Environmental enrichment reverses stress-induced changes in the brain-gut axis to ameliorate chronic visceral and somatic hypersensitivity

Introduction

Behavioral therapies, including cognitive behavioral therapy, hypnotherapy and stress management activities, have emerged as effective treatments for irritable bowel syndrome (IBS), a female predominant disorder of the brain-gut axis. IBS, affecting over 10% of the global population, typically presents with abnormal bowel habits and abdominal pain due to visceral hypersensitivity. While the mechanisms underlying how behavioral therapies treat IBS are still elusive, we had previously shown that chronic stress alters gene expression in brain regions critical for stress processing and nociception. We found that exposure to an enriched environment (EE), the rodent analogue of behavioral therapies, prior to and during the stressor was sufficient to prevent stress-induced changes in glucocorticoid receptor (GR) expression in the central nucleus of the amygdala (CeA) and hippocampus. Pre-exposure to EE also inhibited stress-induced increased colonic permeability and was able to block the induction of stress-induced visceral and somatic hypersensitivity. However, it remains unknown if EE can reverse chronic viscerosomatic hypersensitivity that persists following exposure to stress. We hypothesized that EE after chronic stress would be sufficient to reverse stress-induced changes in i) GR expression in the CeA and hippocampus, ii) ameliorate stress-induced colonic hyperpermeability and iii) restore normal visceral and somatic sensitivity in male and female rats.

Methods

Male and female rats were exposed to daily water avoidance stress (WAS). After confirming the rats had developed visceral hypersensitivity, 50% of the animals were housed in EE for 2 weeks while the other 50% remained in standard housing (SH). At the end of this period, we assessed visceral and somatic sensitivity. We also collected colon tissue to measure colonic permeability. Micro-punches of tissue from the CeA and hippocampus were isolated to measure GR expression. Control animals not exposed to WAS were kept in SH for the duration of the study (n = 8 per group).

Results

In both male and female rats, EE reversed stress-induced visceral (p < 0.001) and somatic (p < 0.01) hypersensitivity when compared to WAS animals housed in SH to levels comparable to control animals. EE exposure also reversed changes in GR expression in both the hippocampus (p < 0.01) and CeA (p < 0.01), normalizing GR expression to control levels. EE exposure ameliorated stress-induced colonic hyperpermeability in both male (p < 0.01) and female (p < 0.01) rats compared to WAS rats in SH.

Conclusion

Our findings suggest that behavioral therapies are viable therapeutic options for IBS as they can counter the stress-induced pathophysiology underlying IBS symptoms including visceral hypersensitivity, increased colonic permeability and altered gene expression.

Serodiagnosis of human brucellosis by an indirect ELISA test using recombinant outer membrane protein 19 kDa (rOMP19) as an antigen

BACKGROUND

Brucellosis remains one of the global health concerns that reemerges in recent years. Delayed or inaccurate diagnosis end to a long treatment duration and financial burden; therefore, finding a good antigen for detection of specific anti-Brucella antibodies is crucial. We intended to evaluate the serodiagnosis value of recombinant Brucella outer membrane protein 19 kDa (rOMP19) using indirect ELISA system compared with Rose Bengal test.

RESULTS

The OMP19 sequence was successfully cloned into pET-28a and produced in E. coli cells (DE3). After extraction and purification of rOMP19, this protein was used for designing indirect ELISA to detect anti-Brucella antibodies in 73 human sera, including 6 brucellosis-positive and 67 brucellosis-negative samples. The accuracy of rOMP19 ELISA was evaluated by receiver operating characteristic (ROC) curve and then compared with Rose Bengal plate test and a commercial anti-IgG Brucella ELISA kit. In comparison with Rose Bengal plate test, the area under the ROC curve was 0.985 (95% CI, 0.96-1.00). From coordinates of the curve, the optimal cut-off value was selected at 0.147, in which the diagnostic sensitivity was 100%, and the specificity was 94%. At this cut-off point, 10 samples were diagnosed as positive (6 true positives and 4 false positives), while negative samples were all correctly diagnosed. The results of our designed rOMP19 ELISA was the same as data obtained from commercial ELISA kit, which applied LPS as an antigen.

CONCLUSIONS

We concluded that OMP19 is an efficient antigen for the serodiagnosis of human brucellosis.

A first comprehensive estimate of electronic waste in Canada

Detailed analysis of electronic waste (e-waste) generation and composition is of utmost importance for the proper management of growing e-waste stream worldwide, containing both hazardous and valuable materials. Considering the absence of such comprehensive and up-to-date studies in Canada, this work presents the first estimate of put-on-market electrical and electronic equipment (EEE), the in-use stocks of EEE and e-waste generation in Canada from 1971 to 2030 for 51 product categories comprising 198 product types. Using a dynamic material flow analysis (MFA), the put-on-market EEE is estimated based on trade data retrieved from national and international import and export statistics, and the in-use stocks of EEE and the resulting e-waste are calculated using the Weibull distribution function. The results show that the total mass of EEE within the 60-year period is estimated to be 42.3 million tonnes, with an annual average growth rate of approximately 0.5%. By 2030, the total accumulated in-use stock of EEE is estimated to exceed 13 million tonnes. The estimated e-waste over the 60-year timespan is 29.1 million tonnes. The total annual e-waste generation in Canada is calculated to be 252 kilo tonnes (kt) and 954 kt in the years 2000 and 2020 respectively, which is estimated to reach 1.2 million tonnes by 2030. The e-waste generation per capita increased from 8.3 kg in 2000 to 25.3 kg in 2020 and is estimated to reach 31.5 kg by 2030. This quantification provides valuable insights to policymakers for setting up targets for waste reduction and identifying the resource circularity potential for efficient management of e-waste.

A comparison of nurses and elderly patients' perceptions of caring behaviors in intensive care units

OBJECTIVE

Differences in patients and nurses' perceptions of caring behaviors arouse patient dissatisfaction. Continuous monitoring and assessment of caring behaviors has revealed its problems, and this in turn would promote care services by planning rational interventions and removing the problems. The present study aimed to compare nurses and elderly patients' perceptions of nurses' caring behaviors in intensive care units in accordance with Watson's transpersonal caring theory.

METHODS

In this descriptive-analytical study, 70 nurses were selected using the census method, and 70 elderly patients over 60 years old were also selected using purposive sampling method from the intensive care units of Lorestan University of Medical Sciences during 2012-2013. Caring Behavior Inventory for Elders (CBI-E) was adopted in this research to detect the nurses and elderly patients' perceptions of caring behaviors. In the data analysis phase, Kruskal-Wallis, Mann-Whitney U, and Pearson correlation tests were used.

RESULTS

The research findings revealed no statistically significant difference between the total scores of nurses' 83.80 (22.93), 95% CI [78.40, 89.20] and elderly patients' 80.09 (26.00), 95% CI [74, 86.20] perception of nurses' caring behaviors (P=0.379). From the viewpoint of the nurses and elderly patients, responding quickly to a patient's call 100.00 (0.00), 95% CI [100.00, 100.00] had the highest mean scores and patient participation in caring process had the lowest mean scores among nurses 22.86 (33.71), 95% CI [15.00, 30.80] and elderly patients 14.29 (28.41), 95% CI [7.63, 20.90].

CONCLUSION

This study indicated the elderlies and nurses' similar perceptions of caring behaviors in intensive care units. This finding would help nurses to recognize and prioritize the elderly patients' care needs, thereby promoting the quality of care services.

The Prevalence and Causes of Low Vision and Visual Impairment in School-Aged Children: The Shiraz Pediatric Eye Study

Purpose

To determine the prevalence and causes of visual impairment (VI) in Shiraz schoolchildren aged between 6 and 12 years.

Methods

In the present population-based study, stratified random sampling was used to select 2400 schoolchildren aged 6-12 years from all four educational districts of Shiraz, Iran. Using the definitions of the World Health Organization, VI was defined as best-corrected visual acuity (BCVA) ≤0.5 logMAR (20/60) in the better eye, and blindness as BCVA worse than 1.3 logMAR (20/400) in the better eye. The low vision was defined as BCVA equal to or worse than 0.5 logMAR (20/60) in either eye. Data were recorded from a detailed interview and ocular examination of each eligible student.

Results

The mean age of the students was 9.1 ± 1.6 years. The prevalence of VI was 3/2001 (0.14%). The cause of VI in all these three patients (100%) was amblyopia due to high refractive errors (high ametropia and astigmatism). Regarding the main refractive errors leading to VI among these three patients, one patient had bilateral high hyperopia (compound hyperopic astigmatism), one of them had bilateral high astigmatism, and the other one had compound myopic astigmatism. According to a visual acuity of less than or equal to 20/60 in at least one eye, 9/2001 (0.4%) of children had low vision.

Conclusions

This study revealed a low prevalence of VI in a sample of 6- to 12-year-old school-aged children. Amblyopia in the setting of high ametropia and astigmatism were the most common causes of VI.

Lactobacillus casei displaying Clostridium perfringens NetB antigen protects chickens against necrotic enteritis

Necrotic enteritis is a serious economical disease of poultry caused by Clostridium perfringens. NetB toxin of Clostridium perfringens is considered the causative agent of necrotic enteritis. Following the withdrawal of in-feed antibiotic growth promoters, there has been an urgent need to develop alternative approaches such as vaccination. Currently, there are no commercially available vaccines to control necrotic enteritis especially in broiler chickens as the target population. In the present study, we constructed a recombinant Lactobacillus casei strain expressing NetB protein of C. perfringens on the cell surface and used this probiotic-based vaccine strain to immunize broiler chickens orally against experimental induction of necrotic enteritis. The birds immunized with the oral vaccine strain were significantly protected against necrotic enteritis challenge and developed strong serum anti-NetB antibody responses to NetB protein. Furthermore, the immunized birds showed higher body weight gains during the challenge experiment compared with control birds. This study showed, for the first time, that a probiotic-based vector vaccine could be a promising vaccine candidate to provide protection against necrotic enteritis in broiler chickens. KEYPOINTS: • The probiotic L. casei carrying pT1NX-netB plasmid displayed NetB antigen on the cell surface. • The LC-NetB vaccine strain induced high anti-toxin antibody response in broiler chickens. • The LC-NetB vector vaccine provided significant protection against experimental NE challenge.

Development of a diagnostic indirect ELISA test for detection of Brucella antibody using recombinant outer membrane protein 16 kDa (rOMP16)

Brucellosis is considered as one of the important global zoonotic diseases that causes medical as well as economic problems especially in tropical countries. The illness has no specific pathognomonic signs; therefore, the rapid and accurate diagnosis of the disease has a very important role in preventing the Brucella spillover and treatment. The purpose of this study was to design a new indirect ELISA test for detection of human brucellosis based on using recombinant Brucella abortus outer membrane protein 16 kDa (rOMP16) as an antigen. OMP16 gene of B. abortus was initially synthesized and cloned in pET-21d vector and then expressed in Escherichia coli cells. The expression was confirmed by the SDS-PAGE, western blotting and dot blotting. The purified protein was coated in ELISA plates and an indirect ELISA was performed on 70 human serum samples. The results were evaluated with a commercial IgG ELISA kit and Rose Bengal plate agglutination tests as reference tests. Diagnostic performance of designed OMP16 ELISA test in comparison with Rose Bengal plate test revealed 100% of sensitivity, 95.00% of specificity and good Fleiss kappa agreement, whereas, where it was compared to commercial ELISA kit, it revealed very good kappa agreement with 100% of sensitivity and 100% of specificity in cut-off value of 0.13. It was concluded that OMP 16 kDa could be acceptable alternative antigen for detecting Brucella IgG antibody with high accuracy.

Real-time radial tagging for quantification of left ventricular torsion

PURPOSE

To develop a real-time radial tagging MRI for accurate measurement of rotational motion and twist of the left ventricle (LV).

METHODS

A FLASH-based radial tagging sequence with an undersampled radial reading scheme was developed for both single and double-slice imaging in real-time. The Polar Fourier Transform was used for reconstruction to push the undersampling artifacts out of a reduced FOV. The developed technique was used to image five normal subjects during rest, plus one during both exercise and rest conditions. LV rotational motions were estimated for five consecutive cardiac cycles in all cases. The process was validated using a numerical phantom. The real-time measurement of global rotational motion was compared with those measured from a non-real-time exam using linear regression analysis and the Bland-Altman plot.

RESULTS

The real-time acquisition was performed successfully with a temporal resolution of 46.2 ms. Image quality was sufficient for the reproducible calculation of rotation at rest and exercise. The feasibility of double-slice acquisition on human was further studied and a real-time twist of the left ventricle was demonstrated. The difference between LV global rotations from real-time and non-real-time approaches was 0.27 degrees. A significant reverse recoiling, induced by exercise, was reproducibly measured by the technique.

CONCLUSION

A real-time radial tagging MRI technique was developed based on the undersampled radial acquisition and Polar Fourier Transform reconstruction, for accurate measuring of the heart rotational motion and twist. The technique was able to extract a meaningful change of diastolic recoiling under stress test conditions during physical activities (cycling).

The prevalence of refractive error in schoolchildren

CLINICAL RELEVANCE

Information on the refractive error prevalence in school-aged children will result in delivering the optimal eye health service to this group.

BACKGROUND

Understanding the prevalence of refractive error in school-aged children is crucial to reduce the consequences of uncorrected refractive error. This study aims to investigate the prevalence of refractive error among school-aged children in Shiraz, Iran.

METHODS

In this cross-sectional population-based study, 2001 schoolchildren aged 6-12 years participated. All participants underwent cycloplegic refraction. Spherical equivalent (SE) of -0.50 dioptre or more was considered as myopia, SE of +2.00 dioptre or more as hyperopia, and astigmatism as cylinder power of 0.75 dioptre or more. The difference of 1.00 dioptre or more between two eyes defined as anisometropia.

RESULTS

The prevalence of myopia was 11.6% (95% confidence interval [CI]: 10.2-13.1%), hyperopia 6.7% (95%CI: 5.6-7.9%), and astigmatism 28.9% (95%CI: 26.9-31.0%), out of which 82.1% had with the rule astigmatism. Anisometropia was detected in 4.0% (95%CI: 3.2-5.0%) of children. Astigmatism and anisometropia were significantly higher in boys (p < 0.001, p = 0.03 respectively). The SE decreased significantly with increasing age (p < 0.001) indicating an increase in myopia with age. In addition, the rate of myopic astigmatism increased with age (p < 0.001). Among studied schoolchildren 97.0% could achieve the best-corrected visual acuity of 6/6 and 3.0% could not in the better eye.

CONCLUSION

Astigmatism was the most common refractive error among primary school children. The prevalence of myopia was relatively higher than other studies conducted in Iran, and it increased with age. These results may highlight the role of lifestyle changes and increased near work activities on the myopic shift in school-aged children. The findings provide information for screening programmes in school-aged children.

Strategies for the direct oxidative esterification of thiols with alcohols

This review paper provides an overview of the main strategies for the oxidative esterification of thiols with alcohols. The review is divided into two major parts according to final products. The first includes the methods for the synthesis of sulfinic esters, while the second contains the procedures for the fabrication of sulfonic ester derivatives.

This review paper provides an overview of the main strategies for the oxidative esterification of thiols with alcohols.

Efficacy of Different Ibuprofen Formulations with Two Prescription Methods on Post Endodontic Pain of Teeth with Irreversible Pulpitis: A Randomized Clinical Trial

Introduction

Pain management during root canal therapy and after that is of great importance in endodontics. This study aimed to compare the effect of two non-steroidal anti-inflammatory drugs (NSAIDs); ibuprofen and ibuprofen lysine with two methods of prescription on pain after single-visit root canal treatment of first and second mandibular molar teeth with irreversible pulpitis.

Materials and Methods

This randomized study recruited subjects experiencing moderate to severe pain from a tooth diagnosed with symptomatic irreversible pulpitis (n=120). Subjects were randomized to receive 400 mg ibuprofen acid or 400 mg ibuprofen lysine regularly or on demand. The primary objective was to measure changes in pain scores at post-operative time frames of 6, 12, 18, 24, 48 and 72 hours after the root canal treatment on a 0-10 numerical rating scale (NRS). Independent T-test, Non-parametric Kruskal-Wallis Test and Friedman Test were used to analyze the data.

Results

Kruskal-Wallis analysis showed a significant difference in NRS score between on-demand ibuprofen group and regular ibuprofen group and also between regular ibuprofen lysine group and regular ibuprofen group at 6 hours after the treatment (P<0.05). But no remarkable difference was observed in the recorded mean pain intensity of four study groups in the other time frames (P>0.05).

Conclusions

Based on this randomized clinical trial, there was no significant difference in the pain intensity of patients using ibuprofen and ibuprofen lysine. Additionally, there was no significant difference in the degree of pain between the on-demand and regular groups, despite the fact that patients in the on-demand group used less medications. Due to the multiple negative effects of NSAIDs, it would be wise to prescribe ibuprofen on demand.

Comparison of the Effect of Nifedipine Alone and the Combination of Nifedipine and Sildenafil in Delaying Preterm Labor: A Randomized Clinical Trial

Objective: Recently, sildenafil as a drug effective in relaxing smooth muscles can be used as an adjunct to delay the onset of uterine contractions and therefore the occurrence of preterm labor. The aim of this study was to evaluate the effect of nifedipine combination with sildenafil on preterm delivery compared with nifedipine alone. Materials and methods: This randomized double-blinded clinical trial was performed on pregnant women with a gestational age of 26-34 weeks with singleton pregnancy and symptoms of preterm delivery. The mothers were randomly assigned into two groups receiving nifedipine plus sildenafil or those receiving nifedipine alone. The time of delivery, maternal and neonatal complications were compared between the two groups. Results: Mothers who received the combination therapy experienced significantly lower preterm delivery within 72 hours of intervention compared to nifedipine alone (4.5% versus 27.3%, p = 0.002). The rate of delivery during the first 7 days after discharge was 7.6% and 31.8% in nifedipine plus sildenafil and nifedipine alone, respectively (P = 0.001). The prevalence of neonatal respiratory distress syndrome (RDS) as well as mean birth weight was higher in the nifedipine group alone. Treatment protocol with nifedipine and sildenafil compared with nifedipine alone was associated with a significant increase in preterm delivery delay (beta =-5.819, p = 0.001). Conclusion: The use of sildenafil in addition to nifedipine causes more delay in delivery in cases of preterm labor, followed by lower risk for RDS, reduces neonatal intensive care unit (NICU) admission, and preserves neonatal birth weight.

Investigating the in vitro photothermal effect of green synthesized apigenin-coated gold nanoparticle on colorectal carcinoma

Applying toxic chemical to the synthesis of stable gold nanoparticles is one of the limitations of gold nanoparticles for therapeutic applications such as photothermal therapy. Plant compounds such as apigenin (API) with therapeutic potential can be applied in the synthesis of gold nanoparticles. API‐coated gold nanoparticles (Api@AuNPs) with an average size of 19.1 nm and a surface charge of −4.3 mV have been synthesized by a simple and efficient technique. The stability of Api@AuNPs in the biological environment was verified through UV‐Vis spectroscopy. Based on Raman and FTIR spectroscopy analysis, chemical binding of API on the surface of Api@AuNPs through hydroxyl and carbonyl functional groups was found to be the main reason for the stability of the Api@AuNPs in comparison with citrate‐coated gold nanoparticles (Cit@AuNPs). The synthesized Api@AuNPs do not cause major toxic effects up to 128 ppm. Api@AuNP‐mediated photothermal therapy leads to the indiscriminate eradication of almost half of both mouse fibroblastic (L929) and colorectal cancer (CT26) cells. Flow‐cytometry analysis revealed that the cell death mechanism is mainly apoptosis. In the apoptosis triggered cell death in photothermal treatment, Api@AuNPs are preferred over commonly used gold nanoparticles in photothermal treatments which mostly trigger the necrosis cell death pathway.

Environmental enrichment prevents stress-induced epigenetic changes in the expression of glucocorticoid receptor and corticotrophin releasing hormone in the central nucleus of the amygdala to inhibit visceral hypersensitivity

INTRODUCTION

Stress is a known trigger for the symptoms of irritable bowel syndrome (IBS), a gastrointestinal (GI) disorder that presents with abnormal bowel habits and abdominal pain due to visceral hypersensitivity. While behavioral therapies have been used to attenuate IBS symptoms, the underlying mechanisms by which these therapies interact with stress-induced pathology remains to be delineated. Here we use a rat model to test the hypothesis that exposure to environmental enrichment (EE) inhibits stress-induced changes within the brain-gut axis to prevent visceral and somatic hypersensitivity and colonic hyperpermeability.

METHODS

Female rats (n = 8/group) were housed in EE one week before and one week during exposure to water avoidance stress (WAS) while controls were housed in standard cages (SH). One day after the final WAS exposure, colonic and somatic sensitivity were assessed by the visceromotor response (VMR) to colorectal distension (CRD) and withdrawal threshold elicited by an electronic von Frey on the hind paw of the rats respectively. All rats were returned to SH for 3 weeks before colonic and somatic sensitivity were reassessed on day 28. The rats were then immediately euthanized and the spinal cord was collected to assess changes in neuronal activation (assessed via ERK phosphorylation) in response to noxious CRD. A separate cohort of animals (n = 8/group) that did not undergo behavioral assessments was euthanized the day after the final WAS exposure and the central nucleus of the amygdala (CeA) was collected to investigate WAS and EE induced epigenetic changes at the glucocorticoid receptor (GR) and corticotrophin releasing hormone (CRH) promoter. The colon from these rats was also collected to assess colonic permeability via changes in transepithelial electrical resistance (TEER) in vitro.

RESULTS

Exposure to stress persistently increased VMR to CRD (P < 0.01) and decreased the hind paw withdrawal threshold (P < 0.001) in female rats. WAS also decreased TEER in the colon tissue of female rats (p = 0.05). In the CeA, WAS induced a decrease in histone acetylation at the GR promoter but increased histone acetylation at the CRH promoter and reduced GR-CRH interactions in the CeA. Analysis of the spinal cord showed that WAS increased CRD-evoked ERK phosphorylation in the dorsal horn. Exposure to EE prevented WAS-induced changes in the CeA, dorsal horn and colon respectively to prevent visceral and somatic hypersensitivity.

CONCLUSION

Our data reveals that behavioral therapies can produce long lasting molecular and epigenetic changes that can prevent stress-induced pathologies even after completion of the therapy. These results highlight the potential mechanisms by which behavioral therapies may ameliorate visceral pain associated stress-related pathologies such as the irritable bowel syndrome.

Natural polymeric nanoparticles as a non-invasive probe for mesenchymal stem cell labelling

Non-invasive tracking of stem cells after transplant is necessary for cell therapy and tissue engineering field. Herein, we introduce natural and biodegradable nanoparticle to develop a highly efficient nanoprobe with the ability to penetrate the stem cell for tracking. Based on the use of (Gd³⁺) to label stem cells for magnetic resonance imaging (MRI) we synthesized nanoparticle-containing Gd³⁺. Gd³⁺ could be used as t₁-weighted MRI contrast agents. In this study, chitosan-alginate nanoparticles were synthesized as a clinical Dotarem^® carrier for decreased t₁-weighted. Scanning electron microscopy (SEM), transmission electron microscopy (TEM), dynamic light scattering (DLS), and Fourier-transform infrared spectroscopy (FTIR) were utilized for nanoprobe characterization and ICP analysis was performed for Gd³⁺ concentration measurement. The results illustrate that nanoprobes with spherical shape and with a size of 80 nm without any aggregation were obtained. Relaxivity results suggest that r₁ in the phantom was 12.8 mM^-1s^-1 per Gd³⁺ ion, which is 3.5 times larger than that for Dotarem^® (r₁ ∼3.6 mM^-1s^-1 per Gd³⁺ ion) and this result for synthesized nanoprobe in stem cells 3.56 mM^-1s^-1 per Gd³⁺ ion with 2.16 times larger than that for Dotarem^® was reported and also enhanced signal in in-vivo imaging was observed. Chitosan-alginate nanoparticles as a novel biocompatible probe for stem cell tracking can be utilized in tissue engineering approach.

Effect of pomegranate juice on vascular adhesion factors: A systematic review and meta-analysis

BACKGROUND

Cardiovascular diseases, obesity, and insulin resistance demonstrate elements of functional impairment of the endothelium. Treatment of endothelial dysfunction with natural products, such as pomegranate, can open new ways in the treatment of cardiovascular diseases.

PURPOSE

The present meta-analysis provides information in highlighting the role of pomegranate in endothelial dysfunction.

METHODS

Various databases, such as PubMed, Scopus, Web of Science, Cochrane, and Google Scholar, were searched up to July 2020 using relevant keywords. We have selected the studies that investigated the effects of pomegranate on vascular adhesion factors, including intercellular adhesion molecule 1 (ICAM-1), vascular cell adhesion molecule 1 (VCAM-1), E-selectin, and interleukin-6 (IL-6). MD with 95% CrI with 100,000 iterations by using Markov chain Monte Carlo code were used.

RESULTS

Pooled effect size of articles in human studies indicated that pomegranate juice was not significantly effective on ICAM-1 [MD: -0.42; CrI: (-1.01, 0.17)], VCAM-1 [MD: -0.20; CrI: (-1.95, 1.40)], and E-selectin [MD: -0.21; CrI: (-1.62, 1.21)] compared to the control group. But it can significantly reduce IL-6 [MD: -1.07; CrI: (-1.90, -0.19)].

CONCLUSION

Generally, present study showed that pomegranate juice has no significant effect on vascular adhesion factors, ICAM-1, VCAM-1, and E-selectin, but can reduce IL-6 significantly. Future prospective randomized clinical trials with longer intervention duration are warranted to obtain a precise conclusion.

Global, regional, and national quality of care and burden of ischemic heart disease, 1990 to 2017: results from the GBD study 2017

Background

Sustainable development goal (SDG) target 3.4 aims at reducing premature death from non-communicable diseases including ischemic heart disease (IHD) by one-third by 2030.

Purpose

We aimed to compare the quality of care (QoC) of IHD between countries, genders, and age groups by employing its fatal and non-fatal estimates from the Global Burden of Diseases study 2017 to guide future policy makings for achieving SDGs.

Methods

We employed three epidemiologically meaningful combinations of fatal and non-fatal estimates of IHD: 1) Mortality to incidence ratio. 2) Disability-adjusted life-years (DALYs) to prevalence ratio. 3) Years of life lost to years lived with disability ratio. In the setting of IHD, the greater these measures, the poorer the QoC of IHD. We summarized these indices by principal component analysis and taking its first principal component as the quality of care index (QCI) scaled from 0 to 100 with the bigger score indicating better QoC. Based on the mean of the socio-demographic index (SDI) of countries between 1990 and 2017, countries were divided into high- and low-SDI groups and their QCIs were compared in different maps (Figure). We defined gender disparity ratio (GDR) as the ratio of female QCI to male QCI for evaluating gender inequity. For evaluation of inequities between age groups, we categorized countries into five groups based on the quintiles of SDI in the year of interest and plotted QCI against age for each group. Statistical analyses were done by R software v3.6.0.

Results

IHD was the fourth contributor to global DALYs in 1990 and climbed to the second rank in 2017. Although all-ages DALYs of IHD increased by 0.6% and was relatively stable, its age-standardized DALYs steadily decreased by 27.7% from 1990 to 2017 worldwide. The global QCI increased by 7.4% from 71.2 in 1990 to 76.4 in 2017. In 2017, the Netherlands, France, Israel, Italy, and Japan had the highest QCI in the world, respectively, and the United States with the QCI of 84.7 was in the third quintile of the high-SDI countries (Figure 1). Peru, Iraq, Thailand, Jamaica, and Saint Lucia had the top five QCIs amongst the low-SDI countries in 2017. The global GDR steadily increased from 1.04 in 1990 to 1.08 in 2017. Most countries of Western Europe, North America, and Australasia have a GDR between 1 and 1.2 in 1990 and 2017. In 1990, the plot of QCI against age demonstrated that QCI of elderlies is lower than other age groups in high, high-middle, and middle SDI countries; nevertheless, this pattern was not evident in low-middle and low SDI countries. Although this difference was disappeared in high SDI countries in 2017, it persisted in high-middle and middle SDI countries.

Conclusions

QoC of IHD has been improved in the last decades; however, it was not consistent between countries, genders, and age groups. These results have implications for monitoring and modifying public health policies toward SDGs and health for all worldwide.

Figure 1. Comparison of QCI of Countries

Funding Acknowledgement

Type of funding source: Foundation. Main funding source(s): Bill and Melinda Gates Foundation

Effects of tramadol administration on male reproductive toxicity in Wistar rats The role of oxidative stress, mitochondrial dysfunction, apoptosis-related gene expression, and nuclear factor kappa B signalling

AIM

The present study investigated the role of redox balance, inflammation, mitochondrial dysfunction, and apoptosis in Tramadol (Tra)-induced testicular toxicity.

METHOD

Twenty-four male Wistar rats were randomly divided into either the control group or the groups receiving different doses of Tra (25, 50, and 75 mg/kg/day, i.p.) for 21 successive days. Testicular tissues were collected for oxidative stress, mitochondrial function, sperm assays and histopathological evaluation. Real-time polymerase chain reaction was performed to evaluate the markers of inflammation and apoptosis.

RESULTS

Tra caused a significant reduction in the sperm count, motility and morphology, while it caused a marked increase in oxidative stress parameters. In addition, Tra induced testicular mitochondrial dysfunction due to the collapse of mitochondrial membrane potential and mitochondrial swelling. It also led to the significant inhibition of anti-apoptotic Bcl-2 expression, besides a significant increase in pro-apoptotic Bax expression. There was a significant increase in the level of tumour necrosis factor-α, interlukin-1β and nuclear factor kappa B. Histopathological degenerative changes were observed in the testis after Tra exposure.

CONCLUSIONS

The present results suggest that Tra exposure may lead to reproductive toxicity due to the loss of the antioxidant defence system, mitochondrial dysfunction, and activation of inflammatory and apoptotic pathways (Tab. 4, Fig. 5, Ref. 63).

Distribution of intraocular pressure in healthy Iranian children: the Shiraz Pediatric Eye Study

PURPOSE

To describe the mean and normal range of intraocular pressure (IOP) and its associations in healthy Iranian school children using the noncontact tonometer.

METHODS

In this cross-sectional study as part of the Shiraz Pediatric Eye Study, a stratified random sampling was performed among elementary school children of Shiraz, Iran. Basic demographics and socioeconomic status of households, past medical history, drug history, and eye health history were collected for each eligible student. Children underwent complete ophthalmic examination. Axial length, corneal curvature, and anterior chamber depth were measured using the IOL-Master 500.

RESULTS

Of 2,001 eligible children, 1,901 (95.0%; 3,802 eyes) with a mean age of 9.1 ± 1.6 years (standard deviation; range, 6-12 years) had reliable IOP. The mean spherical equivalent refraction was 0.5 ± 1.3 D for the right eye and 0.6 ± 1.2 D for the left eye. Mean IOP in the right eye was 15.1 ± 2.5 mm Hg (median, 15.0; range, 8.0-27.0 mm Hg); in the left eye, 15.2 ± 2.5 mm Hg (median, 15.0; range, 9.0-28.0 mm Hg). In multiple regression analyses, the mean IOP was significantly lower among asthmatic children compared to normal participants (P = 0.007). The measured IOP was significantly higher in myopic participants than hyperopic patients (P = 0.003).

CONCLUSIONS

This study provides a useful normative IOP database using the noncontact tonometer for healthy Iranian school children.

New nanoprobe for breast cancer cell imaging based on low-density lipoprotein

Many malignant cancers have an increased demand for lipoprotein due to the requirement for lipids for the rapid proliferation of the tumours and which is met by the increased availability of LDL through upregulation of LDL transporters. This unique phenomenon is the basis for the use of LDL based nanoparticles for cell imaging. In this study, a novel MR-active LDL nanoparticle was synthesised as the MRI probes. This MR-active LDL was characterised by using different techniques including scanning electron microscopy (SEM), dynamic light scattering (DLS), Fourier-transform infra-red spectroscopy (FTIR) and magnetic resonance imaging (MRI). The intracellular uptake of Gd³⁺ and cytotoxicity was measured by ICP-AES and MTT assay respectively. Results suggest that this nanoprobe with spherical shape and size of 55 nm has reduced relaxation time compared to commercial contrast agent and is introduced as an appropriate imaging probe. The amount of reabsorption of nanoprobe increased up to 6 h and given that the connection of the chelator does not have an effect on reabsorption proves that entry through transporter of APO section has done. This study lays the basis for exploring a personalised medicine strategy by directing a patient's own LDL to cancer cell imaging in the early stages.

Effects of cinnamon on controlling metabolic parameters of polycystic ovary syndrome: A systematic review and meta-analysis

ETHNOPHARMACOLOGICAL RELEVANCE

Cinnamon as a traditional medicine has been widely used in various disorders such as headache, toothache, common cold, diarrhea, flatulence, fever, amenorrhea frigidity. However, the effect of cinnamon supplementation on metabolic parameters of polycystic ovary syndrome (PCOS) patients has not been fully assessed.

AIM OF THE STUDY

Clinical trials have shown contradictory effects of cinnamon supplementation on metabolic parameters of polycystic PCOS patients. Therefore, we evaluated the effect of cinnamon supplementation on metabolic parameters of PCOS patients through a systematic review and meta-analysis of clinical trials.

MATERIALS AND METHODS

PubMed, Embase, the Cochrane library, Scopus and Web of Science databases (until August 2019) were searched to identify potential clinical trials with information on cinnamon supplementation on metabolic parameters among PCOS patients. Weighted Mean Differences was pooled using a random-effects model. Standard methods were used for assessment of heterogeneity, publication bias and sensitivity analysis.

RESULTS

Pooling five clinical trials (five treatment arms) together did not show any significant effect on body weight (WMD: -0.74 kg, 95% CI: -3.17 to 1.69) and body mass index (BMI) (WMD: -1.47, 95% CI: -4.07 to 1.12). Our results illustrated that a significant decrease of fasting blood sugar (WMD: -5.32, mg/dL95% CI: -10.46 to -0.17), fasting insulin (WMD: -4.10, μIU/dL95% CI: -6.76 to -0.144) and HOMA-IR (WMD: -0.69 95% CI: -1.37 to -0.004) were observed after cinnamon treatment. Moreover, our findings demonstrated that oral cinnamon supplementation in PCOS patients led to significant reduction of serum level of LDL-C, total cholesterol, and triacylglycerol. Besides, an improvement of serum concentration of HDL-C was shown by cinnamon supplementation.

CONCLUSION

Generally, present study indicated that cinnamon supplementation may help PCOS patients to manage their metabolic parameters. Future prospective randomized clinical trials with longer intervention duration are warranted to obtain a precise conclusion.

High protection of mice against Brucella abortus by oral immunization with recombinant probiotic Lactobacillus casei vector vaccine, expressing the outer membrane protein OMP19 of Brucella species

Brucellosis is a zoonotic disease threatening the public health and hindering the trade of animals and their products, which has a negative impact on the economic development of a country. Vaccination is the most effective way to control brucellosis. The recombinant vector vaccines are promising candidates for immunization in humans and animals. In this study, the gene encoding OMP19 antigen was primarily amplified and cloned into an expression vector called pT1NX, and then transformed to L. casei cell via electroporation technique. The expression was confirmed using specific antibody against the recombinant protein via immunological screening tests such as western blot and immunofluorescence assay. Finally, recombinant L. casei was orally fed to mice and the results were further recorded, indicating that the mice group which received OMP19 through L. casei based vaccine represented a very good general and mucosal immune responses protective against challenges with virulent B. abortus 544 strain compared with negative control recipient groups. Therefore, the vaccine produced in this research plan can be a very good candidate for protection against brucellosis.

The effects of functionalization of carbon nanotubes on toxicological parameters in mice

Carbon nanotubes (CNTs) have emerged as a new class of multifunctional nanoparticles in biomedicine, but their multiple in vivo effects remain unclear. Also, the impact of various functionalization types and duration of exposures are still unidentified. Herein, we report a complete toxicological study to evaluate the effects of single- and multiwalled carbon nanotubes (SWCNTs and MWCNTs) with either amine or carboxylic acid (COOH) surface functional groups. The results showed that significant oxidative stress and the subsequent cell apoptosis could be resulted in both acute and, mainly, in chronic intravenous administrations. Also, male reproductive parameters were altered during these exposures. The amino-functionalized CNTs had more toxic properties compared with the COOH functionalized group, and also, in some groups, the multiwalled nanotubes were more active in eliciting cytotoxicity than the single-walled nanotubes. Interestingly, the SWCNTs-COOH had the least alterations in most of the parameters. Evidently, it is concluded that the toxicity of CNTs in specific organs can be minimized through particular surface functionalizations.

Challenges in the Management of Care of Brain-Dead Patients in the Donation Process: A Qualitative Content Analysis

BACKGROUND

In care of brain-dead patients, nurses face several challenges. It is important to determine the context behind these challenges since they affect the performance of nurses and the organ donation process.

OBJECTIVE

To identify factors affecting the emergence of challenges related to the management of brain-dead patients by nurses in the donation process.

METHODS

In this qualitative conventional content analysis, data were collected by performing 28 semi-structured and in-depth interviews with nurses working in the ICUs. Purposive sampling started from March 2014 until saturation, which was reached in June 2016. Data analysis occurred simultaneously with data collection.

RESULTS

Qualitative analysis of contents provided from interviews led to the extraction of themes that showed the experience of nurses about the challenges of caring for brain-dead patients in the donation process. These themes included "doubt and conflict in accepting the situation" and "defects in an effective and targeted care system." In the end, the main theme of "inconsistency and incompatibility of care management" was abstracted.

CONCLUSION

According to the results of the study, factors involved in the emergence of challenges for nurses in care management included defects in education or managerial problems, which increased tension for nurses.

NIR triggered glycosylated gold nanoshell as a photothermal agent on melanoma cancer cells

Nowadays, gold nanoshells are used in targeted nano photothermal cancer therapy. This study surveyed the application of gold nanoshell (GNs) to thermal ablative therapy for melanoma cancer cells and it takes advantage of the near infrared absorption of gold nanoshells. The synthesis and characterization of glycosylated gold nanoshells (GGNs) were done. The cytotoxicity and photothermal effects of GNs on melanoma cells were evaluated using MTT assay and flow cytometry. The characterization data showed that GGNs are spherical, with a hydrodynamic size of 46.7 nm. Results suggest that the cellular uptake of GGNs was about 78%. Viability assays showed no significant toxicity at low concentrations of GNs. The higher heating rate and toxicity of cancer cells were obtained for the cells exposed to 808 nm NIR laser after incubation with GGNs rather than the GNs. The viability of these cells has dramatically decreased by 29%. Furthermore, 61% more cell lethality was achieved for A375 cells using combined photothermal therapy and treatment with GGNs in comparison to NIR radiation alone. In conclusion, our findings suggest that the synthesized gold/silica core-shell nanoparticles conjugated with glucosamine have high potentials to be considered as an efficient metal-nanoshell in the process of targeted cancer photothermal therapy.

Investigating the effect of near infrared photo thermal therapy folic acid conjugated gold nano shell on melanoma cancer cell line A375

Nowadays, there is growing interest regarding the use of metal Nanoshells as targeted agents of Nano-photo thermal cancer therapy. This study was aimed at synthesis the folic acid (FA)-conjugated with silica @gold core-shell nanoparticles (FA-SiO₂@AuNPs) for improving the treatment of melanoma cancer cells. The characterization data showed that the FA-SiO₂@AuNPs is spherical in shape and its size is ∼73.7 nm. The intracellular uptake of FA-SiO₂@AuNPs into melanoma cells (A375) was measured through the inductively coupled plasma, (∼47.7%). The cytotoxicity of nanoparticles was investigated on A375 and HDF (Human dermal fibroblast) cell lines. Cytotoxicity results indicated that there is no significant cytotoxicity in HDF cell lines treated with nanoparticles. MTT and flow cytometry results showed that the viability of A375 cells treated by SiO₂@Au and FA-SiO₂@AuNPs was decreased significantly to about 31% and 16% respectively. The higher toxicity of cancer cells was obtained for the cells exposed to 808 nm near-infrared (NIR) laser after incubation with FA-SiO₂@AuNPs rather than the non-targeted SiO₂@AuNPs. Furthermore, about 64% more cell death was observed for A-375 cells using both photothermal therapy and treatment with FA-SiO₂@AuNPs compared to photothermal therapy. Additionally, the majority of the cell deaths were related to the apoptosis process, not necrosis. It can be concluded that FA-SiO₂@AuNPs was an effective targeting agent for photothermal therapy in the treatment of melanoma.

Effects of genistein on blood pressure: A systematic review and meta-analysis

Genistein (4',5,7-trihydroxyisoflavone) is a phytoestrogen with potential health benefits in the prevention of cardiovascular disease. However, the evidence regarding its effects on hypertension has not been conclusive. Therefore, we examined the impact of oral genistein supplementation on systolic blood pressure (SBP) and diastolic blood pressure (DBP) via a systematic review and meta-analysis of randomized controlled trials (RCTs). PubMed, ISI Web of Science, Scopus and the Cochrane library databases (until August 2019) were searched to identify potential RCTs with information on genistein supplementation and hypertension. Weighted Mean Difference (WMD) was pooled using a random-effects model. Pooling four RCTs (four treatment arms) together did not show any significant reduction of SBP (WMD: -5.32 mmHg, 95% CI: -14.59 to 3.96) and DBP (WMD: -2.06 mmHg, 95% CI: -6.41 to 2.28) compared to that of the placebo group. However, subgroup analysis by intervention duration suggested that more than 6 months genistein supplementation in metabolic syndrome patients can significantly decrease SBP (WMD: -13.73 mmHg, 95% CI: -18.10 to -9.37) and DBP (WMD: -5.18 mmHg, 95% CI: -6.62 to -3.74). Generally, present study indicated that genistein supplementation had no effect on hypertension, but it seems that longer intervention duration of more than 6 months especially among metabolic syndrome patients may lead to the effectiveness of genistein.

Effects of resveratrol supplementation on bone biomarkers: a systematic review and meta-analysis

The current study presents a comprehensive systematic review and meta-analysis of randomized controlled trials (RCTs) on resveratrol and bone health biomarkers. PubMed, Scopus, and Web of Science (until September 2018) were searched to identify the potential RCTs with information on resveratrol supplementation and bone metabolism biomarkers. Mean differences (MD) were analyzed using a random-effects model. Pooling six RCTs (eight treatment arms with 264 subjects) together identified no significant reduction of serum Ca, osteocalcin, C-terminal telopeptide of type I collagen, and procollagen I N-terminal propeptide values after resveratrol supplementation over placebo treatment. However, a significant increase in serum alkaline phosphatase (ALP) (MD: 5.69 mg/mL, 95% CI: 3.58-7.80, I²  = 95.7%, P < 0.001) and bone alkaline phosphatase (BAP) (MD: 10.57 mmHg, 95% CI: 5.36-15.78, I²  = 99.2%, P < 0.001) values was observed after resveratrol treatment relative to placebo. The findings of this study indicate that resveratrol supplementation increased some key bone biomarkers, such as ALP and BAP. Further precise clinical trials of the effects of resveratrol supplementation on bone health should be conducted.

Comparison of Effectiveness and Patient Satisfaction of Vaginal Versus Oral Misoprostol in Treatment of Missed Miscarriage

BACKGROUND

In recent years' medical management with misoprostol is an effective alternative to surgical evacuation. But there is a dearth of evidence to reveal the effectiveness of the different routes of misoprostol and satisfaction rate among the patients treated with these routes.

AIM

This study was conducted to compare the effectiveness and patient's satisfaction rate of vaginal versus oral misoprostol.

METHODS

It was a prospective non-interventional study. One hundred women of having missed abortion confirmed by ultrasonography examination were enrolled in the trial. Fifty-eight subjects were administered 200 mcg of oral and 42 subjects received 200 mcg of vaginal misoprostol every four hours up to four doses. If complete expulsion did not occur 12 hours after the last dose, the surgical evacuation was done.

RESULTS

There was no significant statistical difference between the effectiveness of treatment with vaginal (78.57%) and oral misoprostol (79.31%) (p = 0.928). The difference between Patients' satisfaction at the time of discharge for the vaginal group (64.29%) and oral group (65.52%) was not statistically significant (P = 0.991). There was an increase in patients' satisfaction for both groups at the follow-up session, but still, the difference was not significant (P = 0.897).

CONCLUSION

This study confirms that there is no statistical difference between the effectiveness and patient satisfaction of oral and vaginal misoprostol in the treatment of missed abortion.

Evaluation of Rationality of Geriatric Patients' Prescription Based On Beers Criteria in a Tertiary Care Hospital in India

AIM

Irrational prescribing for geriatric patients has become an important public health problem worldwide. Because India is one of the most populated countries having a great proportion of old people in the world, studies on the prevalence of inappropriate prescriptions can be very beneficial to increase the knowledge of health care providers and to reduce the occurrence of adverse drug events among this population.

METHODS

A group of 482 inpatients above 64 years old were enrolled in a prospective study. Chart review method was used. The data were collected from patients' prescription and medicine charts. Each prescription was checked individually for the inappropriate drug by using the AGS 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. Suggestions were given to the physicians for inappropriate medications.

RESULTS

The prevalence of potentially inappropriate medication is found to be 11.66% (n = 56). Out of 56 inappropriate medications, the most frequently inappropriate medication is Digoxin (25%) followed by Sprinolactone 19.64%. This study founds age, some medication, length of stay and number of diagnosis as predictors for getting a PIM. Feedback of the physicians varies based on the suggestions.

CONCLUSION

This study concludes that the prevalence of PIMs among geriatrics patients of ≥ 65 years old is 11.66%. Some predictors have been identified for getting a PIM. This study shows that physicians' feedback is dependent on the suggestions being given.

Linaclotide inhibits colonic and urinary bladder hypersensitivity in adult female rats following unpredictable neonatal stress

BACKGROUND

Irritable bowel syndrome (IBS) and bladder pain syndrome (BPS) are female-predominant, chronic functional pain disorders that are associated with early life stress (ELS) and therapeutic options for such patients remain limited. Linaclotide, a guanylate cyclase-C (GC-C) agonist, relieves abdominal pain and bowel symptoms in adult patients suffering from IBS with constipation. Here, we test the hypothesis that linaclotide will reverse colon and bladder hyperalgesia in a female-specific rodent model of adverse early life experience.

METHODS

Neonatal rats were exposed to an odor-attachment learning paradigm of early life stress (ELS). In adulthood, the effect of linaclotide (3 μg kg^-1  d^-1 , p.o.) on colonic and bladder sensitivity was assessed via quantification of the visceromotor response to colorectal distension and the frequency of withdrawal responses to the application of von Frey hairs to the suprapubic region. In another cohort of rats, the effect of linaclotide on ELS-induced colonic and bladder permeability was investigated via measurements of transepithelial electrical resistance (TEER).

KEY RESULTS

Rats exposed to unpredictable ELS exhibited colonic and bladder hypersensitivity that was significantly reduced by linaclotide compared to vehicle-treated controls. Colonic and bladder tissue isolated from adult rats exposed to unpredictable ELS exhibited a decrease in colonic and bladder TEER that was reversed by linaclotide.

CONCLUSIONS AND INFERENCES

Our results demonstrate that neonatal rats exposed to unpredictable ELS develop increased sensitivity and permeability of the colon and bladder in adulthood through a mechanism involving activation of peripheral GC-C signaling.

The Shiraz Pediatric Eye Study; a Population Based Survey of School Age Children: Rationale, Design and Baseline Characteristics

Purpose:

To describe the rationale, study design, methodology, and baseline characteristics of the Shiraz Pediatric Eye Study, a population-based survey of schoolchildren in Shiraz, Iran.

Methods:

This population-based study included schoolchildren aged 6–12 years from all four educational districts of Shiraz who were recruited in years 2015–2016. Stratified random sampling was used to select 2400 participants from all districts. Data were recorded from a detailed interview and ocular evaluation of each eligible student. The eye examination comprised uncorrected and best corrected visual acuity measurement, refraction, external eye examination (including specific strabismus and lid evaluation tests), slit lamp biomicroscopy, intraocular pressure measurement, the Ishihara color vision test, and stereoacuity. Exophthalmometry, optical biometry, and optical coherence tomography were performed for a randomly selected subset of children. General characteristics and socioeconomic variables were also recorded to assess risk factors.

Results:

From a total of 2400 selected students, 2001 (83.3%) participated in the study. The mean age of the students was 9.1 ± 1.6 years, and 59.7% were girls. Most children had at least one parent with a diploma or less than diploma (63.5%), and 2.2% had illiterate parents.

Conclusion:

This study is expected to provide accurate estimates of the prevalence of visual impairments and their related determinants in Shiraz. In addition, it will identify children who should be targeted by blindness prevention programs.

Detection of Brucella abortus by immunofluorescence assay using anti outer membrane protein of 19 kDa antibody

BACKGROUND

Brucellosis in humans is one of the most prevalent zoonotic diseases around the world with more than 500,000 new cases per year. It is a weakening disease that requires long-term antibiotic treatment, often resulting in permanent and disabling consequences. Outer membrane proteins (OMPs) of Brucella, which are non-lipopolysaccharide (LPS) antigens, have been used for the diagnostic kits of brucellosis and vaccine design.

OBJECTIVES

The aim of this study was to identify Brucella abortus with an immunofluorescence (IF) test using an antibody against recombinant outer membrane protein (OMP) of 19 kDa of this bacterium.

MATERIAL AND METHODS

The OMP19 gene of Brucella spp. was synthesized, cloned and expressed in Escherichia coli cells. The OMP19 protein was purified by metal chelate affinity chromatography and subsequently used for the immunization of rabbits to produce a polyclonal antibody. Then, this antibody was conjugated to fluorescein isothiocyanate (FITC) and used for the detection of Brucella by an IF test. Also, the sensitivity and specificity of this antibody for the diagnosis of clinical isolates was calculated.

RESULTS

Outer membrane protein 19 was expressed well and reacted with a commercial antiserum against His-tag in an immunoblot assay. Polyclonal antibodies obtained from the serum of rabbits immunized with the purified protein showed strong reactivity in the enzyme-linked immunosorbent assay (ELISA). Moreover, the polyclonal antibody conjugated to FITC was able to properly identify Brucella abortus. Sensitivity and specificity of this IF test in comparison with a polymerase chain reaction (PCR) assay was 84.2% and 50%, respectively.

CONCLUSIONS

This high-titer antibody could potentially be valuable for the specific diagnostic test of brucellosis.

From threat to gradual lifestyle changes: Iranians' experiences with chronic illnesses

AIM

This study aimed to explore and describe the experience of making a healthy lifestyle change among the patients with chronic illness.

BACKGROUND

Despite the existence of different evidence on the critical role of lifestyle in the prevention and management of chronic diseases, many people face challenges in terms of starting and maintaining a healthy lifestyle.

METHODS

A descriptive qualitative study with in-depth semi-structured interviews was carried out in 2015 in Iran. Thirty-four patients with common chronic illnesses were invited to the study using purposive sampling. The collected data were analysed by content analysis.

FINDINGS

The main themes were: trying to remove the perceived threat, considering and trying to do physical activities, considering and planning for a healthy diet, striving to manage stress and having gradual acceptance of new habits and coping with them.

LIMITATIONS

The participants were selected from among those with chronic illness. However, there is also a need to assess the family and healthcare providers' perspectives.

CONCLUSION AND IMPLICATIONS FOR NURSING

The perceived threat of the disease plays an important role in the process of changing to a healthy lifestyle in Iranian with chronic illnesses. It is necessary for healthcare providers, especially nurses, to use this threat as a golden opportunity to accelerate changes in patients' behaviours.

IMPLICATIONS FOR NURSING POLICY

Findings may help policy makers become aware of the need for nurses to create community-based nursing in Iran. Community nurses can remind patients of perceived threats to their health to motivate them for continued healthy behaviours. Therefore, nursing curricula should be revised and educational programs utilise a community-based health approach.