Showing papers in "Journal of medicine and life in 2018"

MALT lymphoma: epidemiology, clinical diagnosis and treatment.

Abstract: Primary gastric lymphoma (PGL) represents a rare pathology, which can be easily misdiagnosed because of unspecific symptoms of the digestive tract. Histologically, PGL can vary from indolent marginal zone B-cell lymphoma of the mucosa-associated lymphoid tissue (MALT) to aggressive diffuse large B-cell lymphoma (DLBCL). During the years, clinical trials revealed the important role of Helicobacter pylori (H. pylori) in the pathogenesis of gastric MALT lymphoma. Infection with Helicobacter pylori is an influential promoter of gastric lymphomagenesis initiation. Long-term studies revealed that eradication therapy could regress gastric lymphomas.

Hepatic hydatid cyst - diagnose and treatment algorithm.

Abstract: Introduction: the hydatic disease, caused by the larvae of Echinococcus granulosus, is a serious disease, potentially lethal, which can be found anywhere in the world, but especially in endemic areas such as the Mediterranean Basin, Australia, New Zealand, North Africa, Eastern Europe, the Balkans, Middle East and South America. The hydatic cyst is mainly found in the liver (75% of the cases), being asymptomatic in most cases and discovered accidentally on a routine abdominal ultrasound or an ultrasound performed for diagnosing other pathologies. The hepatic hydatid cyst therapy is multimodal, including medical, surgical, and, lately, minimally invasive techniques. Materials and methods: 88 patients were diagnosed with liver hydatid cyst at the General Surgery Clinic of the Colentina Hospital in Bucharest where they were admitted from January 2014 to July 2017. Data collection was realized by consulting the patients' observation sheets, followed by organizing a database of clinical, paraclinical and treatment parameters. Age, gender, place of origin, year and duration of admission, symptoms and signs at admission, paraclinical serological tests relevant for liver function and E. granulosus infection, imaging investigations performed and their results, type of treatment received and post-treatment progress with the complications that occurred were taken in account. Results: some of the results of the study showed some differences comparing to the data from specialty literature, the possible causes being the small number of patients, the paraclinical examinations that were not sufficiently detailed to allow the study of a phenomenon in all its complexity, the lack of information from the patients' first presentation to a doctor or from their previous admissions. Conclusions: patients with hepatic hydatid cyst form a heterogeneous group, semiology being poor and unspecific. Among the laboratory examinations, eosinophilia is a sign of concern but is present in less than half of the patients. Imaging findings are the basis for the diagnosis of hepatic hydatid cysts. Surgical treatment remains the "gold standard" in therapy, but minimally invasive methods with high applicability, less frequent complications and lower hospital requirements are starting to gain ground.

Work-related Musculoskeletal Disorders in Iranian Office Workers: Prevalence and Risk Factors.

Abstract: Objective: This study aimed to identify the prevalence of musculoskeletal disorders (MSDs) and ergonomic risks for Kerman University of Medical Sciences' office workers. Methods: The study sample comprised all office workers in the University and the sample included 129 women and 121 men. Data on MSDs were derived from the Nordic Musculoskeletal Questionnaire, while ergonomic data were collected through two direct observations via the rapid upper limb assessment (RULA) and the rapid office strain assessment (ROSA) method. Results: The results showed that the highest prevalence rates of MSDs were in the lower back (72.4%) and neck (55.2). Results of the postural assessment revealed that 68.8% of the participants' require "further investigation in order to modify their posture" and 27.6% need to "modify their posture soon." From the workstation analysis, the majority of the office workers were at a medium (55.2%) and high-risk level (27.6%). Results also revealed a significant association between some of MSDs in the lower back and neck with the RULA and ROSA score. Conclusions: Based on the results, for the prevention of MSDs, there should be ergonomics workshops for workers to be aware of ergonomics factors in the office. The ergonomics training must also be used in offices; the design of workstations should be improved.

Pistacia atlantica Desf. A review of its traditional uses, phytochemicals and pharmacology.

Abstract: Pistacia atlantica is the main herbal medicine that has been widely used in the Middle Eastern and Mediterranean areas since ancient time. Pistacia atlantica has been used for multiple purposes like stomach diseases, renal disorders, wounds and coughs. The aim of this study is to review its botanical characterization, traditional applications, photochemistry effects and pharmacological activities. Data in this review article was gathered from credible pharmacopeias, electronic databases such as Web of Science, Science Direct, PubMed, EMBASE, Scopus, EBSCO, Google Scholar, SID and Iran Medex and textbooks of Persian medicine such as Canon of medicine (Ibn-e Sina, 980-1037 AD) and Makhzan-al-Advia (Aghili, 18th century). The keywords were searched in Persian and English books on medicinal plants and traditional medicine. The results showed that P. atlantica has many medicinal properties such as antioxidant, antidiabetic, antihyperlipidemic, along with others. It can also be effective in gastrointestinal diseases. Thus, different new drugs can be formulated based on P. atlantica for the management of various diseases.

Respiratory sound analysis in the era of evidence-based medicine and the world of medicine 2.0.

Abstract: Objective This paper describes the state of the art, scientific publications, and ongoing research related to the methods of analysis of respiratory sounds. Methods and material Narrative review of the current medical and technological literature using Pubmed and personal experience. Results We outline the various techniques that are currently being used to collect auscultation sounds and provide a physical description of known pathological sounds for which automatic detection tools have been developed. Modern tools are based on artificial intelligence and techniques such as artificial neural networks, fuzzy systems, and genetic algorithms. Conclusion The next step will consist of finding new markers to increase the efficiency of decision-aiding algorithms and tools.

Interpersonal communication in healthcare.

Abstract: Taking into account that the medical practice and health systems have evolved considerably nowadays, medical establishments require the implementation of marketing guidelines to help maximize performance, with beneficial effects from the social, economic, and medical point of view, to differentiate from competitors. Communication is a fundamental clinical skill that, if performed competently and efficiently, facilitates the establishment of a relationship of trust between the medical staff and the patient-customer, a truly therapeutic alliance. In addition to the medical personnel's competence and the facilities at the doctor's disposal, the willingness manifested during consultation, kindness, openness and attention are offered to patients-customers. The way medical personnel responds to their needs and requests is an element that boosts performance, contributing to an increase in the prestige of the medical unit and the growing interest of patients-customers in it.

Effects of Aerobic Exercises on Serum Levels of Myonectin and Insulin Resistance in Obese and Overweight Women.

Abstract: Background and Aim: Obesity is associated with cardiovascular diseases, metabolic syndrome, and diabetes and insulin resistance. Myonectin is a myokine mostly secreted from skeletal muscles and inversely associated with obesity. The aim of the present study was to evaluate the effects of 8 weeks of aerobic exercises on serum levels of myonectin and insulin resistance in obese and overweight women. Materials and Methods: Eighty obese women were assigned to exercise (34) and control groups (46). The exercise program comprised three weekly 45-minute sessions of aerobic exercise training for 8 weeks that included running with 50-70% of maximum heart rate (first 2 weeks - 50%; second week - 60%; third week - 65%; and the last 2 weeks by 70% of maximum heart rate). Twenty-four hours before and after the training session, fasting myonectin serum levels were measured. ANCOVA was used to assess differences between the groups. Results: Serum levels of myonectin in the experimental group increased significantly (P=0.000); however, insulin resistance significantly decreased in the experimental group (P=0.000). Conclusion: Therefore, considering the role of myonectin in increasing fatty acid uptake, exercise training can play an essential role in decreasing obesity-related diseases and metabolic syndrome; this effect is partly related to the roles of myonectin. Therefore, the use of this type of exercise is recommended to reduce the risk of diseases associated with obesity and metabolic syndrome.

Nonalcoholic fatty liver disease: epidemiology, pathogenesis and therapeutic implications

Abstract: The increase of the prevalence of nonalcoholic fatty liver disease in the context of the explosive epidemy of obesity worldwide over the last decades and the emergence of new effective therapies for viral hepatitis has brought this entity to the forefront of hepatologist concerns. Today is a certainty that fatty liver can complicate with cirrhosis and hepatocellular carcinoma; moreover, nonalcoholic fatty liver disease is the main cause of cryptogenic cirrhosis and the second cause of liver transplantation. This review revises the epidemiology of the disease, brings forward some progress in pathogenesis and outlines the directions to be followed in nonalcoholic fatty liver disease prevention and therapy. Today, nonalcoholic fatty liver disease is considered to be the liver manifestation of metabolic syndome, with its same prevalence (20-30%). If the patients do not die through cardiovascular disease, it can lead to serious liver complications.

Assessing the Effect of Spiritual Intelligence Training on Spiritual Care Competency in Critical Care Nurses.

Abstract: Aim & Objective: Due to the importance of spiritual care as a part of holistic care, this study aimed to investigate the effect of spiritual intelligence training on the nurses' competence in spiritual care in critical care units. Methods: The study was performed on 82 nurses (40 in the experimental group and 42 in the control group). Participants were selected from critical care units of teaching hospitals affiliated to Lorestan University of Medical Sciences. The experimental group took part in eight sessions of spiritual intelligence training, held in the form of workshops. In the control group, no intervention was made. The scale for assessing nurses' competencies in spiritual care was completed before, immediately and one month after the sessions in two groups. Data analysis was performed using SPSS software version 15. Results: The results showed that spiritual intelligence training had a positive effect on nurses' competence in spiritual care. Also, 89% of the nurses who participated in the study had not been given any prior education regarding spiritual care. Nurses considered barriers to spiritual care including inadequate staff, cultural differences, high workload and lack of education on this subject. Conclusions: The present results showed that the training of spiritual intelligence could develop the nurses' competence in spiritual care. The development of spiritual care provided by nurses can result in various outcomes such as increased satisfaction with care in patients, reduced anxiety and symptoms of depression during hospitalization, reduced length of hospitalization and, in general, improved quality of life.

Green tea improves rat sperm quality and reduced cadmium chloride damage effect in spermatogenesis cycle.

Abstract: Introduction: Testicular tissue is part of the reproductive system that some mineral compounds such as cadmium chloride (CdCl2) destroy. Green tea (Camellia sinensis) extract can reduce the tissue damage caused by toxins due to its antioxidant properties. The aim of this study was to evaluate the effect of green tea extract on sperm quality in cadmium chloride toxicity. Materials and Methods: In the present study, male Wistar rats were allotted randomly into four groups, namely control group (C), CdCl2 (1.5mg/kg), GT 1.5% (w/v) and in combinationCdCl2+GT groups. CdCl2 was injected intraperitoneally (1.5 mg /kg) whereas the green tea extract was administrated orally. At 13, 25 and 49 days after treatment, the rats were euthanized and the reproductive organs (testes, epididymis) were excised and used for sperm analysis and histo-morphometric examinations. Results: The mean of the diameter of seminiferous tubes, the number of spermatogonia, Sertoli, Leydig cells and thickness of the germinal layer in the testis were significantly increased (P<0.05) in all groups compared to the CdCl2 group (P<0.05). Sperm motility, sperm count and testosterone were significantly decreased in the CdCl2 group compared to all groups of treatment (p<0.05). The mean of MDA was significantly increased in the CdCl2 group compared to other groups (p<0.05). Conclusion: Green tea has an antioxidant effect that reduces the effects of free oxygen radicals produced from toxins such as cadmium chloride. In addition, it could decrease lipid peroxidation of the cell membrane and ultimately prevent the destruction of tissues in the long run.

Assessment of Frequency and Causes of Medication Errors in Pediatrics and Emergency Wards of Teaching Hospitals Affiliated to Tehran University of Medical Sciences (24 Hospitals).

Abstract: Introduction and Objective: Medical errors and adverse events are among the major causes of avoidable deaths and costs incurred on health systems all over the world. Medical errors are among the main challenges threatening the safety of patients in all countries and one of the most common types of medical errors is medication errors. This study aimed to determine the frequency, type, and causes of medication errors in the emergency and pediatric wards of hospitals affiliated to Tehran University of Medical Sciences in 2017. Materials and Methods: This study was a cross-sectional descriptive study which was conducted on 423 nurses working in teaching hospitals affiliated to Tehran University of Medical Sciences in 2017. The subjects were selected using the stratified sampling method. A total of 49 teaching hospitals in Tehran are affiliated to Tehran University of Medical Sciences and they are divided into two groups of general and specialized hospitals. Of all, 10 general hospitals and 14 specialized hospitals were randomly selected. The required data was collected using a three-part questionnaire. Using the SPSS software (version 18), the collected data was analyzed by means of ANOVA, Pearson Correlation Coefficient, and t-test and the results were reported as frequency, percentage, mean, and standard deviation. Results: According to the results of this study, the mean total number of medication errors that occurred within one month in the pediatric and emergency wards was roughly 41.9 cases, as stated by the nurses. The mean number of medication errors was higher in men than in women. Also, the two variables of gender and the type of shift work were related to medication errors; specifically, it was higher first in the evening and night shifts and then in the morning and evening shifts, respectively. Also, the number was higher in night shifts than in the morning shifts. The most common types of medication errors were: administration of the drugs at the wrong time, using a wrong technique of administration, wrong dosage, forgetting the dosage of the drug, administrating additional doses, administrating the drug to a wrong patient, and following the oral orders of physicians. On the other hand, the most common causes of medication errors in clinical wards were the following: illegible physician orders, shortage of manpower and high workload, incomplete physician orders, the use of lookalike and sound-alike drugs, absence of pharmacist/pharmaceutical expert in the ward, lack of dosage forms appropriate for children, and lack of adequate training regarding drug therapy. Discussion and Conclusion: Considering the results of this study, it is necessary to reduce the workload and working hours of nurses, increase medical staff's awareness of the significance of medication errors, revise the existing techniques of drug prescription, and update the indices of human resource in hospitals. It is also necessary to correct the process of naming and selecting the dosage forms of drugs by the industry.

Effect of fennel vaginal cream on sexual function in postmenopausal women: A double blind randomized controlled trial.

Abstract: Objective: The aim of this study was to assess the effect of fennel on sexual function in postmenopausal women. It was a randomized controlled trial in 60 postmenopausal women with sexual dysfunction who were randomly assigned to two groups receiving either fennel vaginal cream (n=30) or placebo (n=30). Vaginal atrophy in the women was assessed using symptoms such as pallor, dryness, dyspareunia, itching and burning. The pH of the vagina and cytology of the vaginal mucosa were also measured at baseline and 8 weeks after the intervention. All participants were requested to fill out the Female Sexual Function Index (FSFI) at baseline and after 8 weeks. The intervention group was requested to use fennel vaginal cream (5 grams) every night, while the control group used placebo each night for 8 weeks. The data were analyzed using the independent t-test and Chi-square, Mann-Whitney and Wilcoxon tests. All areas of sexual function including arousal, lubrication, orgasm, sexual satisfaction and pain improved in both fennel and placebo groups after 8 weeks; however, the differences in the fennel group were more evident (p<0.05). The total FSFI score was significantly higher in the fennel group compared to the control group (8.2 ±9.4 and 8.03±10.36 before the intervention and changing to 33.79±0.7 and 18.99±1.09 after the intervention in the fennel and placebo groups, respectively; p<0.001). Discussion: According to our results, fennel vaginal cream is an effective means of improving sexual activity in postmenopausal women. The use of this product in women who have sexual dysfunction and contraindications for hormone therapy is recommended.

An investigation into the prevalence of cognitive impairment and the performance of older adults in Guilan province.

Abstract: Introduction: The escalating rate of old people with a functional impairment in Iran and the weakness of the family support due to the diminishing of family size have increased the demand for long-term care for the elderly with cognitive impairment (CI). Objective: The purpose of this research is to explore the frequency of cognitive impairment in the elderly and its association with their daily functional impairment and disability. Method: This is a cross-sectional and descriptive-analytic study conducted in 2016-2017. The study sample consisted of 393 elderly people who were 60 years old or older who live in of Guilan different counties. Samples were selected by using multi-stage cluster sampling. Subsequently, data were analyzed by using the Chi-square test and correlation and regression analysis conducted in SPSS 22. Results: It was observed that 4.3, 28.6, and 37% of the subjects suffered from severe, moderate, and mild cognitive impairment, respectively. Cognitive impairment had a significant relationship with daily functioning and activities requiring special tools. Moreover, cognitive impairment in women, people with low education, and those over 70 years old was more common, and the difference between them was significant (p <0.001). Also, disability was significantly greater in the elderly with cognitive impairment. Conclusion: Many old people need to be cared for after the appearance of cognitive impairment. Therefore, appropriate screening of cognitive impairments is conducive to early diagnosis and prevention of executive functioning problems.

The Level and Frequency of Faculty Incivility as Perceived by Nursing Students of Lorestan University of Medical Sciences.

Abstract: Background: Little evidence exists concerning students' perception of faculty incivility. Given the growing trend of incivility and the stressful nature of these behaviors, the present study aimed to investigate the level and frequency of faculty incivility as perceived by nursing students. Methods: A stratified random sample of 178 students from four nursing faculties of Lorestan University of Medical Sciences participated in the present cross-sectional study. The Incivility in Nursing Education-Revised Survey, consisting of 24 items, was used to investigate the prevalence and frequency of faculty incivility, and the mean and frequency of each item was calculated separately. The data were analyzed using descriptive and analytical statistics (chi-square, independent t-test and analysis of variance), and the significance level was set at 0.05. Results: Most of the participants were single, did not live in a dormitory, and ranged in age from 19 to 23. From their perspective, disrespect, physical threat, property damage, and physical violence were of paramount importance. 61.8% of them argued that they had "sometimes" and "always" experienced "unfair assessment" during the last year. Creating codes of behavior, enhancing awareness of civility, and developing and implementing policies for managing incivility were proposed as the most important strategies for improving civility. Conclusion: Faculty members should be prepared for establishing friendly and respectful relationships, effective teaching, and applying a reality-based assessment. Identifying different and prevalent kinds of faculty incivility and making faculty members aware of them paves the way for faculty members to rethink their performance

Health marketing and behavioral change: a review of the literature.

Abstract: Health marketing as a part of social marketing, must influence individuals, voluntarily, through various social programmes, in order to accept, reject, modify or abandon a behavior in favour of a healthier lifestyle. Acting on individual behavior change, social marketing can influence the behaviour of those who decide public policies, with positive effects in social change. In time, in order to understand and predict a behavior, a number of theories, models and tactics were developed with the aim to identify factors and mechanisms with the greatest impact in the changing process. Cognitive- social theories proved to be more effective, because they offer guidelines for conducting research in behavioral change.

Metastatic neuroendocrine pancreatic tumor - Case report.

Abstract: Rationale.Pancreatic neuroendocrine tumors (NETs) are rare neoplasms that develop from the endocrine tissues of the pancreas. They have a better overall prognosis than pancreatic adenocarcinoma. However, all commonly used classification systems reflect a separation between more indolent, well-differentiated tumors and far more aggressive poorly differentiated types that behave clinically more like small-cell carcinoma of the lung. Objective.To present the case of a 62-year-old man with an aggressive pancreatic NET, with liver, splenic and bone metastases who underwent multidisciplinary treatment including several lines of chemotherapy, somatostatin analogs and radiotherapy. Methods and Results.The patient is a smoker and an occasional drinker, known with type two diabetes mellitus (DM), receiving insulin therapy. He was diagnosed by contrast-enhanced computed tomography (CT) in January 2015 with a locally invasive pancreatic body mass, intraabdominal adenopathies and liver nodules, suggestive of metastases. Histopathological diagnosis was obtained through liver biopsy: neuroendocrine tumor with a 10-15% Ki67 proliferation index. Palliative chemotherapy with oxaliplatin and capecitabine was started in March 2015. In June 2015, Sandostatin LAR was added. In March 2016, he had progressive disease. Subsequently, in September 2016, bone metastasis was found within the T10 vertebra. He underwent radiotherapy for multiple bone metastases in February 2017. Progressive disease was again found during a CT examination in May 2017. His performance status has gradually worsened since then and he died in July 2017. Discussion.As a group, well-differentiated gastroenteropancreatic NETs are generally indolent malignancies with prolonged natural history. Intermediate-grade NETs have a slightly worse prognosis than low-grade tumors. Abbreviations: NETs - neuroendocrine tumors, NEC - neuroendocrine carcinoma, CT - computed tomography, MRI - magnetic resonance imaging, DM - diabetes mellitus, WHO - World Health Organisation, HCV - hepatitis C virus, CEA - carcinoembryonic antigen, AFP - alpha-fetoprotein, 5-HIAA - 5-Hydroxyindoleacetic acid, IHC - immunohistochemistry, EUS - endoscopic ultrasonography, EUS FNA - endoscopic ultrasonography with fine needle aspiration, CgA - chromogranin A, PRRT - peptide receptor radioligand therapy.

The role of anthropometric indices in the prediction of non-alcoholic fatty liver disease in the PERSIAN Guilan Cohort study (PGCS).

Abstract: Introduction: Non-alcoholic fatty liver disease (NAFLD) is an obesity-associated health problem that causes other liver diseases for the patient. Four anthropometric indices: body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR) were analyzed as NAFLD predictors in the present study. Methods: From the total number of individuals who referred to the PERSIAN Guilan Cohort study (PGCS) located in the north of Iran during the period of study, a total of 960 people were enrolled in the present study. NAFLD was diagnosed using through an abdominal ultrasound exam. Height, weight, WC, BMI, WHR and WHtR were later calculated. Chi-square, ANOVA and logistic regression analyses were used to analyze the risk factors. Results: Out of the 960 individuals who were enrolled in the study, 597 (62.2%) were male and 363 (37.8%) were female (with an average age of 47.21 ± 7.29 years). There was a significant relationship between weight and NAFLD (P<0.001). There was also a significant relationship between BMI (OR= 8.41; 95% CI = 5.59-12.75), WC (OR= 2.67; 95% CI = 2.05-3.48), WHR (OR= 3.84; 95% CI = 2.26-6.52), WHtR (OR= 28.53; 95% CI = 6.94-117.31) and NAFLD (P<0.001). The results of the logistic regression analysis showed that WHtR, BMI and WC were effective predictors for the risk of NAFLD while WHtR played a more important role in the prediction of NAFLD. Conclusion: Anthropometric indices, especially WHtR, as a simple screening tool, seem to be an important criterion for the detection of NAFLD.

The Impact of an Educational Program on Blood and Blood Products Transfusion on Nurses' Level of Knowledge and Performance.

Abstract: Objective and background: This study aimed to evaluate the impact of an educational program on blood and blood products transfusion on nurses' knowledge and performance in hospitals affiliated with Mashhad University of Medical Sciences. Method: The present study was a semi-experimental before-after study. We selected study participants through the simple random sampling method using sampling framework of all reference population. Data collection tool was a valid and reliable questionnaire. In order to evaluate the effect of the educational program on nurses' level of knowledge and practice, we asked them to fill out the questionnaires before and after the education course. We analyzed data using SPSS 22. Descriptive statistics such as frequency and percentages and analytical statistics such as Mann- Whitney, Wilcoxon and Kruskal-Wallis were used to report the results. The significance level of the p-value was assumed to be 0.05). Conclusion: Educational programs about blood transfusion can positively influence nurses' knowledge and performance. There is a need to improve nurses' knowledge and performance about the inadvertent side effects of blood transfusion.

The Relationship Between Vitamin D and Postpartum Depression in Reproductive-Aged Iranian Women.

Abstract: Background: The aim of this study was to evaluate the relationship between vitamin D and postpartum depression in reproductive-aged Iranian women. Methods and Results: This study was conducted on 120 women (60 with postpartum depression and 60 without) in Izeh, Iran. A socio-demographic questionnaire and Beck Depression Scale were used for data collection. The ELISA method was used for measuring 25-OH vitamin D (ng). The participants were classified according to their vitamin D level as follows: 25-OH-D 30ng/ml as normal. Data were analyzed using the independent t-test or Mann-Whitney test, chi-square and logistic regression test. The mean level of vitamin D of women with postpartum depression was lower than that in normal women (16.89±7.05 vs. 21.28±7.13, p=0.001). More than 53% of women with postpartum depression had vitamin D 20ng/ml were 3.30 times more likely to have postpartum depression (OR: 3.3, CI: 1.32-8.24, p= 0.01). Discussion: There is a significant relationship between a low level of vitamin D and postpartum depression among reproductive-aged Iranian women. Health policy makers should pay attention to the measuring vitamin D level as one of the primary tests of pregnant women.

The Effect of Life Skills Training on the Self-Management of Patients with Multiple Sclerosis.

Abstract: Background: Training sessions are the most common framework used to provide self-management for patients with multiple sclerosis Objective: This study was conducted to determine the effect of life skills training on the self-management of patients with multiple sclerosis. Findings showed that life skills training had a significant effect on the overall self-management score; thus, self-management of patients increased after training life skills (F = 25.1821, P <0.01). Materials and Methods: This semi-experimental study was conducted on 80 subjects with MS in the MS Society in Tehran (Iran) in 2016. The experimental group received four one-hour sessions of life skills training. The control group received routine care. Patients of both groups filled MS self-management (MSSM) scales at baseline and a month after the last training session. Independent t-test was used to compare findings between the two groups; pairwise t-test was used to compare results before and after the test. Covariance test was used to present the research results and data was analyzed by using SPSS21. Findings: Mean and standard deviation of age were 32.22±8.88 and 33.02±10.34 in the control and experimental groups, respectively. Results: Comparison of total self-management showed a significant difference between the control and experimental groups after receiving life skill training (P<0.01). Moreover, there was a significant difference in the mean of total self-management in the experimental group before and after the intervention; self-management increased after intervention (p-value<0.001). Conclusion: This study showed the positive effect of life skills training because its main goal is to prepare and help patients solve problems and deal with difficulties resulting from the disease. Therefore, life skill training is suggested for patients suffering from MS.

Effects of neuromuscular electrical stimulation in patients with heart failure - review.

Abstract: Research conducted in the last two decades suggests that neuromuscular electrical stimulation of the lower limb muscles (NMES) may be a "bridge" to conventional exercise or an alternative for patients with advanced chronic heart failure (CHF), non-compliant or non-responsive to physical training. Through stimulating the work of the skeletal muscles, NMES increases the functional capacity, muscle mass and endurance in patients with CHF. A beneficial effect of NMES on functional capacity, vascular endothelial function, quality of life and aerobic enzymes activity has been shown. A significant benefit of this novel therapy in heart failure is the fact that the procedure can be home-based, after prior guidance of the patient.

Determination of the Effects of Prone Position on Oxygenation in Patients with Acute Respiratory Failure Under Mechanical Ventilation in ICU.

Abstract: Introduction: Patients under mechanical ventilation are usually in the supine position due to various arterial/venous tubes attached to them. Although many studies emphasize the advantages of prone position for oxygenation, some studies enumerate its disadvantages. Objective: The aim of the present research was to determine the effect of prone position on oxygenation of patients with Acute Respiratory Failure (ARF) under mechanical ventilation in the Intensive Care Unit (ICU). Methods: The present study is a single-group clinical trial (pretest-posttest), which was performed in 2017 in Ahvaz, Iran. The population of the study included 58 patients with ARF under Mechanical Ventilation (MV) in ICU in the Golestan Hospital of Ahvaz City. Patients were asked to lie in a supine position for 2 hours, and their physiological signs were measured twice at one-hour intervals. Arterial Blood Gas was tested at the end of the second interval. Afterward, they lied in the prone position and their physiological signs were again measured twice at one-hour intervals and Arterial Blood Gas (ABG) was tested at the end of the second interval. Collected data were statically analyzed by SPSS v.22. Findings: The prone position had a significant relation to Oxygen Arterial Blood (Sao2) and Pressure of Arterial Oxygen (pao2), (p-value<0.05). Also, on days one and two, there was no significant relationship between the prone position and physiological signs; however, this relation was significant on day three (p-value<0.05). Conclusions: Results showed that the prone position improves sao2 and pao2 without adverse effect on physiological signs.

Gene polymorphisms of TNF-238G/A, TNF-308G/A, IL10-1082G/A, TNFAIP3, and MC4R and comorbidity occurrence in a Romanian population with psoriasis.

Abstract: Rationale.Psoriasis is a prevalent chronic inflammatory disease with worldwide distribution affecting approximately 2% of the Caucasian population. There have been many population- and family-based studies that agree on the strong genetic component of this disease. Several studies have investigated the relationship between cytokine gene polymorphisms, psoriasis, and the occurrence of comorbidities but their data are conflicting. Objective.This study examines cytokine gene single-nucleotide polymorphisms (SNPs) in the context of psoriasis and metabolic syndrome, with a focus on the occurrence of comorbidities in psoriasis patients. The working hypothesis is that particular SNPs may predispose to an accelerated disease course and more comorbidities in psoriasis patients. Methods:This cross-sectional study was carried out in 2016 in the Dermatology Department of "Elias" University Emergency Hospital, Bucharest and included 82 psoriasis patients. Several clinical and laboratory parameters were recorded, and the presence of metabolic syndrome (MetS) was noted. Using real-time PCR, we tested for the following SNPs: rs361525, rs1800629, rs1800896, rs610604, rs17782313. Results:Disease severity was not significantly influenced by any of the five studied SNPs. Gene polymorphism of rs17782313 was found to influence the occurrence of psoriatic arthritis. In these patients, rs610604 and rs17782313 polymorphisms were associated with the presence of diabetes mellitus. Furthermore, rs17782313 influenced the presence of obesity, heterozygotes being more at risk. Our data suggested that MetS occurred independently of the five studied SNPs. Discussion.The influence of certain cytokine gene polymorphisms on multiple organ systems is justification enough for further analysis of the genetic and molecular mechanisms of metabolic syndrome development in psoriasis patients. Abbreviations:single-nucleotide polymorphisms - SNPs, metabolic syndrome - MetS.

A review of cervical spine MRI in ALS patients.

Abstract: Rationale. In recent years, significant advances have been made on the subject of MRI examination techniques, which have opened new avenues of research regarding the spinal involvement in amyotrophic lateral sclerosis (ALS). Objective. Our objective was to compile and analyze the available literature data, concerning the MRI of the cervical spine in ALS, detailing the metrics and their significance in diagnosis and follow-up. Methods and results. We have conducted an extensive search on the subject using literature data published over the last fifteen years, correlating it with our own experience. In ALS, there is a permanent interest in developing new biomarkers that might be sensitive to spatial and temporal patterns of neurodegeneration, which will permit early diagnosis and hopefully lead to new therapeutic approaches. Both diffusion tensor imaging (DTI) and spinal cord morphometry (especially spinal atrophy) reflect different aspects of the disease and correlate with clinical deterioration. Newer approaches like inhomogeneous magnetization transfer (ihMTR) and multiparametric analysis seem to have better sensitivity, are more appropriate for follow-up, and lend themselves to prognostic conclusions. Discussion. We conclude that MRI is a constantly expanding field, a unique non-invasive tool with immense potential in evaluating the in vivo evolution of the neurodegenerative ALS process, both structurally and functionally, with high hopes for the future. Abbreviations: ALS - amyotrophic lateral sclerosis, UMN - upper motor neuron, LMN - lower motor neuron, EMG - electromyography, CST - cortico-spinal tract, FLAIR - fluid-attenuated inversion recovery, MND - motor neuron disease, DTI - Diffusion tensor imaging, FA - fractional anisotropy, MD - mean diffusivity, ihMTR - inhomogeneous magnetization transfer, fMRI - functional MRI.

Diagnostic Value of Oblique Coronal and Oblique Sagittal Magnetic Resonance Imaging (MRI) in Diagnosis of Anterior Cruciate Ligament (ACL) Tears.

Abstract: Introduction: Tears of the anterior cruciate ligament (ACL) are common among young athletes and diagnosis may be difficult especially in the young population. Therefore, finding a new method to increase the correct diagnosis is necessary. Materials and Methods: This double-blind prospective observational study was conducted on 51 patients with suspected ACL rupture. In this study, in addition to the standard protocols, the oblique-sagittal and oblique-coronal MRI were assessed and used in three different methods, including A method (orthogonal MRI protocol), B method (orthogonal MRI protocol and oblique-sagittal MRI), and C method (orthogonal MRI protocol and oblique-coronal MRI). Results: In detecting both complete and partial rupture of ACL, B method had highest diagnostic accuracy (kappa = 0.338, P=0.001), and after that, C method had acceptable accuracy (kappa = 0.292, P=0.011). In addition, in detecting a partial rupture of ACL, B method (kappa = 0.5, P<0.001), and C method had acceptable accuracy (kappa = 0.361, P=0.006). Meanwhile, in detecting a complete rupture of ACL, B method had the highest diagnostic accuracy (kappa = 0.898, P<0.001), and subsequently A method had significant accuracy (kappa = 0.812, P<0.001). Conclusions: Our results showed that the evaluation of ACL rupture by oblique-sagittal MRI in addition to orthogonal MRI protocol is accurate and with high sensitivity and specificity values. It allows to find abnormal images immediately with higher accuracy in the emergency department and more critically ill patients may benefit from the advantages of this imaging protocol.

Could Homeopathy Become An Alternative Therapy In Dengue Fever? An example Of 10 Case Studies.

Abstract: Background:Dengue fever is one of the most rampant epidemics in India of late and any therapy that may help limit the sickness and hospital admissions is worth considering. In India complementary and alternative medicine physicians are medically trained and hence have a role to play in delivery of public health. Case Series:We present a retrospective case series of 10 Indian patients who were diagnosed with dengue fever and treated exclusively with homeopathic remedies at Bangalore, India. This case series demonstrates with evidence of laboratory reports that even when the platelets dropped considerably there was good result without resorting to any other means. Conclusions:A need for further, larger studies is indicated by this evidence, to precisely define the role of homeopathy in treating dengue fever. This study also emphasises the importance of individualised treatment during an epidemic for favourable results with homeopathy. Abbreviations:DF: dengue fever, NS1: non-structural protein 1 antigen, IgG: immunoglobulin G, IgM: immunoglobulin M, +ve: positive, -ve: negative, WBC: white blood cells, RBC: red blood cells, ESR: erythrocyte sedimentation rate.

Long-term survival following neoadjuvant chemotherapy and concomitant radiochemotherapy in locally advanced cervical cancer: results of the Oncology Institute "Prof. Dr. Ion Chiricuta" experience.

Abstract: Objective:to analyze the efficiency of (NACT) followed by concurrent radiochemotherapy (RCT) in patients with locally advanced cervical cancer, 5-year overall, specific and disease-free survival and the prognostic factors correlated with the response and survival. Materials and methods:207 patients with cervical carcinoma stages IIB-IIIB, who received 2-4 cycles of neoadjuvant chemotherapy followed by concurrent chemoradiation were retrospectively analyzed for an objective response (OR), overall survival (OS), and disease-specific survival (DSS) rate. All patients received platinum-based NACT followed by concurrent RCT to a total dose (TD) of 46 Gy/pelvis when patients were evaluated for surgery. Patients with favorable parametrial response optionally underwent surgery. The rest of the patients continued radiochemotherapy exclusively. Results:The baseline characteristics were: median age at diagnosis - 52 years; 82% squamous and 12% adenocarcinoma histologies; 67 patients (32.4%) with FIGO stage IIB, 87 (42%) with stage IIIA and 53 (25.6%) with stage IIIB. The OR rate was 56.5% post-NACT and the complete response (CR) after exclusive RCT was 19.7% while pathological complete response (pCR) in patients that underwent surgery was 61.2%. The median follow-up was 58.3 months. Overall and disease-specific survivals at 5 years were 78% and 84%, respectively. The OS for stages IIB and IIIA was 84%, and 61% for stage IIIB while the DSS rates were 90% for stage IIB, 86% for stage IIIA and 72% for stage IIIB. The disease-free intervals (DFS) rates were 88%, 76% and 69% for stages IIB, IIIA and IIIB, respectively. Conclusions:Neoadjuvant chemotherapy followed by concurrent chemoradiation produces higher response rates and improvements in disease-specific survival and disease-free survival rates compared to RCT.

Molecular Analysis of katG Encoding Catalase-Peroxidase from Clinical Isolate of Isoniazid-Resistant Mycobacterium tuberculosis.

Abstract: Isoniazid (INH) is a drug for the treatment of tuberculosis in patients infected with Mycobacterium tuberculosis. The katG enzyme, or catalase-peroxidase, activates the pro-drug INH that is coded by the katG gene in M. tuberculosis. Mutations of the katG gene in M. tuberculosis are a major INH resistance mechanism. The M. tuberculosis clinical isolate R2 showed INH resistance at a high level of 10 µg/mL. However, the molecular basis for the resistance is unclear. The identification of a mutation in the katG gene of the clinical isolate R2 showed four mutations, i.e., C1061T, G1261 A, G1388T, G2161A, which correspond to the amino acid substitutions T354I, G421S, R463L, and V721M, respectively. The mutant katG gene, along with the wild-type were cloned, expressed and purified. The mutant enzyme showed 86.5% of catalase and 45% of peroxidase activities in comparison to the wild type. The substitutions of T354I and G421S in mutant katG R2 created significant instability in the adduct triad complex (Trp107-Tyr229-Met255), a part of the active site of the catalase-peroxidase enzyme in the model structure analysis. The events could be based on the high resistance of the clinical isolate R2 toward INH as the molecular basis.

Our 20-year experience with experimental colonic anastomotic healing

Abstract: Aim: To present our experience with experimental colonic anastomoses and compare it with the results of other experienced researchers. Materials and Method: The published experimental studies of our research group up to 1996, as well as results of other researchers in this field, are demonstrated and discussed. Different actions of administered substances on the anastomotic healing were compared and represented. Various chemotherapeutic agents were evaluated in experimental models without colorectal cancer as independent risk factors for the anastomotic healing. Moreover, numerous pharmaceutical agents such as steroids, immunomodulators, vasodilators and the use of fibrin glue are also assessed in detail. Results: Cytostatics, as well as steroids, impair the colonic anastomotic healing, but the combined administration of other agents can reverse this negative effect. Fibrin glue seems to protect the colonic anastomosis, while iloprost could be a potential candidate for further exploration in patient trials. Tacrolimus, despite its immunosuppressive action, seems to promote the anastomotic healing. This observation could be useful for patients with inflammatory bowel disease under tacrolimus therapy, who undergo a non-elective colectomy. Obstructive conditions predispose to anastomotic insufficiency, and therefore, substances to avoid this threatening complication are also assessed. Tacrolimus and iloprost showed a remarkable action against anastomotic leakage under artificially obstructive conditions. Conclusion: Further studies, especially in forms of clinical protocols, are necessary in order for these results to find their place in safe daily practice.

Clinico-epidemiological profile and redox imbalance of lung cancer patients in Algeria.

Abstract: Hypothesis: How are the epidemiologic repartition and the physiopathology of lung cancer (LC) in Algeria? Objective: Our study aimed to establish the clinico-epidemiological profile and evaluate redox imbalance in Algerian patients with LC. Methods and results: Our study concerned 94 Algerian patients with LC treated at two hospitals of Algiers, the capital of Algeria. The clinico-epidemiological profile was established. Moreover, the redox imbalance was evaluated by dosing oxidative stress (OS) parameters in tumor tissues and blood. We noted that the average age was 62.06 years, and 79 among the 94 patients were male, 94.59% of which were smokers. The most common histological type was adenocarcinoma (45.45% of cases), followed by squamous cell carcinoma (37.88%) small-cell carcinoma (4.86%) and other histological types (6.67%), while the most frequent clinical stage was IV (66.95 %). 23 of the 94 patients were exposed to particular risk factors such as masonry products, metal mechanics, coal smoke and so forth. In other respects, the OS parameters: NO (Nitrogen monoxide), AOPP (Advanced Oxidation Protein Products) and MDA (Malondialdehyde) were higher in tumor tissues compared to peritumoral stroma (control), unlike the catalase activity. Otherwise, AOPP and MDA were significantly higher in patients' blood than in healthy control blood, in contrast to the catalase activity. Discussion: The LC has a heterogeneous repartition regarding the sex, age, histological types, the smoking status and professional exposition to risk factors in the Algerian population. Moreover, the oxidative stress impacts the physiopathology of LC.