Physical and functional evaluations in oncological patients elective to medium and large operations

PURPOSE

To evaluate the risk of sarcopenia on the length of hospital stay and deaths in preoperative cancer patients as well its relation to physical and functional capacity.

METHODS

Preoperative patients admitted to the Cancer Hospital of Mato Grosso comprised the sample. Sociodemographic data, lifestyle data, and a questionnaire for sarcopenia screening were collected. Subsequently, total body mass, height, muscle strength, muscle mass, and physical performance were evaluated. The primary, secondary and tertiary outcomes were sarcopenia, length of stay and death, respectively. The data were tabulated and analyzed using the statistical software SPSS (25.0). The significance level was 5%.

RESULTS

We observed 12 (7.4%) patients with low muscle strength, 20 (12.3%) patients with low muscle mass, 11 (6.8%) patients with low physical performance, and 18 (11.1%) patients with scores for possible sarcopenia. When the risk of sarcopenia was observed, 44 (27.2%) patients had at least one risk related to muscle disorder. When analyzing the prevalence and association of sarcopenia with sociodemographic variables, we observed that education level was associated with sarcopenia (p = 0.031). In addition, there was an association between preoperative sarcopenia and postoperative death (p = 0.006). Finally, there were important correlations between muscle strength and physical performance (p < 0.05), between muscle strength and the sarcopenia questionnaire (p < 0.001), and between physical performance and the sarcopenia questionnaire (p < 0.05).

CONCLUSION

The results suggest the need for counseling and the need to evaluate patients for risk of sarcopenia, since early intervention, such as dietary supplementation and physical exercise, may favor a better postoperative prognosis, possibly corresponding to shorter hospital stays and longer survival and quality of life for patients, especially those who will undergo surgical procedures.

Identifying data elements and key features of a mobile-based self-care application for patients with COVID-19 in Iran

Mobile Health applications have shown different usages in the COVID-19 pandemic, which consisted of empowering patient's awareness, promoting patient's self-care, and self-monitor behaviors. The purpose of this study is to identify key features and capabilities of a mobile-based application for self-care and self-management of people with COVID-19 disease. This study was a descriptive-analytical study that was conducted in two main phases in 2020. In the first phase, a literature review study was performed. In the second phase, using the information obtained from the review of similar articles, a questionnaire was designed to validate identified requirements. Based on the results of the first phase, 53 data elements and technical key features for mobile-based self-care application for people with COVID-19 were identified. According to the statistical population, 11 data elements for demographic requirements, 11 data elements for clinical requirements, 15 data elements for self-care specifications, and 16 features for the technical capability of this app were determined. Most of the items were selected by infectious and internal medicine specialists (94%). This study supports that the use of mobile-based applications can play an important role in the management of this disease. Software design and development could help manage and improve patients' health status.

Combined Physical Training Increases Plasma Brain-Derived Neurotropic Factor Levels, But Not Irisin in People Living with HIV/AIDS

This study evaluated plasma levels of brain-derived neurotropic factor (BDNF), irisin, and lactate in people living with HIV/AIDS who completed a combined physical training program. Nineteen HIV+ participants (age: 39.60 ± 10.96 years; carrier time: 7.75 ± 7.88 years; time of ART: 6.41 ± 5.93 years) performed strength/aerobic training (combined physical training) in the same session for 8 weeks and levels of BDNF, irisin, and lactate were assessed. BDNF (pg/mL) was higher post-CPT (Pre: 1258.73 ± 372.30; Post: 1504.17 ± 322.30; p < 0.001). Irisin (ng/mL) showed no change (Pre: 115.61 ± 72.41; Post: 125.87 ± 81.14; p = 0.973). There was positive correlation between irisin and lactate (mmol/L) pre (r = 0.55, p = 0.04), and lactate values were higher in the group with the highest value of irisin (3.65 ± 0.69 × 2.82 ± 0.59, p = 0.02). Combined physical training results in increased basal BDNF in people living with HIV/AIDS, this finding suggests that increased concentration of BDNF may be associated with decreased chances of developing cognitive disorders or HIV-associated dementia. Further studies involving molecular mechanisms on this subject are necessary.

Barriers and associated factors for adequate antenatal care among Afghan women in Iran; findings from a community-based survey

BACKGROUND

Almost a third of Afghan women living in Iran are at childbearing age. Antenatal care (ANC) is an inextricable part of healthy pregnancy and could prevent the adverse birth outcomes. Almost 97% of Iranian expectant women are receiving adequate ANC (4 or more visits). However, the situation for pregnant Afghan women is unclear. Some studies indicated low access to ANC among Afghan women. In the present study, we aimed to explore the sociodemographic factors and potential barriers associated with adequate ANC among Afghan women in Iran.

METHODS

A cross sectional study was conducted between June 2019 and August 2019. Using time location sampling (TLS), we recruited 424 Afghan women aged 18-45 years old at three health centers in south region of Tehran. The data were collected on sociodemographic characteristics and the reported reasons for inadequate ANC using a questionnaire and analyzed applying bivariate, and multivariate analyses. Factor analysis was performed to reduce the number of potential reasons for inadequate ANC in order to improve the precision of regression analysis.

RESULTS

Almost a third of Afghan women in this study had adequate ANC (≥ 8 visits). The women in older age group, those with higher education and family income, women with longer length of stay, those of legal status were more likely to have adequate ANC. In multivariate analysis, the poor knowledge and attitude toward ANC (AOR = 0.06; 95% CI [0.03-0.15]), the poor quality of services (AOR = 0.17 95% CI [0.07-0.41]); and to some extent, the difficulties in access (AOR = 0.33; 95% CI [0.11-1.00]) were the main obstacles toward adequate ANC among the study population.

CONCLUSION

Our study emphasized the important role of the personal knowledge and attitude toward ANC with adequate antenatal care among Afghan women in Iran. This could be addressed by well-oriented interventions and health education for Afghan women. The collaboration between central government with international agencies should be directed toward enhancing the social support, promoting the awareness and knowledge, and expanding the safety net services to improve the access and quality care among Afghan women in Iran.

"It is good, but I can't afford it …" potential barriers to adequate prenatal care among Afghan women in Iran: a qualitative study in South Tehran

Background

An estimated 96% of registered refugees in Iran are Afghan. Almost half of them are young women at the reproductive age. The adequate maternity care is crucial for healthy pregnancy. There is limited knowledge regarding the access and adequacy of maternity care among Afghan women in Iran. The reports from ministry of health (MOH) implicate higher prevalence of perinatal complications in Afghan population. This mainly attributed to the inadequate prenatal care during pregnancy. Therefore, this paper explores the potential barriers to prenatal care among Afghan women in Iran.

Methods

Using convenience sampling, thirty pregnant Afghan women were recruited at three community health centers with the highest number of Afghan visitors in Tehran, the capital city of Iran. Data were collected through face-to-face interviews in Persian language using an interview guide. The interviewers were two bilingual Afghan graduate midwifery students. Each interview lasted for an hour. The questions regarding the concerns and experienced obstacles in seeking prenatal care were asked. The interviews were transcribed into original language (Persian) and analyzed using content analysis and further translated back into English. The main themes were extracted grouping the similar codes and categories after careful consideration and consensus between the researchers.

Results

The financial constraints and lack of affordable health insurance with adequate coverage of prenatal care services, particularly the diagnostic and screening tests, were the most frequent reported obstacles by Afghan women. In addition, personnel behavior, transportation issues, stigma and discrimination, cultural concerns, legal and immigration issues were also mentioned as the source of disappointment and inadequate utilization of such services.

Conclusions

The findings of present study emphasize the necessity of available and most importantly, affordable prenatal care for Afghan women in Iran. Providing an affordable health insurance with adequate coverage of prenatal and delivery services, could reduce the financial burden, facilitate the access, and ensure the maternal and child health in this vulnerable population. The issues of fear and concern of deportation must be removed for at least illegal Afghan mothers to ensure their access to maternity care and improve the health of both mother and offspring.

Prevalence survey of infection with Treponema pallidum among HIV-positive patients in Tehran

OBJECTIVE

To identify the frequency of syphilis among Iranian HIV-positive patients.

METHODS

A cross-sectional study on the prevalence of syphilis and HIV co-infection among 450 patients diagnosed with HIV infection was conducted between 2004 and 2008 at Imam Khomeini hospital, Tehran, Iran. The lab tests including CD4 cell count, cerebrospinal fluid, veneral disease research laboratory (VDRL), fluorescent treponema antibody-absorption (FTA-Abs) and viral load were performed for all the patients. Data regarding medical history and their demographics were also collected.

RESULTS

Of all 450 HIV-positive patients, 24 (5.3%) had a positive VDRL test and only two men had a FTA-Abs positive test which means 0.45% of them had a definite co-infection of syphilis. 65.3% of the HIV-positive patients were injection drug users that the co-infection prevalence of them was 0.7%. We did not find any patient with neurosyphilis.

CONCLUSIONS

Considering the increasing prevalence of HIV and also extensive use of highly active antiretroviral therapy in developing nations, the diagnosis of syphilis should be timely established using screening tests among such patients.

Mechanisms of anti-retroviral drug resistance: implications for novel drug discovery and development

Anti-retroviral drug resistance evolves as an inevitable consequence of expanded combination Anti-retroviral Therapy (cART). According to each drug class, resistance mutations may occur due to the infidel nature of HIV reverse transcriptase (RT) and inadequate drug pressures. Correspondingly, resistance to Nucleoside Reverse Transcriptase Inhibitors (NRTIs) occurs due to incorporation impairment of the agent or its removal from the elongating viral DNA chain. With regard to Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs), resistance mutations may alter residues of the RT hydrophobic pocket and demonstrate high level of cross resistance. However, resistance to Protease Inhibitors requires complex accumulation of primary and secondary mutations that substitute amino acids in proximity to the viral protease active site. Resistance to novel entry inhibitors may also evolve as a result of mutations that affect the interactions between viral glycoprotein and CD4 or the chemokine receptors. According to the current studies, future drug initiative programs should consider agents that possess higher genetic barrier toward resistance for ascertaining adequate drug efficacy among patients who have failed first-line regimens.

Adherence to Antiretroviral Therapy Among Iranian HIV/AIDS Patients

PURPOSE

Treatment adherence of 95% or higher is recommended for appropriate therapeutic response and improving the function of immune system in HIV positive patients. To the best of our knowledge, there was report of adherence to HAART regimen from Iran. In the present study, we have reported the HAART adherence rate of Iranian HIV positive patients.

METHOD

In a twelve-month period, all patients older than 18 years old who referred to HIV clinic were on HAART regimen enrolled in the study. Beside demographic and clinical characteristics of Iranian HIV positive patients, Adherence to HAART was assessed by self-report and pill count methods at during the three consecutive months of the patients’ visits.

RESULTS

The mean of patients’ adherence to HAART regimen based on the self-report method was 69.4%, 64.6% and 62.8% in the first, second and third month of follow up, respectively. The mean of adherence rates in three months followup assessed by self-report (65.5%) and pill count (60.4%) methods were correlated significantly (r=0.93 and p<0.001). Living with family members, changing the HAART regimen and stage of disease had a significant relationship with adherence rates.

CONCLUSION

Although the adherence level of Iranian HIV infected patients is acceptable compared to other countries, the available antiretroviral medications are limited in our country, therefore, encouraging patients to have higher levels of adherence is more important.

Wart lesion in a patient associated with HIV infection and treatment under IMOD therapy

We report a 27-year-old hemophilic male who was HIV positive and under Highly Active Antiretroviral Therapy (HAART) along with wart lesions. When IMOD therapy started concurrently with HAART, the skin lesions disappeared.

Role of fine-needle aspiration in the management of thyroid nodules

OBJECTIVE

To show the benefits of fine-needle aspiration biopsy (FNAB) in managing thyroid nodules.

METHODS

As a retrospective study, reports of 888 FNABs of the thyroid performed during a period of 11 years (1996-2007) at Tehran University of Medical Sciences, Sina Hospital and Endocrine Clinic, Tehran, Iran were reviewed. Histological diagnoses were available for 182 cases, and we compared cytological diagnoses of FNAB with pathologic reports.

RESULTS

The cytology diagnoses by FNAB were: papillary 6 (3.2%); follicular neoplasm 51 (28%); follicular adenoma 10 (5.4%); Hurthle cell neoplasm 8 (4.3%); suspicious 20 (10.9%); inconclusive 2 (1%); and benign 85 (46.4%). Due to surgery pathologic reports, malignant cytologies were: 6 (100%) for papillary, 1 (1.96%) for follicular neoplasm, 4 (50%) for Hurthle cell neoplasm. In suspicious reports, 11 (55%) reports of pathology were malignant; and in inconclusive reports, one report (50%) was malignant.

CONCLUSION

Fine needle aspiration is a useful technique for selecting patients with nodular thyroid disease for surgery.

A cross-sectional study of anemia in human immunodeficiency virus-infected patients in iran

BACKGROUND

Anemia is a frequent complication of infection with human immunodeficiency virus (HIV). The causes of HIV-related anemia are multifactorial. This study was conducted to evaluate the factors associated with anemia in HIV-infected patients.

METHODS

A total of 642 patients with HIV/AIDS attending the HIV Clinic at Imam Khomeini Hospital in Tehran, Iran enrolled in this study. A detailed history and physical examination was done for all the patients. Investigations included CD4+ count, hemoglobin concentration, and red blood cells morphology.

RESULTS

Among HIV-infected patients, 87% were males. The mean duration of antiretroviral therapy was 17.9+/-9.2 months. The mean (+/-SD) hemoglobin level was 12.9+/-2.31 mg/dL. Evaluation of red blood cell morphology showed macrocytosis in 11%, normocytosis plus normochromia in 41.1%, and microcytosis plus hypochromia in 47.9% of the patients. The prevalence of anemia (defined as hemoglobin<10 mg/dL) was 10.3%. Anemia was positively associated with female sex (OR=3.01), CD4 level (CD4 count of <200) (OR=3.49), and antituberculous drug administration (OR=4.57).

CONCLUSION

Female sex, stage of HIV infection, and antituberculous drug use were the most important factors associated with anemia in HIV-infected patients in our study.