Long-Term Effects of Opium Consumption Following Percutaneous Coronary Intervention: A 10-year Follow-Up Study

Background

Opium consumption has been an overlooked health issue in the Iranian population, and the prognostic role of opium consumption in patients undergoing coronary revascularization is unknown.

Hypothesis

We aimed to assess the association between opium consumption and long-term cardiovascular outcomes after percutaneous coronary intervention (PCI).

Methods

We screened 2203 consecutive patients who underwent elective PCI between April 2009 and April 2010 at Tehran Heart Center. Exclusion criteria were unsuccessful PCI, non-elective PCI, and missing opium use data. Opium consumption was defined as self-reported ever use of any traditional opium substances. Outcomes of interest were all-cause mortality and a composite of major adverse cardiac and cerebrovascular events (MACCE). The association between opium use and study outcomes was evaluated using the inverse probability of treatment weighting (IPTW) method. Cumulative hazard curves were demonstrated to further assess the association visually. Furthermore, the effect of opium consumption on individual components of MACCE was evaluated in a competing risk setting.

Results

A total of 2025 elective PCI patients were included (age: 58.7 ± 10.67, 29.1% women), among whom 297 (14.6%) patients were opium users. After a median follow-up of 10.7 years, opium consumption was associated with a higher risk of all-cause mortality (IPTW-hazard ratio [HR] = 1.705, 95% CI: 1.125-2.585; P = 0.012) and MACCE (IPTW-HR = 1.578, 95% CI: 1.156-2.153; P = 0.004). The assessment of MACCE components suggested a non-significant borderline trend for higher non-fatal myocardial infarction (IPTW-sub-distribution HR [SHR] = 1.731, 95% CI: 0.928-3.231; P = 0.084) and mortality (IPTW-SHR = 1.441, 95% CI: 0.884-2.351; P = 0.143) among opium users.

Conclusions

Opium consumption is associated with a more than 50% increase in long-term risk of mortality and MACCE in patients undergoing PCI. These findings accentuate the importance of preventive strategies to quit opium addiction in this population.

The role of BAFF and BAFF-R inhibitors in the treatment of immune thrombocytopenia; a focused review

Immune thrombocytopenia (ITP) is an autoimmune-driven disease characterized by increased destruction and impaired platelet production resulting in an enhanced risk of bleeding. Immunosuppressant agents are the most common treatment strategies for ITP. Despite their efficacy, these medications often cause unpredictable side effects. Recent investigations revealed that patients with ITP exhibit elevated B-cell activating factor (BAFF) levels in both their spleens and serum. Belimumab, a BAFF inhibitor, illustrated a promising therapeutic avenue for managing ITP by interfering with BAFF activity and long-lived plasma cell production. Both clinical and experimental studies have yielded positive outcomes when combining rituximab with an anti-BAFF monoclonal antibody in treating ITP. In addition, ianalumab, a monoclonal antibody with a dual mechanism that targets BAFF-R and deletes peripheral BAFF-R+ B cells, is currently being used for ITP treatment [NCT05885555]. The upcoming results from novel BAFF inhibitors, such as ianalumab, could offer clinicians an additional therapeutic option for treating ITP.

Platelet-rich plasma as a new and successful treatment for lichen planopilaris: A controlled blinded randomized clinical trial

INTRODUCTION

Lichen planopilaris (LPP) is one of the most common causes of scarring hair loss caused by immune-mediated inflammation resulting in atrophy and scaling. The key to preventing this irreversible hair loss is diagnosing and starting treatment at the earliest possible stage. As there is no definite cure for LPP, the therapy could be challenging. In the study, we conducted a single-blinded randomized clinical trial to evaluate the therapeutic effects, safety, and tolerability of platelet-rich plasma versus topical clobetasol in the treatment of LPP.

METHOD

A randomized single-blinded controlled clinical trial was conducted in 24 LPP patients referring to our dermatology clinic between August 2022 and March 2023. Patients in the control group were treated with topical clobetasol 0.05% applied at night, and patients in the case group, in addition to topical clobetasol, received three sessions of PRP injection monthly. Both groups were assessed 1, 2, and 6 months after the start of the study by the Lichen Planopilaris Activity Index (LPPAI), physician and patient satisfaction, tolerability, and recording adverse effects.

RESULTS

The average age in the clobetasol and PRP groups was 43.75 ± 13.51 and 42.75 ± 9.67, respectively (p = 0.83). In terms of gender, all 12 cases (100%) in the clobetasol group and 9 cases (75%) in the PRP group were female (p = 0.21). Both PRP and topical clobetasol effectively reduced LPPAI in the first 2 months; however, after 6 months, the LPPAI significantly increased in the clobetasol group (p = 0.001). There were no significant differences in LPPAI between the two groups at the beginning of the study and after 1 month. However, the mean LPPAI score in the clobetasol group was significantly higher than in the PRP group at 2 and 6 months after the start of the study (p = 0.01). Patient satisfaction with treatment increased in both groups during follow-up sessions, but at the end of the follow-up period, it was significantly higher in the PRP group (p = 0.03). Finally, the study did not have any serious adverse effects, and the pain experienced during PRP injection was tolerable for the patients. Overall, treatment tolerability was excellent in both groups.

CONCLUSION

Given the different efficacy profiles, PRP could be considered a new and effective choice for the treatment of LPP.

Fabrication and multiscale modeling of polycaprolactone/amniotic membrane electrospun nanofiber scaffolds for wound healing

BACKGROUND

Enhancing the efficiency of cell-based skin tissue engineering (TE) approaches is possible via designing electrospun scaffolds possessing natural materials like amniotic membrane (AM) with wound healing characteristics. Concentrating on this aim, we fabricated innovative polycaprolactone (PCL)/AM scaffolds through the electrospinning process.

METHODS

The manufactured structures were characterized by employing scanning electron microscope (SEM), attenuated total reflection-Fourier transform infrared (ATR-FTIR) spectroscopy, tensile testing, Bradford protein assay, etc. In addition, the mechanical properties of scaffolds were simulated by the multiscale modeling method.

RESULTS

As a result of conducting various tests, it was concluded that the uniformity and distribution of fibers decreased with an increase in the amniotic content. Furthermore, PCL-AM scaffolds contained amniotic and PCL characteristic bands. In the case of protein release, greater content of AM led to the release of higher amounts of collagen. Tensile testing revealed that scaffolds' ultimate strength increased when the AM content augmented. The multiscale modeling demonstrated that the scaffold had elastoplastic behavior. In order to assess cellular attachment, viability, and differentiation, human adipose-derived stem cells (ASCs) were seeded on the scaffolds. In this regard, SEM and 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-2H-tetrazolium bromide (MTT) assays showed significant cellular proliferation and viability on the proposed scaffolds, and these analyses illustrated that higher cell survival and adhesion could be achieved when scaffolds possessed a larger amount of AM. After 21 days of cultivation, particular keratinocyte markers, such as keratin I and involucrin, were identified through utilizing immunofluorescence and real-time polymerase chain reaction (PCR) tests. The markers' expressions were higher in the PCL-AM scaffold with a ratio of 90:10 v v-1 compared with the PCL-epidermal growth factor (EGF) structure. Moreover, the presence of AM in the scaffolds resulted in the keratinogenic differentiation of ASCs even without employing EGF. Consequently, this state-of-the-art experiment suggests that the PCL-AM scaffold can be a promising candidate in skin bioengineering.

CONCLUSION

This study showed that mixing AM with PCL, a widely used polymer, in different concentrations can overcome PCL disadvantages such as high hydrophobicity and low cellular compatibility.

Seroprevalence and risk factors of brucellosis in Arabian horses

Background

Brucellosis, as a zoonotic disease, mainly occurs in horses by Brucella abortus, Brucella canis and Brucella suis. The disease in equines is often asymptomatic, but the clinical signs in horses are mostly characterized by bursitis, arthritis and tenosynovitis.

Objectives

This study, thus, aimed to determine the seroprevalence of brucellosis and its associated risk factors in the Arabian horses of Khuzestan province, South‐west Iran.

Methods

To that end, the blood samples randomly collected from 180 Arabian horses were analyzed for the presence of anti‐Brucella antibodies by Rose Bengal plate test (RBPT), serum agglutination test (SAT), 2‐mercaptoethanol test (2‐ME) and a commercial i‐ELISA kit.

Results

The ROC curve analysis showed that the best cut‐off point for S/P values in i‐ELISA turned out to be 26.25%. The results showed that the overall seroprevalence of brucellosis based on parallel interpretation of the test results was 12.22% (Positive/Tested = 22/180). The prevalence of acute and chronic brucellosis was 8.3 and 3.9%, respectively. The seroprevalence of brucellosis with RBPT and i‐ELISA methods was 1.11% (2/180) and 7.22% (13/180), respectively. According to what SAT revealed, 9.44% (17/180) of sera had a titer of 40 or greater, and at 2‐ME, 7.22% of samples (13 out of 180 samples) depicted a titer of 40. The results of i‐ELISA, SAT and 2‐ME were significantly different from those of RBPT (p < 0.01); however, there was no significant difference between i‐ELISA, SAT and 2‐ME in findings (p > 0.05).

Conclusions

The results of this study recommend that i‐ELISA be used for screening purposes of brucellosis in horses. The findings confirmed that Arabian horses are natural hosts for the Brucellae. It is, thus, necessary to adopt appropriate prevention and control programs by health authorities and horse owners so as to reduce the distribution and transmission of the infection in the regions where brucellosis is prevalent.

Pansclerotic Morphea Following COVID-19: A Case Report and Review of Literature on Rheumatologic and Non-rheumatologic Dermatologic Immune-Mediated Disorders Induced by SARS-CoV-2

While mucocutaneous manifestations of COVID-19 have been frequently reported and added to our knowledge every day during the pandemic, another issue is the COVID-related diseases that can present as intensified lesions of underlying diseases, a new disease, or changes in the behavior of an old lesion. Given that immune system overreaction and cytokine storm are among the most prominent events in COVID-19, the incidence of autoimmune diseases is expected to increase after COVID-19, as confirmed in several reports. To increase the body of knowledge about short- and long-term outcomes of COVID-19 for specialists, it is essential that similar cases be reported and collected for years to come. The present study investigated a case of pansclerotic morphea that rapidly progressed a few weeks after infection with COVID-19 in a 57-year-old woman with no history of any autoimmune skin or rheumatic diseases. She was prescribed outpatient COVID-19 treatment of azithromycin, vitamins D and C, and then quarantined for 2 weeks. The manifestations of the disease were exacerbated at each follow-up and sampling visit at short intervals. This kind of pansclerotic morphea is reported for the first time.

The Effects of Silibinin on SORT1 Gene Expression and A2780s Ovarian Cancer Cell Line Viability

Introduction: Ovarian cancer is one of the deadliest genital cancers among females and mainly originates from epithelial cells. The cancer generally remains asymptomatic until metastasis. Silibinin, a derivative of Silybum marianum, is a flavonoid with anticancer effects against many tumor cells. The sortilin1 (SORT1) gene has been shown to be overexpressed in ovarian tumors. Here, we investigated the effects of silibinin on SORT1 gene expression and the viability of ovarian A2780s cancer cell line.Methods: The A2780s ovarian cancer cell line was treated with silibinin at the concentrations of 50, 100, and 200 μM for 24 hours, and IC50 (half-maximal inhibitory concentration) was determined. Then the viability percentage of the cells treated with 100 μM silibinin was determined at 24, 48, and 72 hours. After 24 and 48 hours exposure to 100 μM silibinin, RNA was extracted, followed by cDNA synthesis and SORT1 gene expression analysis using glyceraldehyde 3-phosphate dehydrogenase (GAPDH) as the reference gene by real-time Polymerase chain reaction (PCR).Results: Silibinin in a dose- and time-dependent manner reduced the viability of ovarian cancer cells (P < 0.05), accompanied by a reduction in SORT1 gene expression.Conclusion: The present study showed that silibinin had toxic effects against the A2780s ovarian cancer cell line, suggesting this compound as a potential anticancer agent.

Changes of Pelvic Organ Prolapse Symptoms and Quality of Life One Year After Pessary Fitting

Pelvic organ prolapse (POP) is the descend of pelvic organs, including the uterus, bladder, and rectum, to the vaginal wall. Patients with POP may present with symptoms such as vaginal bulging with other symptoms like urinary, defecatory, or sexual dysfunction. This study was conducted to evaluate the changes of POP symptoms one year after pessary fitting. Patients with symptomatic pelvic organ prolapse who presented to the pelvic floor clinic of an academic hospital between August 2016 and April 2019 were considered. Pelvic organ prolapse symptoms, including urinary, defecatory, sexual, and bulging symptoms, were recorded before and one year after pessary fitting. Pelvic floor distress inventory (PFDI)-20 and pelvic floor impact questionnaire-7 (PFIQ-7) were evaluated before and after treatment for all subjects. We analyzed the characteristics of 110 patients who used the pessary for 12 months. At the baseline, the most common prolapse symptoms were vaginal bulging and pelvic pressure. All urinary, defecatory, and sexual symptoms significantly improved one year after regular pessary use (P<0.001). Changes in PFDI-20 and PFIQ-7 before and after pessary use showed a significant improvement in both frequency and satisfaction of sexual function (P<0.001). The study showed significant improvement in bulging, urinary, and defecatory symptoms. Although the majority of patients were not sexually active, a significant proportion of sexually active patients reported an increase in sexual satisfaction.

The Clinical Course and Prognostic Factors of COVID-19 in Patients with Chronic Kidney Disease, A Study in Six Centers

INTRODUCTION

Coronavirus disease 19 (COVID-19), has recently emerged as a great health challenge. The novel corona virus may affect the kidneys mainly as acute kidney injury (AKI). Also, the outcome of COVID-19 may be different in patients with underlying kidney disease. The aim of this study was to compare the outcome of COVID-19 in patients with and without underlying kidney disease.

METHODS

This was a retrospective study on 659 hospitalized COVID-19 patients in six centers of Iran. Patients were classified into kidney (chronic kidney disease (CKD), end-stage kidney disease (ESKD) or kidney transplantation) and non-kidney groups. The clinical conditions and laboratory data were extracted from the charts. Outcome was defined as death during hospitalization or within 30 days of discharge.

RESULTS

Among 659 COVID-19 patients (mean age: 60.7 ± 16.4, 56% male), 208 were in the kidney group (86 ESKD, 35 kidney transplants, and 87 CKD patients). AKI occurred in 41.8%. Incidence of AKI was 34.7% in non-kidney, 74.7% in CKD, and 51.4% in kidney transplant patients (P < .001). Totally 178 patients (27%) died and mortality rate was significantly higher in CKD patients (50.6 vs. 23.4%, P < .001). AKI was associated with increased mortality rate (OR = 2.588, CI: 1.707 to 3.925). Initial glomerular filtration rate (GFR) < 44.2 mL/min and elevated lactate dehydrogenase (LDH) and C-reactive protein (CRP) had significant association with mortality.

CONCLUSION

We showed a higher mortality rate in COVID-19 patients with AKI and CKD. Low initial GFR and elevated LDH and CRP were associated with high mortality in COVID-19 patients.

Non-enzymatic glucose sensor based on a g-C3N4/NiO/CuO nanocomposite

In this paper, a non-enzymatic glucose sensor was developed based on a g-C₃N₄/NiO/CuO nanocomposite immobilized on a glassy carbon electrode (GCE). Field emission scanning electron microscopy (FE-SEM), transmission electron microscopy (TEM), energy-dispersive X-ray spectroscopy (EDX), X-ray diffraction (XRD), and Brunauer-Emmett-Teller (BET) were utilized for the characterization of the synthesized g-C₃N₄/NiO/CuO nanocomposite. The electrocatalytic activity of the nanocomposite was investigated by cyclic voltammetry, and the amperometric technique was applied for monitoring glucose. The g-C₃N₄/NiO/CuO/GCE exhibited better electrocatalytic performance than g-C₃N₄/GCE, g-C₃N₄/CuO/GCE and g-C₃N₄/NiO/GCE. Under optimized conditions, the proposed sensor offered a linearity ranging from 0.4 μM to 8.5 mM with a detection limit of 0.1 μM and a sensitivity of 362.12 μA mM^-1 cm^-2. The constructed sensor displayed favorable reproducibility, outstanding selectivity, and long-term performance. These results reveal that the sensor is a promising candidate for blood glucose sensing.

Zinc deficiency may play a crucial role in dialysis-associated bacterial infections

Introduction: Systemic bacterial infections are a common cause of mortality and morbidity in hemodialysis patients. Zinc has a critical role in several immune system functions. Patients who have enough amounts of zinc are able to better face infections caused by various pathogens in comparison to those with zinc insufficiency Objective We sought to assess the role of zinc deficiency in dialysis-associated bacterial infections. Patients and Methods: Eighty-Three adult patients with end-stage renal disease (ESRD) on hemodialysis including 43 patients with bacterial infectious complications and 40 non-infected patients as well as 41 healthy individuals were enrolled. Clinical data, laboratory values including serum zinc level and imaging findings were collected. SPSS was utilized to analyze the data with a significance cutoff set at P < 0.05. Results: Out of 124 participants, 80 (64.51%) were males and 44 (35.49%) were females. The mean age of infected hemodialysis group, non-infected hemodialysis group, and healthy controls were 50.8 ± 16.25, 49.1 ± 18.1, and 56.3 ± 18.2 years, respectively. Catheter site infection (37.3%) and urinary tract infection (30.2%) were the most common infections. The mean serum zinc concentration was significantly lower in the infected patients, compared to non-infected patients and healthy individuals (P < 0.001). Conclusion: The ESRD patients on hemodialysis have lower serum zinc levels which are associated with increased risk of bacterial infection. The role of screening for zinc deficiency and use of supplemental zinc in these patients need to be studied.

The impact of sofosbuvir/daclatasvir or ribavirin in patients with severe COVID-19

OBJECTIVES

Sofosbuvir and daclatasvir are direct-acting antivirals highly effective against hepatitis C virus. There is some in silico and in vitro evidence that suggests these agents may also be effective against SARS-CoV-2. This trial evaluated the effectiveness of sofosbuvir in combination with daclatasvir in treating patients with COVID-19.

METHODS

Patients with a positive nasopharyngeal swab for SARS-CoV-2 on RT-PCR or bilateral multi-lobar ground-glass opacity on their chest CT and signs of severe COVID-19 were included. Subjects were divided into two arms with one arm receiving ribavirin and the other receiving sofosbuvir/daclatasvir. All participants also received the recommended national standard treatment which, at that time, was lopinavir/ritonavir and single-dose hydroxychloroquine. The primary endpoint was time from starting the medication until discharge from hospital with secondary endpoints of duration of ICU stay and mortality.

RESULTS

Sixty-two subjects met the inclusion criteria, with 35 enrolled in the sofosbuvir/daclatasvir arm and 27 in the ribavirin arm. The median duration of stay was 5 days for the sofosbuvir/daclatasvir group and 9 days for the ribavirin group. The mortality in the sofosbuvir/daclatasvir group was 2/35 (6%) and 9/27 (33%) for the ribavirin group. The relative risk of death for patients treated with sofosbuvir/daclatasvir was 0.17 (95% CI 0.04-0.73, P = 0.02) and the number needed to treat for benefit was 3.6 (95% CI 2.1-12.1, P < 0.01).

CONCLUSIONS

Given these encouraging initial results, and the current lack of treatments proven to decrease mortality in COVID-19, further investigation in larger-scale trials seems warranted.

Relationship Between Pulmonary Hypertension Before Kidney Transplantation and Early Graft Dysfunction

INTRODUCTION

Pulmonary hypertension (PHTN) is a common complication in patients with chronic kidney disease. Delayed Graft Function (DGF), on the other hand; is an essential complication after kidney transplantation. These two complications increase morbidity and mortality in patients. The effect of PHTN on cardiovascular and graft blood supply, as well as the same mechanisms underlying PTHN and DGF; led us to investigate the relationship between them.

METHODS

In this retrospective cohort study, 306 patients aged 18 years or older who underwent kidney transplantation at our center over a 4-year were enrolled. PTHN was diagnosed by transthoracic echocardiography performed by a cardiologist. DGF refers to the cases where the patient needs dialysis in the first week after kidney transplantation or if serum creatinine is ≥ 3 mg/dL on the 5th day after surgery.

RESULTS

The prevalence of PHTN was 43 (14.1%), and the prevalence of DGF was 80 (26.1%). PHTN was not correlated with age, sex, duration of dialysis, type of dialysis, and cause of renal failure. But DGF was associated with the duration and type of dialysis. DGF was found to be higher in patients undergoing hemodialysis (P < .05), and patients with a higher mean duration of dialysis were also more likely to have DGF (P < .05). Also, we concluded that there was a significant relationship between PHTN and DGF (P < .05), meaning that patients with PTHN before transplantation were more likely to develop DFG.

CONCLUSION

This study found that pre-transplant PTHN is an independent predictor of DGF in renal transplant patients.

Uterine Conserving Surgery in Patient With Cervicovaginal Agenesis: A Case Report

Congenital absence of the vagina with variable uterine development known as Mullerian agenesis or Mayer-Rokitansky-Kuster-Hauser syndrome. Cervicovaginal agenesis in the presence of normal uterus is very rare. Conservative surgery has recently been suggested in patients with congenital cervicovaginal atresia in order to relieve the symptoms and maintain fertility. A 13-year-old female referred to a pelvic floor clinic, because of primary amenorrhea and severe cyclic pelvic pain. Ultrasonography revealed a large amount of blood accumulation in the uterine cavity, and also, the cervicovaginal agenesis was reported. Both ovaries were normal. A neovagina was created by dissection of the space between the bladder and rectum. Under ultrasonography guidance, two Pezzer catheters were inserted between uterine ending and neovagina, so the catheters kept the canal patent, a soft mould was applied to prevent the vaginal stricture. Cervicovaginal agenesis, accompanied by normal functional endometrium, is a rare but challenging Mullerian anomaly in the case of surgical treatment. One of the successful conservative treatment in a fully educated patient is the vaginal reconstruction and uterovaginal anastomosis by stenting and continues the application of vaginal mould.

Burnout among Iranian nurses: a national survey

BACKGROUND

Nurses, particularly critical care nurses, are exposed to high levels of stress and burnout. Burnout is associated with many deleterious consequences affecting health care outcomes. The present study is intended to determine the dimensions of burnout in nurses on surgical, medical and critical care units and its relationship with demographic characteristics.

METHODS

In this descriptive research study, performed at critical and non- critical care units, 743 nurses were randomly selected by quota sampling from medical sciences universities in Iran. Data collection instruments included a "demographic questionnaire" and the "Persian version of the Copenhagen Burnout Inventory. Data were analyzed using SPSS20.

RESULTS

The findings showed that regarding all dimensions, the lowest level of burnout belonged to surgical wards whereas the highest level pertained to critical care wards indicating a significant difference among various aspects of burnout in different wards, i.e., surgery, medical, and critical care. There was no significant difference in gender, academic degree, and marital status in any of the aspects of burnout in critical care units; yet, the difference was significant between surgical and medical wards (P < 0.05). There were a negative significant correlation between some dimensions of burnout with age and nursing experience in critical care and medical wards (P < 0.05). Whereas in surgical wards, there were a positive significant correlation between some aspects of burnout with nursing experience and age (P < 0.05).

CONCLUSION

This study found that the critical care nurses have significantly higher level of burnout compared to the medical-surgical nurses. These results should be considered when planning burnout prevention schedules for nurses.

The effect of education around ethical principles on nurses' perception to patient safety culture in an Iranian mental health inpatient unit: a pilot study

Background & objectives

Patient safety is a crucial factor in the provision of quality healthcare and is therefore a global health concern. It is an area in which ethical concerns and high-quality clinical practice are inextricably linked. This study investigates the effect of education around ethical principles on nurses’ perception of patient safety in a psychiatric unit.

Materials & methods

This pre- and post-test descriptive study was conducted in a mental health inpatient unit in a hospital in Tehran, capital of Iran, in 2018. A total of 33 nurses, selected by census sampling, participated in the study. Data was collected using a demographics questionnaire and Hospital Survey on Patient Safety Culture (HSOPSC), and was analyzed with SPSS21.

Results

The mean score of patient safety was 116.85 ± 9.98 before the educational intervention, 143.58 ± 7.21 immediately after intervention, and 153.12 ± 9.47 1 month after intervention. The rate of error report by most participants over the past 12 months was 3–5 and 6–10 events before intervention, and 6–10 events immediately after and 1 month after intervention. Also, 42.4% of the participants assessed patient safety after intervention as very good and 36.4% assessed it as acceptable and very good 1 month after intervention whereas most of the participants (45.5%) assessed patient safety as acceptable before intervention.

Conclusion

Education on ethical principles exerts a positive effect on nurses’ perception of patient safety culture. Thus, it is recommended as an effective method of promoting nurses’ perception of this variable. In this way, healthcare quality and enhanced patient safety can be achieved.

The discrimination of acute tubular necrosis and prerenal azotemia using two biomarkers simultaneously

Introduction: The fractional excretion of sodium (FE Na) in urine has appeared as a helpful way to distinguish prerenal azotemia from acute tubular necrosis (ATN). Objectives: The urinary index of sodium has some limits. Lithium can be an additional careful indicator. The goal of our study was to assess the standards fractional excretion of sodium and lithium, (FE Na and FE Li) in distinguishing pre-renal azotemia (PRA) from ATN. Patients and Methods: Twenty-seven patients with prerenal azotemia, 25 patients with ATN and 20 healthy persons were included in this investigation. The plasma and urine sodium, creatinine and lithium levels were assessed. Additionally, FE Na and FE Li were calculated. To assess the diagnostic usefulness of FE Na and FE Li in discriminating prerenal azotemia from ATN, we created a receiver operating characteristic (ROC) curve. Results: The area under the curves (AUCs) of fractional excretion of Li and Na were 0.84 and 0.83 for distinguishing prerenal azotemia from ATN, respectively. There was a significant direct association between FE Na and FE Li in patients with ATN (P=0.001). No significant association of FE Na and FE Li in patients with prerenal azotemia was detected (p=0.26). By a cutoff point of 2.96%, the sensitivity and specificity for FE Na, were 68% and 75%, respectively for distinguishing PRA from ATN. By a cutoff point of 4.17%, the sensitivity and specificity of FE Li were 80% and 79%, respectively, for distinguishing prerenal azotemia from ATN. Conclusion: This investigation appeared a high AUC and accuracy of fractional excretion of sodium and lithium as a diagnostic method for distinguishing prerenal azotemia from ATN when used simultaneously. However, the discrimination of sensitivity and specificity of fractional excretion of lithium was greater than the fractional excretion of Na.

Correlation between nursing managers' leadership styles and nurses' job stress and anticipated turnover

AIM

To investigate the relationship between leadership style with nurse job stress and anticipated turnover.

BACKGROUND

An appropriate leadership style should promote the efficacy of nurses. Different leadership styles can affect nurse's job stress and the numbers of nurses leaving their workplace or their profession.

METHODS

In this cross-sectional correlational study, 1,617 nurses were selected from the governmental hospitals in Iran 2016-2017. Data were analyzed using descriptive and inferential statistics in SPSS₂₀ .

RESULTS

Nursing Manager's leadership style was transactional leadership. Both transformational and transactional leadership style have a significant relationship with job stress and anticipate staff turnover. A positive relationship was found between a laissez-faire leadership style with job stress and anticipated turnover.

CONCLUSION

The transformational and transactional leadership styles can reduce nurse's job stress and intention to leave, so nurse leaders can use combination of transformational and transactional leadership for improving job satisfaction and quality of nursing services.

IMPLICATIONS FOR NURSING MANAGEMENT

Leaders should emphasize a clear expression of values, objectives, and mission of the organisation; and try to raise confidence in employees, respecting and caring for them, supporting their views and suggestions, and being optimistic about the future.

The epidemiological and histological trend of bladder cancer in Iran

Introduction

Bladder cancer is the ninth common cancer in the world, the third common cancer among men in the Arabic and Western Asian countries, and the second in some regions of Iran (a country in the Middle East). There was no study on the epidemiological and histological trend of bladder cancer in Iran. This study aimed to the epidemiological and histological trend of bladder cancer in Iran.

Materials and Methods

In this study, data were extracted from annual cancer registry reports of Iranian Ministry of Health between 2003 and 2008. Standardized incidence rates were calculated using the world standard population and incidence rate was calculated by age groups, sex, and histological type. Data on epidemiologic trend and histology were analyzed using Joinpoint software package.

Results

A total of 23,291 cases were reported. Almost 17.70% (4127 cases) were women and 82.30% (19,170 cases) men. The sex ratio (male to female) was 4.65. Joinpoint analysis showed the significant increased trend of age-standardized incidence rate (ASIR) for both sexes. The annual percentage change of standardized incidence rate was 11.5 (confidence interval [CI]: 9.0-14.0) in women and 10.8 (CI: 8.0-13.6) in men. Two histological types of transitional cell carcinoma (TCC), not otherwise specified and papillary TCC included 43.89% and 49.86% of all cancer cases, respectively.

Conclusion

According to this study the trend of ASIR of bladder cancer in Iran is rising, so it is necessary to conduct further researches in future to provide accurate information on the cancer and investigate related risk factors and implement prevention programs in Iran.

Using Enamel Matrix Derivative to Improve Treatment Efficacy in Periodontal Furcation Defects

PURPOSE

Furcations are complicated periodontal defects. Untreated furcations lead to loss of the involved teeth and supporting tissues. It has been demonstrated that regenerative biomaterials are beneficial in reconstruction of the bone surrounding furcation-affected teeth. These biomaterials range from bone grafts and nonresorbable/resorbable barrier membranes to biologics that are able to trigger inactive regenerative processes in periodontal tissues. Selection of appropriate material(s) to treat furcations is challenging. The aim of this article is to provide a comparative outlook on different biomaterials applicable in regeneration of furcations with a focus on enamel matrix derivative (EMD).

METHODS

Scientific databases including PubMed/MEDLINE, ScienceDirect, and EMBASE were searched, and 28 articles were found primarily for this specific study. Full texts were studied to identify relevant studies; 17 studies were excluded because of irrelevancy, while 11 main studies were ultimately selected. Other references have been used for general statements.

RESULTS

EMD is a protein complex widely used in the regeneration of different periodontal defects. To assess the effects of EMD for treatment of root furcations, clinical studies involving EMD with and without barrier membranes and bone grafts were selected and compared. Briefly, this study reveals that when EMD is combined with open flap debridement (OFD), guided tissue regeneration (GTR), or bone grafting (BG), the amount of class II furcations converted to class I increases significantly. EMD also reduces tissue swelling and patient discomfort after treatment.

CONCLUSIONS

This study provides evidence to find the best combination of biomaterials to treat furcation defects. The best results are obtained if EMD is combined with β-TCP/HA alloplastic bone grafts.

The Relation of Carotid Arteries' Intima-Media Thickness With Snoring and Obstructive Sleep Apnea in Type 2 Diabetes Patients

In recent decades, the relation of carotid artery intima-media thickness (IMT) as a marker of atherosclerosis with snoring and sleep disorders has been drawing attention. The aim of this study was to evaluate the relation of carotid arteries IMT with snoring in type 2 diabetic patients. This cross-sectional study was performed on type 2 diabetes patients referring to Mashhad University of Medical Sciences' clinics. The stop Bang, Epworth sleepiness scale, and Stanford questionnaires were used for evaluation of daily sleepiness and snoring. For assessment of carotid artery thickness, Madison X8 ultrasound with 10 MHz superficial probes was utilized. The data were entered into SPSS software, and then the ANOVA test with Turkey, chi-square comparison technique, and Kruskal Wallis with Mann-Whitney U technique was used. The level of significance was considered P≤0.05. In total 80 patients (37 snorers and 43 non-snorers) entered the study. The mean carotid artery IMT in the group of snoring patients (0.72±0.17) was significantly higher than non-snorers (0.56±0.17) (P<0.001). Frequency of daily based on Stanford and ESS questionnaires was 23.8% and 39.2%. The association of sleepiness and snoring was confirmed by Stanford and ESS questionnaires with P=0.026 and P=0.007. Patients with higher risk of apnea had higher thickness of the mean carotid artery IMT (P<0.001). The mean carotid artery IMT had a positive significant relation with age (P=0.002), serum creatinine level (P<0.002), blood cholesterol (P=0.02) and HbAIC level (P=0.04). Findings of this study provides evidence on the relation of carotid artery IMT in diabetic patients with snoring independent of other effective factors. Also, results showed that snoring is associated with increased daily sleepiness and patients with higher risk of apnea had higher thickness of the mean carotid artery IMT.

Urinary tract infections in kidney transplant recipients 1st year after transplantation

Background:

One of the main causes of adverse complications following kidney transplantation is urinary tract infection (UTI). This study was done to define the incidence rate, clinical profiles, causative microorganisms, and UTI risk factors among kidney transplant recipients in Mashhad city.

Materials and Methods:

In this retrospective study, we perused medical files of 247 kidney recipients who underwent transplant surgery at Mashhad University Montaserie Hospital, during 2012–2014. All patients were followed for UTI during the 1^st year after surgery.

Results:

75 episodes of UTI developed by 152 pathogens in 56 (22.7%) of patients during 1-year follow-up. 26.6% of total UTIs were diagnosed within the 1^st month after transplantation. The most frequently isolated uropathogens were Escherichia coli (55.3%, n = 84). The high rate of candiduria (8.5%) was observed, too.

Conclusion:

UTI is known as one of the hospitalization reasons in kidney transplantation recipients. Defining appropriate antibiotic prophylaxis against bacterial and fungal agents and early removal of urethral catheter are suggested to decrease posttransplantation complications.

Epidemiology of Infectious Complications in Renal Allograft Recipients in the First Year After Transplant

OBJECTIVES

Renal transplant is one of the best ways to extend life of patients in the end stage of renal disease. Infections are significant causes of morbidity and mortality after renal transplant. The aim of this study was to evaluate frequency, risk factors, causative pathogens, and clinical manifestations in renal transplant recipients from Mashhad City during the first year after transplant.

MATERIALS AND METHODS

This research was conducted at Montaserie Hospital of Mashhad University of Medical Sciences from March 2013 to July 2015. All studied cases were followed for 1 year. In this retrospective study, our study cohort comprised 193 kidney transplant recipients, including 118 male (61.1%) and 75 female (38.9%) patients, with mean age of 34.4 ± 12.2 years. Of the total patients, 58 received kidneys from living donors (30.1%) and 135 received kidneys from deceased donors (69.9%).

RESULTS

We found that 151 infectious episodes had occurred in 96 patients. The most common infectious site involved the urinary tract (39.1%). Escherichia coli was the most frequently isolated pathogen. The only significant infection risk factor to affect transplant outcomes during the first year was age.

CONCLUSIONS

Infections are highly prevalent during the first year after transplant. Prevention and effective antibiotic therapy can reduce the related adverse effects.

Breast Cancer in Iranian Woman: Incidence by Age Group, Morphology and Trends

BACKGROUND

Breast cancer is the most common cancer and the first cause of cancer death in women worldwide, with infiltrating duct carcinoma as the most common morphology. This study aimed to investigate trend of breast cancer incidence by age groups and histological changes in Iranian women between 2003 and 2008.

MATERIALS AND METHODS

This is analytic study, carried out based on re-analysis of the Cancer Registry Center report of health deputy for women's breast cancer in Iran during a 6-year period (2003-2008). Statistical analysis for incidence time trends and morphology change percentage carried out joinpoint regression analysis using the software Joinpoint Regression Program.

RESULTS

A total of 36,340 cases were reported for Iranian women in the six years. Analytical trend showed an increasing incidence trend with significant annual percentage change (APC) of 15.2 (CI: 11.6 to 18.8). The lowest and highest significant increased trend were related to age groups of 40 to 44 years and above 85 years, respectively; with APCs of 13.0 and 25.1, respectively. Of total cases, 78.7% of cases were infiltrating duct carcinoma, decreasing from 82.0% in 2003 to 76.6% in 2008, which was significant with an APC equal to -1.76 (CI:-2.7 to -0.8).

CONCLUSIONS

The incidence trend of breast cancer is rising in Iranian women. The highest incidence was observed in the age groups 45-65 and 80-85. In conclusion, to reduce breast cancer incidence and its burden, preventive and screening programs for breast cancer, especially in young women, are recommended in Iran.

Sources of Stress and Coping Strategies among Iranian Physicians

BACKGROUND: Physicians are at risk of having high levels of stress which affect their performance. Finding the stressors and the coping skills to manage stress could be used to develop program to decrease stressful situation. No study has been done on Physicians' stress and coping in Iran. The main objective of this study is to find out the main stressors and coping strategies among Iranian Physicians working in hospital in Tehran-Iran.METHODS: A cross-sectional study was performed on 780 Physicians,using a questionnaire consisted of two sections ;The first section were the stressors which included 67 questions and The second section were The Brief COPE with 28-items for assessing a broad range of coping behaviors among respondents.RESULTS: A total of 1100 questionnaires were distributed to all the available Physicians in the hospitals selected. 780 Physicians returned complete questionnaires with observed response rate of 75%. The majority of respondents (56.9%) were women. The first 3 sources of stress in workplace (Job stressors) are physical environment problem (75%), too much volume of work and poorly paid. The main sources of stress outside the work place (non-job stressors) ranked by Physicians were; financial problem (9.09), not enough time to spend with family (8.87), conflicts with household tasks (7.36).The top five coping strategies used by Iranian Physicians were Behavioral Disengagement, Planning, Instrumental support, Acceptance, and turning to religion.CONCLUSIONS: This study revealed that both workplace and non-job sources of stress can affect the Physicians performance and there is an association between gender and coping skills.

Covalently bonded double-charged ionic liquid on magnetic graphene oxide as a novel, efficient, magnetically separable and reusable sorbent for extraction of heavy metals from medicine capsules

Development of a new SPE sorbent with a chemically bonded double-charged ionic liquid on magnetic graphene oxide to solve the disadvantages of ionic liquid based SPE methods.