Caregiving consequences in cancer family caregivers: a narrative review of qualitative studies

Background

Cancer is a significant public health issue, causing various challenges for individuals affected by it. As cancer progresses, patients often become dependent on others for support. Family caregivers and members play a crucial role in the recovery and rehabilitation of these patients. However, caregivers themselves face numerous challenges throughout the course of their family member's illness. Exploring the experiences of family caregivers can inform long-term planning and supportive interventions to address their caregiving difficulties. This study reviews previous literature on caregiving outcomes.

Method

This study presents a narrative review of qualitative studies, analyzing a total of 23 articles. The results were extracted and organized into subcategories. After revision by the research team, main categories were identified. These categories encompass both positive and negative outcomes of caregiving.

Results

The findings of this review demonstrate that caring for a family member with cancer has significant implications for caregivers. These implications include: (A) Positive outcomes of caregiving (such as achieving self-management and balance, promoting kinship intimacy, finding meaning and purpose, and experiencing spiritual growth) and (B) Negative outcomes of caregiving (including care-related physical exhaustion, disruption of personal life plans, psycho-emotional consequences, and socio-economic burden).

Conclusion

The results of this study highlight the challenges faced by family caregivers and emphasize the importance of addressing their needs within the healthcare system. By providing support and attention to their well-being, caregivers can enhance their resilience and adaptability in managing caregiving difficulties.

Lithium and preventing chemotherapy-induced peripheral neuropathy in breast cancer patients: a placebo-controlled randomized clinical trial

BACKGROUND

Chemotherapy-induced peripheral neuropathy (CIPN) is a common adverse effect of some chemotherapy regimens. Lithium has been suggested for CIPN in some animal studies. We aimed to study lithium's preventive effect on CIPN in breast cancer patients treated with taxanes and platinum-based medications.

METHOD

A double-blind placebo-controlled randomized clinical trial (RCT) was implemented on 36 breast cancer patients in two equal-size groups by block randomization. Participants in both groups consumed daily tablets, either placebo or lithium (300 mg), for 5 days in each course of chemotherapy. The tablets were prescribed 1 day before the start of chemotherapy. The electromyography (EMG) and nerve-conduction-velocity (NCV) tests were achieved before the first chemotherapy, 3 and 9 months after the treatment. The changes and signs or symptoms of CIPN, such as numbness, tingling, freezing, sensitivity to touch, muscle weakness, fibrillation, and knee and elbow reflex disorders, were recorded by examination. The trend of outcome changes was compared between two groups during the 9 months of study.

RESULTS

In both groups, neurologic signs and symptoms were exacerbated during the first 3 months and improved up to the ninth month of study. Results showed significant changes of all EMG-NCV variables during the 9 months of research in each group (P < 0.001), but the interaction of time and group effect was not significant in none of those indices. All symptoms changed significantly over the study time (P < 0.001) without significant statistical difference between the two groups (P=0.352). No side effect was found during the study.

CONCLUSION

The study showed that 300 mg lithium prescription once daily for 5 days might not effectively prevent CIPN in breast cancer patients. Evaluation of lithium effect on CIPN on different cancers in future studies is suggested.

TRIAL REGISTRATION

Iranian Registry of Clinical Trials IRCT20160813029327N10 .  Registration date: May 16, 2018.

Impact of loganin on pro-inflammatory cytokines and depression- and anxiety-like behaviors in male diabetic rats

Behavioral disturbances are observed in most patients suffering from diabetes. According to some evidence, pro-inflammatory cytokines have a key role both in diabetes and behavioral disorders, such as anxiety and depression. In this study, the effect of chronic administration of loganin, as a bioflavonoid, was investigated on pro-inflammatory cytokines and depression- and anxiety-like behaviors in streptozotocin-induced diabetes in male Wistar rats. Blood levels of interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) were assessed by enzyme-linked immunosorbent assay method. Depression- and anxiety-like behaviors were evaluated by forced swimming test (FST), elevated plus maze (EPM), and open field test (OFT), respectively. Body weight was also measured before the interventions and after the experiments in all groups. Our findings show that loganin-treated animals had significantly lower serum concentrations of IL-6 and TNF-α compared with the diabetic group. In the EPM test, loganin treatment significantly increased the percentage of the open arm time and open arm entries. Moreover, loganin treatment significantly decreased the grooming time and restored distance traveled and center crossing in the OFT. However, it decreased immobility time in the FST. Loganin treatment also significantly restored body weight gain and attenuated blood glucose changes in the diabetic rats. These results indicate that loganin possibly alleviates depression- and anxiety-like behaviors associated with diabetes through lowering the blood glucose and pro-inflammatory cytokine levels. More research is required to show the exact mechanism of antidepressant and anxiolytic effects of loganin in diabetes.

Impact of loganin on pro-inflammatory cytokines and depression- and anxiety-like behaviors in male diabetic rats

Behavioral disturbances are observed in most patients suffering from diabetes. According to some evidence, pro-inflammatory cytokines have a key role both in diabetes and behavioral disorders, such as anxiety and depression. In this study, the effect of chronic administration of loganin, as a bioflavonoid, was investigated on pro-inflammatory cytokines and depression- and anxiety-like behaviors in streptozotocin-induced diabetes in male Wistar rats. Blood levels of interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) were assessed by enzyme-linked immunosorbent assay method. Depression- and anxiety-like behaviors were evaluated by forced swimming test (FST), elevated plus maze (EPM), and open field test (OFT), respectively. Body weight was also measured before the interventions and after the experiments in all groups. Our findings show that loganin-treated animals had significantly lower serum concentrations of IL-6 and TNF-α compared with the diabetic group. In the EPM test, loganin treatment significantly increased the percentage of the open arm time and open arm entries. Moreover, loganin treatment significantly decreased the grooming time and restored distance traveled and center crossing in the OFT. However, it decreased immobility time in the FST. Loganin treatment also significantly restored body weight gain and attenuated blood glucose changes in the diabetic rats. These results indicate that loganin possibly alleviates depression- and anxiety-like behaviors associated with diabetes through lowering the blood glucose and pro-inflammatory cytokine levels. More research is required to show the exact mechanism of antidepressant and anxiolytic effects of loganin in diabetes.

Removal of dye molecules from aqueous solution by carbon nanotubes and carbon nanotube functional groups: critical review

Scheme for the adsorption of dye molecules by CNTs and CNT functionality.

Identification of Visceral Leishmaniasis-Susceptible Areas using Spatial Modelling in Southern Caucasus

This study explores the application of spatial modelling techniques to generate susceptibility maps for a neglected zoonotic disease, visceral leishmaniasis (VL), in an endemic area in southern Caucasus that includes Iran, Armenia and Azerbaijan. The social and physical environment of southern Caucasus has been mainly characterized by the presence of several factors that are strongly associated with VL, which has caused a significant number of infections during the past decade. Three popular spatial modelling techniques, consisting of the weights of evidence, logistic regression and fuzzy logic methods, were evaluated and trained using a study area in north-western Iran where an inventory of highly infected areas and high-quality evidential factors was available. Model performance was assessed using the receiver-operating characteristic (ROC) approach. According to the results of these assessments, the fuzzy logic method with γ = 0.5 was chosen for the prediction of VL incidence in southern Caucasus. The susceptibility map generated using the fuzzy logic method indicated that VL followed a spatial pattern at the conjunction of the three countries, which suggests that the prevalence of VL in southern Caucasus is socio-ecologically dependent.

Efficacy and safety of permethrin 5% topical gel vs. placebo for rosacea: a double-blind randomized controlled clinical trial

BACKGROUND

Rosacea is a chronic, multifactorial, dermatological condition. Increased density of Demodex folliculorum mites in the skin of rosacea patients suggests a possible role for these mites in the pathophysiology of rosacea.

OBJECTIVE

To evaluate the effects of permethrin 5% topical gel vs. placebo on Demodex density (Dd) and clinical presentations of rosacea patients, and also to further refine the quantitative assessment of Dd in the non-invasive standard skin surface biopsy (SSSB).

METHODS

Twenty patients with bilateral papulopustular rosacea and ≥5 mites/cm² were enrolled in the study. Participants and physicians were blinded to the group assignments. Each patient applied permethrin on one side and placebo on the other side of the face twice daily for 12 weeks. SSSB and photography and Rosacea Clinical Scorecard of the National Rosacea Society were used to assess the patients at the baseline, 2nd, 5th, 8th, and 12th weeks for both sides of the face. Causality and severity of adverse drug reactions (ADRs) were assessed by WHO Scale and Hartwig Scale, respectively.

RESULTS

Dd was not significantly different between the two groups at the baseline. In both groups, Dd significantly decreased after 12 weeks compared to the baseline. At the end of the 12th week, the Dd in the permethrin group was significantly lower than the placebo group. Severity of the clinical presentations decreased in both groups at the end of week 12 in comparison to the baseline, particularly in the permethrin group. ADRs were all mild and in most cases unlikely related to permethrin.

CONCLUSION

Permethrin 5% gel can significantly reduce the Dd and severity of presentations in rosacea patients and can be a safe and effective option in the management of this chronic disorder. This new SSSB technique offers an easy, quick, inexpensive, and non-invasive sampling method proper for quantitative assessment of Dd.

Preparation and characterization of an AC–Fe3O4–Au hybrid for the simultaneous removal of Cd2+, Pb2+, Cr3+and Ni2+ions from aqueous solution via complexation with 2-((2,4-dichloro-benzylidene)-amino)-benzenethiol: Taguchi optimization

Activated carbon (AC) was magnetized with Fe₃O₄nanoparticles (AC–Fe₃O₄-NPs), loaded with Au nanoparticles (AC–Fe₃O₄–Au-NPs), modified with DBABT and applied for the ultrasound-assisted removal of Cd²⁺, Pb²⁺, Cr³⁺and Ni²⁺ionsviacomplexation with DBABT.

Comparison of nickel oxide and palladium nanoparticle loaded on activated carbon for efficient removal of methylene blue

Palladium nanoparticles (Pd-NPs) and nickel oxide nanoparticles (NiO-NPs) were synthesized and loaded on activated carbon (AC). This novel material successfully used for the removal of methylene blue (MB) dye from aqueous medium. Full characterization of both material using X-ray diffraction, transmission electron microscopy, scanning electron microscopy and Brunauer–Emmet–Teller analyses for Pd-NP show their high surface area (>1340 m2/g) and low pore size (<20 Å) and average particle size lower than 45 Å and for NiO-NP show their high surface area (>1316.1554 m2/g) and low pore size (<20 Å) and average particle size lower than 46 Å in addition to high reactive atom and presence of various functional groups. These unique properties make them possible for efficient removal of MB. In batch experimental set-up, optimum conditions for maximum removal of MB by both adsorbents were attained following searching effect of variables such as central composite design. The Langmuir isotherm was found to be highly recommended for fitting the experimental equilibrium data. The kinetic of adsorption of MB on both adsorbents strongly can be fitted by a combination of pseudo-second order and intraparticle diffusion pathway. The experimental result achieved in this article shows the superiority of Pd-NP-AC for MB removal than NiO-NP-AC, so the maximum adsorption capacities of Pd-NP-AC and NiO-NP-AC were 555.5 mg/g and 588.2 mg/g, respectively.

General anesthesia in cesarean sections: a prospective review of 465 cesarean sections performed under general anesthesia

BACKGROUND

In many countries, neuraxial blocks comprise the majority of anesthetics given for cesarean section. In Iran, however general anesthesia for cesarean section is prevalent. In our institution, the rate of general anesthesia for cesarean section is 39%, providing an opportunity to collect data regarding airway management in the parturients. We report on the outcomes of a series of patients who received general anesthesia for cesarean section.

METHODS

A prospective observational study was conducted in two university hospitals, with approximately 5,500 deliveries annually. Demographics and airway characteristics were recorded. Eight potential risk factors for difficult intubation (short neck, obesity, facial edema, swollen tongue, receding mandible, and single, missing or protruding maxillary incisors) were analyzed. Then, laryngoscopic view, difficulty at intubation, and major complications were recorded.

RESULTS

Data were obtained from 465 patients. There was a significant correlation between higher Mallampati score and both higher laryngoscopic view graded on the Cormack-Lehane system (P < 0.001) and difficulty at intubation (P-Value = 0.05). Emergency cesarean section was not associated with difficult intubation (P = 0.67). Multivariate analysis showed that receding mandible was the only potential risk factor for difficult tracheal intubation (P < 0.001) and removed short neck or protruding maxillary incisor which initially was powered as a risk factor by univariate analysis. A grade 3 laryngoscopic view was obtained in 15 cases (3.2%). There was no case of grade 4 view. There was only one failed intubation (0.2%), and 9 cases of very difficult intubation (1.9%).

CONCLUSION

General anesthesia for cesarean section is safe with minimal risk.

Acoustic resonance scattering from a multilayered cylindrical shell with imperfect bonding

The method of wave function expansion is adopted to study the three dimensional scattering of a time-harmonic plane progressive sound field obliquely incident upon a multi-layered hollow cylinder with interlaminar bonding imperfection. For the generality of solution, each layer is assumed to be cylindrically orthotropic. An approximate laminate model in the context of the modal state equations with variable coefficients along with the classical T-matrix solution technique is set up for each layer to solve for the unknown modal scattering and transmission coefficients. A linear spring model is used to describe the interlaminar adhesive bonding whose effects are incorporated into the global transfer matrix by introduction of proper interfacial transfer matrices. Following the classic acoustic resonance scattering theory (RST), the scattered field and response to surface waves are determined by constructing the partial waves and obtaining the non-resonance (backgrounds) and resonance components. The solution is first used to investigate the effect of interlayer imperfection of an air-filled and water submerged bilaminate aluminium cylindrical shell on the resonances associated with various modes of wave propagation (i.e., symmetric/asymmetric Lamb waves, fluid-borne A-type waves, Rayleigh and Whispering Gallery waves) appearing in the backscattered spectrum, according to their polarization and state of stress. An illustrative numerical example is also given for a multi-layered (five-layered) cylindrical shell for which the stiffness of the adhesive interlayers is artificially varied. The sensitivity of resonance frequencies associated with higher mode numbers to the stiffness coefficients is demonstrated to be a good measure of the bonding strength. Limiting cases are considered and fair agreements with solutions available in the literature are established.

Acoustic scattering characteristics of a thick-walled orthotropic cylindrical shell at oblique incidence

The method of wave function expansion is adopted to study the scattering of a plane harmonic acoustic wave incident at an arbitrary angle upon an arbitrarily thick cylindrically orthotropic homogeneous cylindrical shell submerged in and filled with compressible ideal fluids. A laminate approximate model and the so-called state space formulation in conjunction with the classical transfer matrix (T-matrix) approach are employed to present an analytical solution based on the three-dimensional exact equations of anisotropic elasticity. The solution is used to correlate the perturbation in the material elastic constants of an air-filled and water-submerged aluminium cylindrical shell to the sensitivity of resonances associated with various modes of wave propagation appearing in the backscattered amplitude spectrum (i.e., axially guided, Lamb, Rayleigh and Whispering Gallery waves). The effects of shell wall thickness as well as inner fluid loading on the frequency response of the shell are also examined. A limiting case is considered and good agreement with the solution available in the literature is obtained.

Development of immunoaffinity solid phase microextraction probes for analysis of sub ng/mL concentrations of 7-aminoflunitrazepam in urine

We report on the development of solid phase microextraction probes for drug analysis, prepared with antibodies specific for benzodiazepines covalently immobilized to the surface. In the technique, immobilized antibody probes are exposed to a sample containing the drug for 30 min. Extracted drugs are subsequently desorbed from the probes in 500 microL of methanolic desorption solution, which is dried, reconstituted in a small volume of injection solution and analysed by LC-MS/MS. The antibodies were characterized both before and after immobilization, to facilitate the rational selection of antibodies for such analyses. Polyclonal and monoclonal antibodies were compared as was the impact of affinity purification of the polyclonal antibody to isolate the drug-specific fraction. The probes were evaluated for utility in analyzing 7-aminoflunitrazepam at sub ng/mL concentrations in urine, which is expected to be found several days after a single oral dose of 2 mg of flunitrazepam. Such analyses are required in monitoring for abuse of this drug, both in terms of 'club drug' use and in cases of drug-facilitated sexual assault. In these cases drug concentrations in blood and urine are much lower than in chronic abuse cases and are difficult to analyse by conventional methods. The method developed has a limit of detection of 0.02 ng/mL, with accuracy ranging from 1% to 27% and precision (% R.S.D.) ranging from 2% to 10% between the lower and upper limits of quantitation for the analysis of 7-aminoflunitrazepam in urine. The dynamic range of the method is from 0.02 ng/mL, which is limited by the instrument sensitivity, to 0.5 ng/mL, which is approaching the capacity of the probes. This would allow for quantitative analysis of samples at concentrations below that measurable by many other methods for general benzodiazepines analysis from urine, and a highly selective screen for samples at higher concentrations. The method has similar limits of detection to the most sensitive literature methods specifically designed for such analysis but with the advantage of significantly simplified sample preparation. This simplification makes the technique more amenable for use by both professionals and non-professionals.

Preparation and Characterization of a Monoclonal Antibody Against Mannoprotein ofCandida albicans

BALB/c mice were immunized via injection with whole cell of Candida albicans serotype A. The spleens were fused with myeloma cells of SP2/0 origin. A mannoprotein-reactive monoclonal antibody (MAb) was selected and characterized by ELISA technique. This MAb reacted with strains of Candida such as C. albicans, C. tropicalis, and C. albicans of the Persian Type Culture Collection (PTCC). However, our antibody did not react with other Candida species such as C. parapsilosis, C. glabrata, C. stellatoidae, C. lusitania, C. krusei, and S. cervisiae. These antibodies also did not recognize extracts of other fungal species such as Aspergillus fumigatus and Aspergillus flavus, and bacterial strains such as Staphylococcus aureus and Pseudomonas aeruginosa. Polyclonal antibody produced in this study could not differentiate the above species and was reactive towards all fungal species mentioned above except bacterial strains of S. aureus and P. aeruginosa. Western blot analysis of ligand affinity-purified mannoproteins of C. albicans wall protein using this MAb showed reactivity toward a single protein band in the region of 55-65 kDa molecular weight. The same antibody, when examined with unpurified C. albicans extract, reacted with a broad band in the region of 55-105 kDa, which we concluded was due to a possible different glycosylation pattern of mannoprotein in crude extract in which the higher molecular weight protein was eliminated by ligand-binding affinity purification.

Preconcentration of chromium (III) and speciation of chromium by electrothermal atomic absorption spectrometry using cellulose adsorbent

A simple and sensitive method has been developed for species selective determination of chromium(III) and chromium(VI) in water by electrothermal atomic absorption spectrometry. The procedure is based on selective absorption of Cr(III) on a cellulose micro column (pH 11, 0.5 mol L(-1) NaCl). Total chromium was subsequently determined after appropriate reduction of Cr(VI) to Cr(III). Recoveries of more than 97% were found. A concentration factor of 100 was achieved. The relative standard deviations (n=10) at the 40 ng L(-1) level for chromium(III) and chromium(VI) were 2.3% and 1.8% and corresponding limits of detection (based on 36) were 1.8 ng L(-1) and 5.1 ng L(-1), respectively. No interference effects have been observed from other investigated species and the method has been successfully applied to natural water samples.

Separation and Spectrophotometric Determination of Uranium in Caspian Sea Water

Samples of Caspian sea water (from the Islamic Republic of Iran) were collected from a range of depths, up to 400 m, at 10 stations; uranium is successfully separated using a flotation technique and determined spectrophotometrically at 650 nm using arsenazo(III) as complexing reagent.

Hormonal regulation of interstitial collagenase in the uterine cervix of the pregnant guinea pig

The uterine cervix is a hormonally responsive organ whose function is tightly regulated during pregnancy. Interstitial collagenase is believed to play a key role in the mechanism of cervical dilatation. This study examines the hormonal regulation of procollagenase gene expression in primary monolayer cell cultures derived from cervices of 50-day pregnant guinea pigs. Procollagenase production was constitutive in these cells. Activity was stimulated up to 2-fold by interleukin 1 beta, 17 beta-estradiol, and estrone. The effect of estradiol was completely inhibited by indomethacin and the estrogen antagonist, tamoxifen. The endogenous and the stimulated procollagenase were completely blocked by cycloheximide and by actinomycin D, indicating the need for protein and messenger RNA (mRNA) synthesis, respectively. Progesterone and 17-OH progesterone also stimulated procollagenase production at physiological concentrations (10(-8) M). The stimulatory effect of progesterone was blocked by the antiprogesterone RU38486. Procollagenase mRNA was stimulated by interleukin 1 beta (5 U/ml) and by 17 beta-estradiol (10(-10)-10(-8) M) and progesterone (10(-8) M). But progesterone at 10(-4) M completely blocked the stimulatory effect of 17 beta-estradiol on procollagenase mRNA. Increased availability of prostaglandins by mobilization of arachidonic acid by phospholipase A2 or by the addition of prostaglandin F2 alpha and prostaglandin E2 resulted in a 2-fold increase in procollagenase activity in culture media. These studies demonstrate that procollagenase gene expression is hormonally controlled in the cervix of pregnant guinea pig.

Beta-sympathomimetic agents: use in perinatal obstetrics

Beta-sympathomimetic agents are used extensively in obstetrics to inhibit premature labor. Knowledge of the pharmacology, mode of action on smooth muscle, and cardiovascular and metabolic side effects of these agents is essential for the obstetrician and perinatologist. This review article draws extensively on recent animal research data to explain mechanisms of action and long-term effects of beta-sympathomimetic agents.

High levels of serum collagenase in premature labor--a potential biochemical marker

An improved sensitive assay for collagenase, which uses [3H]telopeptide-free collagen as a substrate, was used to measure changes in serum collagenase levels in 96 women and ten men (18-35 years old). Both latent and active forms of collagenase were detected in serum by molecular sieve chromatography; these forms had a relative molecular weight (Mr) of 65,000 and 45,000, respectively. Only latent collagenase was detected in crude serum after destroying inhibitors by treatment with 3 M potassium thiocyanate. Collagenase levels in males were lower than in nongravid females (34 +/- 5 versus 53 +/- 5 U/dL; mean +/- SEM; 1 unit = 1 microgram collagen digested per minute at 30C). During pregnancy there was no significant change in serum collagenase levels until the onset of spontaneous labor in full-term pregnancies (37-42 weeks), at which point there was a 66% increase over the nongravid level to a value of 88 +/- 5 U/dL. There was a further rise at one day postpartum, and high levels continued for at least four days. Women in premature labor (24-36 weeks) exhibited an eightfold increase in the level of serum collagenase to 405 +/- 110 U/dL; 16 of 17 patients in this group had collagenase levels above the 95th percentile for women at 16-40 weeks but not in labor. This evaluation of serum collagenase may provide a key for detecting premature labor. It is suggested that the increase in serum collagenase arises from the lower uterine segment and cervix.

Rise in serum levels of PZ-peptidase, an enzyme involved in collagen breakdown, in human pregnancy and labor

PZ-Peptidase is an enzyme capable of cleaving small peptides that are produced during the metabolic breakdown of collagen. It is conveniently assayed by use of the synthetic peptide 4-phenylazobenzyl-oxycarbonyl-L-prolyl-L-leucyl-glycyl-L-pro lyl-D-arginine. An improved assay is reported which permits measurements of small amounts of this enzyme in 0.1 ml of serum. The enzyme activity in serum was found to rise from 1.3 U/L (1 U = 1 mumol cleaved per minute) in nongravid patients to 4.0 U/L in patients at term, who display no objective or subjective signs of labor. Patients in active labor show a further elevation of activity to 6.5 U/L. These results are believed to reflect changes in collagen metabolism related to remodeling of the uterus and skeleton in pregnancy and to cervical dilatation and placental separation at the time of labor.