giant liver hemangiomas, of up to 10 cm (most commonly) and even 20+ cm in size (according to occasional reports) can, and usually will develop symptoms and complications that require prompt surgical intervention or other kind of therapy. HH belong to the class of hepatic "incidentalomas", so-called because they are diagnosed incidentally, on imaging studies performed as routine examinations or for other reasons than the evaluation of a possible liver mass. Less than half of HH present with overt clinical symptoms, consisting, most often, of upper abdominal pain (this is usually the case for large lesions, which cause the distension of Glisson's capsule). Hepatic hemangiomas require a careful diagnosis to differentiate from other focal hepatic lesions, co-occurring diagnoses are also possible.

Actual data on epidemiological evolution and prevention endeavours regarding traumatic brain injury.

Abstract: Knowledge of the epidemiology of traumatic brain injury (TBI) is required both to prevent this disorder and to develop effective care and rehabilitation approaches for patients.The aim of this article is to find solutions to decrease the incidence of TBI and offer recommendations for their prevention.We analyzed epidemiological studies on TBI by performing a systematic review of literature, using information reported by different centers, collecting data on demographics, showing characteristics of TBI including incidence, identification of risk groups on differences in age, gender, geographical variation, severity and mortality.Studies suggest that the incidence of TBI is between 18 and 250 per 100,000 persons per year. Men and people living in social and economical deprived areas, usually young adults and the elderly are high-risk groups for TBI.Prevention remains the "key point" in medicine and especially for TBI, saving the patient from unnecessary often-harsh sufferance.Most public epidemiological data showed that TBI is a major cause of mortality and disability. The effort to understand TBI and the available strategies to treat this lesion, in order to improve clinical outcomes after TBI, may be based on an increase in research on the epidemiology of TBI. A coordinated strategy to evaluate this public health problem in Romania would first of all rely on a related advanced monitoring system, to provide precise information about the epidemiology, clinical and paraclinical data, but concerning the social and economic connected consequences, too.CNS = central nervous system, ED = emergency department, EU = European Union, FTE = Full Time Employees, GCS = Glasgow Coma Scale, TBI = traumatic brain injury, US = United States, WHO = World Health Organization.

Mesenchymal stem cells in multiple sclerosis - translation to clinical trials.

Abstract: Rationale. Home health care (HHC) has been developed more than any other industry in the past decade. Conflict between nurse and family can diminish the aid produced to the home care patients. Objective. This research was guidance to explore the nature of conflicts between the patient's families and nurses in homes of dangerous care patients, in an Iranian context. Methods and results. Using the qualitative comfortable study system and the purposive sampling, 15 participants including 7 nurses (4 males and 3 females) operating in houses and 8 members of family who had a care receiving mechanical ventilation at house, were interviewed during 2013 and 2014. The main sources of conflict were due to nurse expectations, family belief, and personal qualities of nurses. The team guider tried to prevent the conflict by different measures, but in some samples, the conflict arose. Both members of family and nurses accepted the team leader as the judge. At first, he tried to keep the situation stable and gave some notification to the nurse and some descriptions to the members of family. In some samples, that the family could not adapt to the position and efforts to solve the conflict were unsuccessful, the team relation with the family being cut. Conclusion. Home care situation is prone to conflict due to various factors. The mentioned sources of conflict in home trial were changed from the ones of the hospital. Based on these results appropriate interventions suitable for home conditions should be implemented.

The polycystic ovary syndrome: an update on metabolic and hormonal mechanisms.

Abstract: Polycystic ovary syndrome (PCOs) is a public health important disease, affecting one in five women at reproductive age. The clinical implications include reproductive, metabolic and psychological features. This article reviews the literature data related to the new metabolic and hormonal mechanisms in PCOs. Recognizing the real diagnostic of PCOs, using the right criteria, is a challenge in current practice.

Oxidative stress and alopecia areata.

Abstract: Alopecia areata (AA) is an inflammatory and autoimmune disease presenting with non-scarring hair loss. The aethiopathogenesis of alopecia areata is unclear and many factors including autoimmunity, genetic predisposition, emotional and environmental stress are thought to play important roles in its development. Antioxidant/ oxidant balance perturbation is a common feature in autoimmune, emotional and environmental stress. Therefore, our paper discusses the implications of oxidative stress in alopecia areata.

Brain-heart axis--Review Article.

Abstract: There has been a large confirmation over the last decades that stroke may produce cardiac changes (echocardiographic, electrocardiographic, enzymatic). In ischemic stroke, systolic dysfunction is associated with a high risk of mortality during hospitalization. A recent study demonstrated that cardiac diastolic dysfunction could also accompany acute stroke besides the systolic dysfunction already pointed out by previous studies, being a predictive marker of acute cerebrovascular events. Increased sympathetic activity is contributory, inducing a reversible cardiac myocyte damage and cardiac enzyme surges. Some of the most frequent electrocardiographic abnormalities in stroke are ST segment abnormalities and various tachyarrhythmias (especially atrial fibrillation) and bradyarrhythmias. One can infer the importance of careful and continuous electrocardiographic monitoring of the stroke patient in order to identify these quite frequent electrocardiographic alterations, as it is well known that death due to cardiac arrhythmias is common among acute stroke patients. In order to increase the diagnostic yield, a high level of NTproBNP (N-terminal of the prohormone brain natriuretic peptide) may be used as a discriminant for the patients with a higher probability of cardiac arrhythmias and mortality at presentation, during hospitalization and on the long term. In such patients, cardiac monitoring techniques are more likely to reveal abnormalities. A high BNP level may have potentially important management implications as it may signal a worse prognosis and may prompt the undertaking of certain therapeutic measures. This review summarizes the possible pathological mechanisms of heart-brain connections and their clinical and therapeutical implications.AF = atrial fibrillation, ECG = electrocardiography, HRV = heart rate variability, cTn = cardiac troponin, SAH = subarachnoid hemorrhage, CK-MB = creatine kinase-MB, BNP = brain natriuretic peptide, NT-proBNP = N-terminal of the prohormone brain natriuretic peptide, ANP = atrial natriuretic peptide, mRS = modified Rankin Scale, NIHSS = the National Institutes of Health Stroke Scale.

Fallopian tubes--literature review of anatomy and etiology in female infertility.

Abstract: Background. The objective of the present research is to establish the connection among the decent masters of the emotional empowerment perspectives of nurses in Imam Reza (AS) Kermanshah Hospital in 2015. Methods. The required information are gathered at the start of the towering utilization of the Internet search and library. Data relevant to the communication are gathered by using questionnaires. Standard information are gathered. The population of the research included all formal hospital-training nurses, meaning the persons responsible with the behaving of patients in Medical Sciences Kermanshah University, respectively 550. Based on the formula of the Cochran, 226 questionnaires were simple random Bayat samples; 219 surveys are delivered, used, and returned from the ultimate population. The accuracy and their confirmation are already under investigation and confirmation. Findings. The findings indicated a psychological association with the ethical leadership and the enabling nurses. There is also a clear (sig = .000). Moreover, there is a direct and clear link [sig = .000] between the moral leader and enabling the psychological views of the nurses. Discussion. Based on the results of the present research, it can be said that the master of morality led to the emotional empowerment of nurses. The moral evil leader of the yen means creating faith, work happiness, increased efficiency and it activates the effective organizational goals.

Preventing Medicine mistakes in pediatric and neonatal patients.

Abstract: Medicine mistakes are significant issues that happen in clinic environments. Several portions make the pediatric community extra sensitive to medicine faults, and possible complexities are rising from medicine board. These involve the various dosage forms of the identical medication availability, inaccurate dosing, absence of regulated dosing regimen, and process development. Electric information like EMBASE, MEDLINE, Global Pharmaceutical Abstracts, ASSIA, PsycINFO, British Nursing Index, CINAHL, were sleeked among 1985 and December 2014. Study choice Inclusion and exclusion standard are used to specify the eligible publications though title investigation followed by abstract and then full text investigation. Medicine mistakes were most often reported in pediatric and neonatal patients. This was in consensus with literature information about the occurrences in other specialties. Fatal or life-threatening harm because of medicine mistakes was not often reported. However, most studies reported that the possible for the cases impairment as an outcome of a mistake is a significant problem. Investigation of types and level of medicine faults might results in steps towards the prevention of these faults and the improvement in the neonatal care quality and safety.

Review of bacterial and viral zoonotic infections transmitted by dogs.

Abstract: Dogs are a major reservoir for zoonotic infections. Dogs transmit several viral and bacterial diseases to humans. Zoonotic diseases can be transmitted to human by infected saliva, aerosols, contaminated urine or feces and direct contact with the dog. Viral infections such as rabies and norovirus and bacterial infections including Pasteurella, Salmonella, Brucella, Yersinia enterocolitica, Campylobacter, Capnocytophaga, Bordetella bronchiseptica, Coxiella burnetii, Leptospira, Staphylococcus intermedius and Methicillin resistance staphylococcus aureus are the most common viral and bacterial zoonotic infections transmitted to humans by dogs. This review, focused on the mentioned infectious diseases by describing general information, signs and symptoms, transmission ways, prevention and treatment of the infection. As far as the infections are concerned, the increase of the knowledge and the awareness of dog owners and the general population regarding zoonotic infections could significantly mitigate zoonoses transmission and consequently their fatal complications.

On reactive oxygen species measurement in living systems.

Abstract: Studies devoted to the detection and measurement of free radicals in biological systems generally generated accepted methods of reactive oxygen species (ROS) level analysis. When out of control, ROS induces tissue damage, chronic inflammatory processes and cellular functional disturbances. Aerobic organisms have adapted to defense against ROS aggression by developing potent antioxidant mechanisms. Recent advances in ROS measurement methodology allow the study of ROS biology at a previously unachievable level of precision. However, their high activity, very short life span and extremely low concentration, make ROS measurement a challenging subject for researchers.

Recurrence after hepatic resection in colorectal cancer liver metastasis -Review article-.

Abstract: The outcomes and management of colorectal liver metastasis have undergone many changes. The incidence of recurrence after liver resection for hepatic metastasis remains very high. Liver resection, which provides the only curative treatment, is believed to have improved the long-term outcome of these patients. However, the management and outcomes of patients with colorectal liver metastasis have greatly improved in the last decade, suggesting that the current use of aggressive multimodality treatments, including surgical resection combined with modern chemotherapeutic regimens, effectively prolong the life expectancy of these patients.

Corneal neovascularization and biological therapy.

Abstract: Corneal avascularity is necessary for the preservation of optimal vision. The cornea maintains a dynamic balance between pro- and antiangiogenic factors that allows it to remain avascular under normal homeostatic conditions. Corneal neovascularization (NV) is a condition that can develop in response to inflammation, hypoxia, trauma, or limbal stem cell deficiency and it is a significant cause of blindness. New therapeutic options for diseases of the cornea and ocular surface are now being explored in experimental animals and clinical trials. Antibody based biologics are being tested for their ability to reduce blood and lymphatic vessel ingrowth into the cornea, and to reduce inflammation. Numerous studies have shown that biologics with specificity for VEGF A such as bevacizumab and ranibizumab (a recombinant antibody and an antibody fragment, respectively) or anti-tumor necrosis factor-α microantibody, are effective in the treatment of corneal neovascularization.

Low-frequency rTMS in patients with subacute ischemic stroke: clinical evaluation of short and long-term outcomes and neurophysiological assessment of cortical excitability

Abstract: Repetitive transcranial magnetic stimulation (rTMS) is used alone or in combination with physiotherapy for rehabilitation of stroke patients TMS mapping can also quantify the excitability of the motor area in both the ipsilesional (IL) and contralateral (CL) hemisphereThis study is the first to measure the dynamics of cortical excitability by TMS mapping before and after treatment with low-frequency (LF) rTMS in the contralesional hemisphere at three different timepoints Furthermore, the patients were clinically evaluated during the same visit as the mapping to establish both short and long-term outcomes after rTMS treatmentA total of 16 participants with acute ischemic stroke were assessed 10 days post-stroke by TMS mapping The patients were randomized into two equal groups: a real rTMS group and a sham group The rTMS group received LF-rTMS to the contralesional hemisphere for 10 days, starting on the first day after the first mapping Each subject was also evaluated by mapping on days 45 and 90 after stroke onset The primary clinical outcome measured was the Fugl-Meyer Assessment for Upper Extremity (FMA-UE) on days 10, 45 and 90 post-stroke At 10 days after stroke onset, both groups presented low excitability in the lesion side and high excitability in the non-affected side In the real rTMS group, at 45 days after stroke, a downward trend in the excitability of the contralesional hemisphere and an upward trend in the excitability of the lesioned side were observed At 90 days after stroke, a tendency toward balanced excitability between both hemispheres was observed In the sham group, at both 45 and 90 days, we observed increased excitability in the non-affected side compared to the side with the lesioned motor area At 45 days, the real rTMS group demonstrated a better recovery of the upper limb motor function than the sham group, but at 90 days, there was no significant difference between the two groupsThese results demonstrated that LF-rTMS treatment enhances rebalance of the excitability patterns in both hemispheres and led us to question the "one size fits all" approach widely used in rTMS interventionsAmax = maximum amplitude, Amean = AM = averaged amplitude, APB = abductor pollicis brevis, CL = contralesional, DTI = diffusion tensor imaging, EEG = electroencephalography, EMG = electromyography, FMA-UE = Fugl-Meyer Assessment for Upper Extremity, HS = hot spot, IHC = interhemispheric functional connectivity, IL = ipsilesional, LF-rTMS = low-frequency repetitive transcranial magnetic stimulation, MCA = middle cerebral artery, MEP(s) = motor evoked potential(s), NIBS = non-invasive brain stimulation, rMT = resting motor threshold, RP = responsive points, rTMS = repetitive transcranial magnetic stimulation, TMS = transcranial magnetic stimulation

Metformin-clinical pharmacology in PCOs.

Abstract: Oligo-anovulation, hyperandrogenism and insulin resistance characterizes polycystic ovary syndrome (PCOs) Metformin is the oldest insulin sensitizer used in the management of type 2 diabetes mellitus In PCOs, metformin decreases the serum lipids, androgen and insulin; induces ovulation and regular menstrual cycle; increases the pregnancy rate

Features of Polycystic Ovary Syndrome in adolescence.

Abstract: Rationale To elucidate the prepubertal risk factors associated with the development of Polycystic Ovary Syndrome (PCOS) and determine the special clinical manifestations of the syndrome in this transitional time of a woman's life Objective To propose therapeutic targets and regimens, not only to prevent the long-term complications of the syndrome, but also to improve the self-esteem of a young girl who matures into womanhood Methods and results A systematic review of literature was performed through electronic database searches (Pubmed, Medline and Embase) Studies published in English-language, peer-reviewed journals from 1996 to 2013 were included The selected studies focused on the risk factors, the unique features and treatment options of the PCOS in puberty The pathogenesis of the PCOS was hypothesized to be based on interactions between genetic and certain environmental factors The diagnosis was usually difficult in young girls The syndrome was related to a greater risk of future infertility, type II diabetes mellitus, the metabolic syndrome and cardiovascular disease Early treatment was crucial to prevent the long-term complications of the syndrome, especially infertility and cardiovascular disease Discussion The recognition of the early signs of PCOS during or even before adolescence is of great importance It is essential to establish the correct diagnosis for PCOS and rule out other causes of androgen excess in young women with hyperandrogenism The type of treatment applied should be considered on an individual basis Abbreviations PCOS = Polycystic Ovary Syndrome

Current endoscopic methods of radical therapy in early esophageal cancer.

Abstract: Background: Direct laryngoscopy (DL) is considered the most common method of tracheal intubation. On the other hand, evidence shows the growing role of video laryngoscopy in danger airway administration. Objectives: Due to the importance of a proper training to accomplish an accurate and fast intubation by the student of anesthesia, this research was conducted to assess the effects of DL and video laryngoscopy (Glidescope VL) training on the success rate of tracheal intubation by low-skill students. Materials/Patients and styles: 50 undergraduate students of anesthesiology took part in this randomized control educational intervention. Having no considerable experience in intubation, they were selected and divided randomly into two equal groups (n = 25); video-laryngoscopy via GlideScope VL and direct laryngoscopy (DL) via a Macintosh blade were prepared by the same experienced anesthesiologist. All the participants practiced intubation six times on the same mannequin within a routine airway situation. The maximum acceptable time for each intubation was 3 minutes and three times of successful intubation was considered as an appropriate intubation skill. The required time for laryngoscopy and intubation at each stage, the grade of glottis view, the reasons for an unsuccessful intubation and the amount of successful intubations were recorded and compared between groups. Results: There was a clear variation between the 2 teams, in all the steps, based on the required time for laryngoscopy and intubation (p = 0.0001). Data analysis was performed by using repeated measures data which demonstrated that the necessary time for laryngoscopy and intubation during the study was clearly lower in the GlideScope VL team (p = .0001). In first five rounds of training, the glottis view in the DL group was significantly better than in the VL group (p < 0.05). Conclusion: Based on the result of today' study, routine airway intubation by using GlideScope VL is significantly faster than direct laryngoscopy. It seems that further studies are needed to investigate the effect of the educational program on different laryngoscopy and intubation situations.

Genetic factors involves in intracranial aneurysms--actualities.

Abstract: Intracranial aneurysm (IA) is a common vascular disorder, which frequently leads to fatal vascular rupture leading to subarachnoid hemorrhage (SAH). Although various acquired risk factors associated with IAs have been identified, heritable conditions are associated with IAs formation but these syndromes account for less than 1% of all IAs in the population. Cerebral aneurysm disease is related to hemodynamic and genetic factors, associated with structural weakness in the arterial wall, which was acquired by a specific, often unknown, event. Possibly, the trigger moment of aneurysm formation may depend on the dynamic arterial growth, which is closely related to aging/ atherosclerosis. Genetic factors are known to have an important role in IA pathogenesis. Literature data provide complementary evidence that the variants on chromosomes 8q and 9p are associated with IA and that the risk of IA in patients with these variants is greatly increased with cigarette smoking. Intracranial aneurysms are acquired lesions (5-10% of the population). In comparison with sporadic aneurysms, familial aneurysms tend to be larger, more often located in the middle cerebral artery, and more likely to be multiple.DNA = deoxyribonucleic acid, FIA = familial Intracranial Aneurysm, GWAS = genome-wide association studies, IL-6 = interleukin-6, ISUIA = International Study of Unruptured Intracranial Aneurysms, IA = Intracranial aneurysm, mRNA = Messager ribonucleic acid, SNPs = single-nucleotide polymorphisms, SMCs = smooth muscle cells, sIAs = sporadic IAs, SAH = subarachnoid hemorrhage, TNF-α = tumor necrosis factor-alpha, COL4A1 = type IV collagen alpha-1.

Current therapies and mortality in acromegaly.

Abstract: Acromegaly is a rare disease most frequently due to a GH secreting pituitary adenoma. Without an appropriate therapy, life of patients with acromegaly can be shortened with ten years. Pituitary surgery is usually the first line therapy for GH secreting pituitary adenomas. A meta-analysis proved that mortality is much lower in operated patients, even uncured, than the entire group of patients and is similar with the general population in patients with GH 30% utilization of SRAs reported a lower mortality ratio than studies with lower percentages of SRA administration. Although therapy with DA has long been used in patients with acromegaly, there are no studies reporting its effect on mortality, but its efficacy is limited by the low remission rate obtained. The use of conventional external radiotherapy, although with good remission rate in time, was linked with increased mortality, mostly due to cerebrovascular diseases.Mortality in acromegaly can be reduced to expected levels from general population by using modern therapies either in monotherapy or by using multimodal approaches in experienced centers.

Prevalent osteoporotic fractures in 622 obese and non- obese menopausal women.

Abstract: Hypothesis. The osteoporotic fractures represent a worldwide economical issue. In order to prevent them, we need to understand the risk factors constellation. Although obesity was traditionally considered as protective against osteoporosis, recent data exposed an increased risk of falling and thus a high risk of some fractures. Objective. We aimed to analyze the body mass index (BMI) in relationship with the bone mineral density (BMD) and the prevalent fractures. Methods and Results. Between 2008 and 2014, a cross-sectional observational study included Romanian menopausal Caucasian women without a previous diagnosis of bone maladies, or specific anti-osteoporotic therapy. Prevalent fragility fractures were both self-declared and incidental vertebral. All the subjects had lumbar BMD (GE Lunar Prodigy DXA machine). Out of 622 females (mean age of 58.65 years, mean BMI of 30.30 kg/ m2), 39.22% were obese (BMI ≥ 30kg/ m2). The fracture prevalence was 1.35% versus 1.67% in obese versus non-obese patients. The correlation coefficient between lumbar BMD and BMI was r=0.165, p<0.005. BMI in the fracture group was 31.68 kg/ m2 vs. 30.04 kg/ m2 in the non-fracture group (p=0.08). 15.91% of the entire cohort had prevalent fractures. Obesity prevalence among females with fractures was 30.3% versus 40.73% in the non-fracture group. The most frequent sites were distal forearm (42.42%) and vertebral (21.21%). Discussions & Conclusions. Although the vertebral fractures might be underdiagnosed in our study and despite the fact that we enrolled a relatively young menopausal population, BMI positively correlated with BMD, regardless of the fractures' prevalence. In early menopause, the most frequent fracture is distal forearm. BMI is higher in patients with prevalent fractures vs. non-fractures (borderline significance). Obesity might not protect from any type of fracture but future evidence is necessary since one third of osteoporotic fractures are met in women with a BMI ≥ 30kg/ m2.

Sentinel lymph node biopsy (SLNB) vs. axillary lymph node dissection (ALND) in the current surgical treatment of early stage breast cancer.

Abstract: The identification and biopsy of the sentinel lymph node has become a standard method of treatment for stage I and II breast cancer in the last decades, taking into account the fact that the management of the axilla in patients with breast cancer has evolved from the routine lymphadenectomy to a selective attitude, based on the histopathological evaluation of the sentinel lymph node, as well as on the tumor and on the patients' characteristics. Since the introduction of the method into clinical practice, in 1994, different methods of identification have been used (radioisotope injection, vital blue dye, or, more recently, lipophilic contrast agent for ultrasound visualization or paramagnetic nanoparticles (NPs) or the method of indocyanine green fluorescence), each presenting certain limits, but the radioisotopic method proving the most accurate. Moreover, during the development of the method, beside the standard indications specific for T1 or T2 breast tumor, without clinical or imagistic axillary adenopathies, their extension to a series of other particular situations such as the following, has been tried: ductal carcinoma in situ, multicentre tumors, after excisional biopsy or tumors preoperatively treated by neoadjuvant chemotherapy. The aim of the paper is to present the progress made regarding the current stage in the use of sentinel lymph node technique in breast cancer, while mentioning the established indications, as well as the ones that are still debating and need further studies. Likewise, the cases in which the axillary lymph node dissection remains the major indication for treatment of the axilla, in patients with early stage breast cancer, will be discussed.

Congenital scoliosis: an up-to-date

Abstract: Congenital scoliosis represents a spinal malformation due to defects of formation, segmentation or mixed ones. It is characterized by a longitudinal and rotational imbalance. 54 patients were analyzed and 39 out of them were operated by various approaches with anterior and posterior instrumentations during 2000 and 2012. The impossibility to appoint some patients encountered in the daily practice into the known classifications, allowed us to purpose two categories of congenital scoliosis related to the predominance of spinal deviances in the coronal and transversal views. No certain etiology of congenital scoliosis has been identified until today. The susceptibility of some polygenic defects is obvious due to the presence of a sum of defects associated to most of the congenital scoliosis cases and the rarity of the presence of a unique defect. The diagnosis requires a thorough clinical and imaging examination in order to establish an individualized therapeutic strategy. The treatment of congenital scoliosis is different from the adolescent idiopathic one. Therapeutic criteria are significantly different. It is essential to assess the difference in growth of the concavity related to the convexity when choosing a particular procedure. The magnitude of the curve and the progressive rate are fundamental issues to the surgeon.

Competence of novice nurses: role of clinical work during studying.

Abstract: Aim: Clinical competence is to carry out the tasks with excellent results in a different of adjustments. According to various studies, one of the factors influencing clinical competence is work experience. This experience affects the integrity of students' learning experience and their practical skills. Many nursing students practice clinical work during their full-time studying. The aim of this qualitative research was to clarify the role of clinical work during studying in novice nurses' clinical competence. Methods: This qualitative content analysis performed with the conventional approach. All teaching hospitals of Hormozgan University of Medical Sciences selected as the research environment. To collect data, deep and semi-structured interviews, presence in the scene and manuscripts used. To provide feedback for the next release and the capacity of the data, interviews were transcribed verbatim immediately. Results: 45 newly-graduated nurses and head nurses between 23 and 40 with 1 to 18 years of experience participated in the study. After coding all interviews, 1250 original codes were derived. The themes extracted included: task rearing, personality rearing, knowledge rearing, and profession rearing roles of clinical work during studying. Conclusion: Working during studying can affect performance, personality, knowledge, and professional perspectives of novice nurses. Given the differences that may exist in clinical competencies of novice nurses with and without clinical work experience, it is important to pay more attention to this issue and emphasize on their learning in this period.

Acute anterior uveitis and other extra-articular manifestations of spondyloarthritis.

Abstract: Pseudomonas Aeruginosa is one of the leading opportunistic infectious agents especially in immune-suppressed patients such like burn victims. Carbapenems like Imipenem (IMP) and Meropenem (MEM) are the choice antimicrobial drugs, which used in the treatment of Penicillin and Aminoglycoside-resistant Pseudomonas Aeruginosa isolates. Based on the importance of the detection of infectious source and their resistance transfer algorithm have a main effect on the control of nosocomial infections this study designed for to consider the antibiotic sensitivity and the genetic pattern of Pseudomonas Aeruginosa isolate in burned patients hospitalized in Ghotbeddin Shirazi Hospital with RAPD-PCR technique. According to the Antibiogram results, the most sensitivity was related to the Gentamicin with 50% while the most resistant related to the Nalidixic Acid, Erythromycin, and Cefotaxime with 90% resistant to all. With RAPD-PCR technique used primers 272, 277 and 287 were detected 18, 15, and 11 algorithms respectively. RAPD-PCR is a genotyping method with a high efficiency and good for the study of bacterial epidemiology and polymorphism.

CT vs. MRCP in choledocholithiasis jaundice.

Abstract: Rationale Obstructive jaundice can raise problems to diagnostic imaging. The radiologist must choose the most appropriate examination that delivers the most important diagnostic information because the differences between a lithiasic obstruction and a tumoral one are vital. This information helps the surgeon speed up the process of decision-making, because the treatment may be very different in relation to the nature of the obstruction. Objective This study tries to demonstrate the diagnostic accuracy of computed tomography (CT) and magnetic resonance cholangiopancreatography (MRCP) in detecting the obstacle in the common bile duct (CBD) and the possibility of establishing the lithiasic nature of the obstruction. Methods and results A retrospective analysis was analyzed during an interval of 18 months that included jaundice patients admitted in the General Surgery Department of "Coltea" Clinical Hospital. They were examined by CT scanning and by MRCP, being suspected of choledocholithiasis. 63 patients were included in the study, 34 females and 29 males. 33 CT scans and 30 MRCP exams were performed. Discussion CT scan is useful in detecting residual or iterative choledocholithiasis in patients after cholecystectomy, contrast enhanced CT (CECT), being able to differentiate between lithiasic and non-lithiasic obstruction. MRCP delivers important anatomic details of the biliary tree; it is superior to CT in diagnosing the hepatocholedochal lithiasis; MRCP tends to replace endoscopic retrograde cholangiopancreatography (ERCP)--the diagnostic "gold standard" reducing the number of unnecessary invasive diagnostic procedures.

Impact of maternal melatonin suppression on forced swim and tail suspension behavioral despair tests in adult offspring.

Abstract: Melatonin is an essential hormone, which regulates circadian rhythms and has antioxidative and anticarcinogenic effects. As melatonin secretion is suppressed by light, this effect was examined on the offspring of the Wistar rat females exposed to continuous light (500 lux) during the second half of the pregnancy (day 12 to 21). Control rats were kept under a 12:12 light-dark cycle. The resulted male offspring have been behaviorally assessed for depression after postnatal day 60 by using Forced Swim Test (FST) and Tail Suspension Test (TST). Animals resulted from the melatonin deprived pregnancies have developed an abnormal response in the TST, but a normal FST behavior. Also, TST active movement was different in the melatonin suppression group compared to the control group. These findings suggest that intrauterine melatonin deprivation might be linked to the depressive like behavior in adult male offspring.

Morbidity after reversal of Hartmann operation: retrospective analysis of 56 patients.

Abstract: Background Despite patient selection, postoperative morbidity after reversal of Hartmann's procedure remains significant. Aim The objective of this study was to investigate risk factors associated with morbidity after conversion of Hartmann's operation. Patients and methods We retrospectively analyzed data of 56 patients who underwent reversal procedures between January 2004 and May 2015 in a single center. We evaluated the following variables: demographic characteristics, medical comorbidities, etiology for Hartmann operation, preoperative lab values, intraoperative surgical details and short-term outcomes (hospital stay, medical and surgical complications, mortality). Results There were 37 men (66.1%) and the mean age was 57 years. The most frequent indications for Hartmann's procedure were colorectal cancer in 25 patients (44.6%) and complicated diverticulitis in 10 patients (17.9%). The mean time to the reversal procedure was 9 months. Morbidity rate was 16.1% (9 patients) with an anastomotic leakage rate of 3.6% (2 patients) and mortality rate was 3.6% (2 patients). The most common medical complication was diarrhea (4 patients, 7.2%). Bivariate analysis demonstrated that the only factor significantly associated with postoperative complications was presence of multiple comorbidities. Conclusions Multiple medical comorbidities is the only predictive factor for postoperative complications after Hartmann's reversal and therefore patient selection for this type of surgery is critical.

Hepatoprotective effect of Zataria Multiflora Boisson cisplatin-induced oxidative stress in male rat.

Abstract: Background: This research aimed to evaluate the protective effects of methanolic extract of Zataria Multiflora Boiss (Z. Multiflora) against hepatic damage induced by cisplatin in male Wistar rats. Methods: Hepatotoxicity was induced in Wistar male rats by a single intraperitoneal administration of cisplatin, 7 g/ kg body weight. A methanolic extract of Z. Multiflora was administered orally at doses of 50 mg/ kg, 100 mg/ kg, 200 mg/ kg and 400 mg/ kg body weight daily for seven days after being cisplatin-induced. The study included the histopathological examination of the liver sections. The activity of aspartate transaminase (AST), alanine transaminase (ALT), and alkaline phosphatase (ALP) were evaluated as markers of liver damage. The superoxide dismutase (SOD), the activity of Catalase (CAT), and glutathione peroxidase (GSH-Px) and malondialdehyde (MDA) and nitric oxide (NO) content in serum were measured as an oxidative stress factor. Results: The results showed that rat treated with cisplatin resulted in a significant increase in serum activity, AST, ALT and ALP in treated mice. Management with Z. Multiflora reduced the business of these enzymes to nearly normal levels. In parallel with these changes, this extract reduced cisplatin-induced oxidative stress by inhibiting lipid peroxidation and protein carbonylation, and restoring the antioxidant enzyme (SOD, CAT, and GSH-Px) and elevation of the glutathione level. Conclusion: Biochemical and histological observations showed the hepatoprotective effect was found in a dose-dependent manner in Z. Multiflora methanolic extract. This protective effect can be attributed to the antioxidant compounds.

Clinical evolutional aspects of chronic subdural haematomas - literature review.

Abstract: Apparently trivial, one of the most frequent pathologies in neurosurgical practice, chronic subdural haematoma, continues to be a challenge for the neurosurgeons both from the therapeutic and postoperatory complications point of view, taking into account that it is frequently met in elders, who usually present a complex pathology. The fact that, by definition, there is a latent period between the moment the brain injury, usually minor, occurs and the appearance of clinical symptomatology, frequently makes the trauma be ignored, this complicating the diagnosis and most of the times delaying the application of the adequate treatment. Developing slowly in time, in weeks or months, the aspect that chronic subdural haematoma usually occurs in elders should not be neglected, its clinical symptomatology often debuting with memory and attention disorders, so that the patient is usually referred to psychiatrists or neurologists, only a paraclinical investigation (CT scan or MRI) being able to establish the diagnosis. Even the appearance of the lateral signs is subjected to many diagnosis confusions because patients deny the existence of a trauma in over 50% of the cases.

The role of self-efficacy and assertiveness in aggression among high-school students in Isfahan.

Abstract: Background. Nowadays, one sixth of the world's population is represented by adolescents, nearly 1.2 billion people being of age 10-19. According to the 2011 census in Iran, the estimation of adolescent population was 12 million, which represents 16% of the Iran population. Undoubtedly, adolescence is the most dominant stage of life. During this period, adolescents face biological, cognitive, and emotional changes that may be accompanied by inappropriate behavioral responses such as aggression. Considering pressures of peer groups during adolescence, assertiveness has an important role as a social skill. It seems that the success of adolescents in dealing with these problems depends on their self-efficacy. This study was designed to explore the role of self-efficacy and assertiveness in aggression among high-school students. Material and methods. This cross-sectional and correlational study was conducted among 321 first grade high-school students during 2014 and 2015. Samples were extracted from six education and training regions by a multi-stage random sampling. In this study, the questionnaire included demographic, Rathus Assertiveness, self-efficacy for children and aggression data. Results. The results showed that there was a notable negative association between aggression and assertiveness (p < 0.003) and also between assault and self-efficacy (p < 0.001). Conclusions. An increase in assertiveness and self-efficacy resulted in a decrease of aggression. So, training was recommended to reinforce self-efficacy beliefs and assertiveness behaviors for mental health promotion.

Current diagnosis and treatment of chronic subdural haematomas.

Abstract: A developed society is usually also characterized by an elderly population, which has a continuous percentage growth. This population frequently presents a cumulus of medical pathologies. With the development of the medication and surgical treatment of different affections, the life span has increased and the pathology of an old patient has diversified as far as the cumulus of various pathological diseases in the same person is concerned. Chronic subdural pathologies represent an affection frequently met in neurosurgery practice. Any neurosurgeon, neurologist and not only, has to be aware of the possibility of the existence of a chronic subdural haematoma, especially when the patient is old and is subjected to an anticoagulant or antiaggregant treatment, these 2 causes being by far the etiological factors most frequently met in chronic subdural haematomas. With an adequate diagnosis and treatment, usually surgical, the prognosis is favorable. Although the surgical treatment presents a categorical indication in most of the cases, the fact that there are many surgical techniques, a great relapse rate, as well as the numerous studies, which try to highlight the efficiency of a technique as compared to another, demonstrate that the treatment of these haematomas is far from reaching a consensus among the neurosurgeons. The latest conservatory treatment directions are still being studied and need many years to be confirmed.CT = computerized tomography, MRI = magnetic resonance imaging.