Bradycardia Following Oral Corticosteroid Use: Case Report and Literature Review

Introduction: Corticosteroids are used in various clinical conditions that include many immune-mediated inflammatory diseases. Different side effects were described including cardiac arrhythmias. Most of those arrhythmias were in the form of bradycardia which usually occurs with high intravenous steroid doses. More significant arrhythmias and cardiac arrest were also described. In this report we describe a case of bradycardia that developed after the use of oral corticosteroids.Case report: We report a case of bradycardia that developed in a 14 year-old male after receiving oral prednisone. The patient had steroid- sensitive nephrotic syndrome and presented with anasarca that started to develop few days prior to hospitalization. He had no underlying heart disease. Vitals was normal. Investigations confirmed a new nephrotic relapse. Oral prednisone 80 mg / day divided into three doses was started. Albumin infusions were initially given with intravenous furosemide to control the edema. Seven days after hospitalization, he developed bradycardia with a pulse rate of 50-60 per minute, which was less than 50% of the baseline heart rate. He didn’t develop significant symptoms and he had no other apparent corticosteroids side effects. Cardiac evaluation and echocardiography were normal. Electrocardiogram revealed only sinus bradycardia.The bradycardia recovered after decreasing the dose of steroids to 60 mg PO every other day and he was discharged in stable condition a few days later.Conclusion: Cardiac arrhythmias may develop with all forms of steroids including oral prednisone. Bradyarrhythmias can occur even with standard doses of oral prednisone

Systemic Lupus Erythematosus with Severe Nephritis That Mimicked Henoch-Schoenlein Purpura

Introduction: Systemic lupus erythematosus (SLE) belongs to a family of related autoimmune rheumatic disorders that are capable of affecting multiple organs, and they are all associated with a variety of autoantibodies. Henoch Schoenlein purpura (HSP) is a sort of systemic vasculitis that is not associated with auto-antibodies and can affect different organs including the kidneys. Case report: A 12 year-old girl presented with abdominal pain, low grade fever, swollen and tender feet and left hand, skin rash on the lower extremities, and high blood pressure. Initial laboratory tests revealed severe proteinuria, microscopic hematuria and low C3 level. Renal biopsy showed diffuse proliferative glomerulonephritis with IgA, fibrinogen and C3 deposits. The case was accordingly diagnosed as HSP with severe IgA nephropathy. Treatment was started with mycophenolate mofetil (MMF) and pulse methylprednisolone followed by prednisolone. The patient improved and treatment was discontinued after 5.5 months. One month after withdrawal of her medications, the patient presented again with serositis and recurrent proteinuria. Both antinuclear antibodies (ANA) and anti dsDNA were positive. At this point she was diagnosed to have SLE disease and immunosuppressive treatment was restarted. Following this, symptoms disappeared, proteinuria regressed and anti-dsDNA titer dropped. Conclusion: This case presented with features of HSP and was later-on diagnosed to have SLE. This kind of clinical overlapping has not been reported in the literature to the best of our knowledge.Keywords: Henoch-Schoenlein Purpura; Nephritis; Systemic Lupus Erythematosu

Awareness of the Importance of and Adherence to Patients’ Rights Among Physicians and Nurses in Oman: An analytical cross-sectional study across different levels of healthcare

Objectives: This study aimed to determine the extent to which physicians and nurses in Oman were aware of the importance of and adhere to patients’ rights and whether this differed according to role, nationality, position and institutional healthcare level. Methods: This analytical cross-sectional study was carried out between December 2015 and March 2016 at various governmental healthcare institutions in Oman. A self-administered questionnaire was distributed to 1,385 practitioners at all healthcare levels. Results: A total of 1,213 healthcare practitioners (response rate: 87.58%) completed the survey, of which 685 (56.47%) were nurses and 528 (43.53%) were physicians. Overall, awareness of the importance of patients’ rights was high (91.51%), although adherence to these rights in practice was low (63.81%). The right of the patient to be informed was considered least important and was least adhered to (81.2% and 56.39%). Nationality, role and institutional level were significantly associated with awareness (P = 0.002, 0.024 and 0.034, respectively). Non-Omani staff were significantly more likely than Omani staff to be aware of (odds ratio [OR] = 1.696; P = 0.032) and adhere to (OR = 2.769; P <0.001) patient rights. Furthermore, tertiary care staff were twice as likely as primary care staff to perceive the importance of patient rights (OR = 2.076; P = 0.019). While physicians were more likely than nurses to be aware of the importance of patient rights, this difference was not significant (OR = 1.516; P = 0.126). Conclusion: These findings may help inform measures to enhance awareness of and adherence to patients’ rights in Oman.Keywords: Medical Ethics; Patient Rights; Awareness; Adherence; Physicians; Nurses; Oman

Evaluation of meat and meat product oxidation and off-flavor formation: Managing oxidative changes

One of the primary issues with processed foods during heat treatment and freezing storage is fat oxidation, which causes significant changes in fats due to their interaction with reactive oxygen species (ROS). This interaction leads to the creation of various aldehydes that have a high affinity for large molecules, such as proteins, leading to the formation of final products of advanced oxidation processes that contribute to food spoilage. Co-oxidation can also result in extensive damage. Another problem affecting the quality and nutritional value of meat products is protein oxidation, which can occur during storage via freezing and thawing or as a result of heat treatment. Heat treatment can cause physical and chemical changes, such as the loss of some essential amino acids and the transformation of certain amino acids into carbonyl compounds via various mechanisms. Protein oxidation is indicated by the accumulation of these carbonyl compounds, and the heat treatment can lead to the denaturation of myoglobin, which is responsible for the brown color of cooked meat and is influenced by several factors. Active protein aggregates can interact with the oxidation products of polyunsaturated fatty acids and with carbohydrate glycation or glycoxidation to produce Maillard products. It is critical to understand the oxidative changes that occur in fats and proteins in food, particularly in meat products, since these components are among the primary constituents of food.One of the primary issues with processed foods during heat treatment and freezing storage is fat oxidation, which causes significant changes in fats due to their interaction with reactive oxygen species (ROS). This interaction leads to the creation of various aldehydes that have a high affinity for large molecules, such as proteins, leading to the formation of final products of advanced oxidation processes that contribute to food spoilage. Co-oxidation can also result in extensive damage. Another problem affecting the quality and nutritional value of meat products is protein oxidation, which can occur during storage via freezing and thawing or as a result of heat treatment. Heat treatment can cause physical and chemical changes, such as the loss of some essential amino acids and the transformation of certain amino acids into carbonyl compounds via various mechanisms. Protein oxidation is indicated by the accumulation of these carbonyl compounds, and the heat treatment can lead to the denaturation of myoglobin, which is responsible for the brown color of cooked meat and is influenced by several factors. Active protein aggregates can interact with the oxidation products of polyunsaturated fatty acids and with carbohydrate glycation or glycoxidation to produce Maillard products. It is critical to understand the oxidative changes that occur in fats and proteins in food, particularly in meat products, since these components are among the primary constituents of food

Effectiveness of an Interactive Educational Video on Knowledge, Skill, and Satisfaction of Nursing Students

Objectives: Nursing education requires innovative teaching strategies for learning fundamental nursing skills to develop proficient nurses for the future. However, nursing educators face challenges in teaching and retaining the skill competency and knowledge of the nursing students given shortages of nursing faculty and scarcity of opportunities for clinical practice. Therefore, this study aimed to compare the interactive educational video-based strategy versus traditional general demonstration for teaching a basic nursing skill. Methods: This cross-sectional comparative study followed 55 nursing students enrolled in a fundamentals of nursing laboratory course during the Spring 2020 semester, at the College of Nursing of Sultan Qaboos University, Oman. The control group was subjected to traditional general demonstration-based teaching of the oral medication procedure, while the experimental group learned the same skill through an interactive educational video. The knowledge, skill competency and satisfaction levels of both groups were assessed post-intervention using standardized questionnaires. Results: There was no statistical difference between the two groups in knowledge level and skill competency scores. Regarding satisfaction, 92% of the students were satisfied with video learning and 87% with the traditional approach. Conclusion: It is evident that the interactive video learning strategy for learning fundamental nursing skills is as effective as the traditional face-to-face general demonstration-based approach.Keywords: Nursing, Video, Knowledge, Satisfaction, Education, Teaching, Oman

Prognostic Impacts of Angiopoietins in NSCLC Tumor Cells and Stroma: VEGF-A Impact Is Strongly Associated with Ang-2

INTRODUCTION: Angiopoietins and their receptor Tie-2 are, in concert with VEGF-A, key mediators in angiogenesis. This study evaluates the prognostic impact of all known human angiopoietins (Ang-1, Ang-2 and Ang-4) and their receptor Tie-2, as well as their relation to the prognostic expression of VEGF-A. METHODS: 335 unselected stage I-IIIA NSCLC-patients were included and tissue samples of respective tumor cells and stroma were collected in tissue microarrays (TMAs). Immunohistochemistry (IHC) was used to semiquantitatively evaluate the expression of markers in duplicate tumor and stroma cores. PRINCIPAL FINDINGS: In univariate analyses, low tumor cell expression of Ang-4 (P = 0.046) and low stromal expressions of Ang-4 (P = 0.009) and Ang-2 (P = 0.017) were individually associated with a poor survival. In the multivariate analysis, low stromal Ang-2 (HR 1.88; CI 95% 1.15-3.08) and Ang-4 (HR 1.47, CI 95% 1.02-2.11, P = 0.04) expressions were independently associated with a poor prognosis. In patients with high tumor cell expression of Ang-2, a concomitantly high tumor VEGF-A expression mediated a dramatic survival reduction (P<0.001). In the multivariate analysis of patients with high Ang-2 expression, high tumor VEGF-A expression appeared an independent poor prognosticator (HR 6.43; CI 95% 2.46-16.8; P<0.001). CONCLUSIONS: In tumor cells, only Ang-4 expression has prognostic impact in NSCLC. In tumor stroma, Ang-4 and Ang-2 are independently associated with survival. The prognostic impact of tumor cell VEGF-A in NSCLC appears strongly associated with a concomitantly high tumor cell expression of Ang-2

Prognostic impact of peritumoral lymphocyte infiltration in soft tissue sarcomas

<p>Abstract</p> <p>Background</p> <p>The purpose of this study was to clarify the prognostic significance of peritumoral lymphocyte infiltration in the capsule of soft tissue sarcomas (STS). Multiple observations in preclinical and clinical studies have shown that the immune system has a role in controlling tumor growth and progression. Prognostic markers in potentially curable STS should guide therapy after surgical resection. The immune status at the time of resection may be important, but the prognostic significance of peritumoral lymphocytes is unknown.</p> <p>Methods</p> <p>Tissue microarrays from 80 patients with STS were constructed from duplicate cores of tissue from the tumor and the peritumoral capsule. Immunohistochemistry was used to evaluate the CD3+, CD4+, CD8+ and CD20+ lymphocytes in the tumor and the peritumoral capsule.</p> <p>Results</p> <p>In univariate analyses, increasing numbers of CD20+ (<it>P </it>= 0.032) peritumoral lymphocytes were associated with a reduced disease free survival (DSS). In multivariate analyses, a high number of CD20+ peritumoral lymphocytes (<it>P </it>= 0.030) in the capsule was an independent negative prognostic factor for DSS. There were no such associations of lymphocyte infiltration in the tumor.</p> <p>Conclusions</p> <p>A high density of CD20+ peritumoral lymphocytes is an independent negative prognostic indicator for patients with STS. Further research is needed to determine whether CD20 cells in the peritumoral capsule of STS may promote tumor invasion in the surrounding tissue and increase the metastatic potential.</p

The number and microlocalization of tumor-associated immune cells are associated with patient's survival time in non-small cell lung cancer

<p>Abstract</p> <p>Background</p> <p>Tumor microenvironment is composed of tumor cells, fibroblasts, endothelial cells, and infiltrating immune cells. Tumor-associated immune cells may inhibit or promote tumor growth and progression. This study was conducted to determine whether the number and microlocalization of macrophages, mature dendritic cells and cytotoxic T cells in non-small cell lung cancer are associated with patient's survival time.</p> <p>Methods</p> <p>Ninety-nine patients with non-small cell lung cancer (NSCLC) were included in this retrospective study. Paraffin-embedded NSCLC specimens and their clinicopathological data including up to 8-year follow-up information were used. Immunohistochemical staining for CD68 (marker for macrophages), CD83 (marker for mature dendritic cells), and CD8 (marker for cytotoxic T cells) was performed and evaluated in a blinded fashion. The numbers of immune cells in tumor islets and stroma, tumor islets, or tumor stroma were counted under a microscope. Correlation of the cell numbers and patient's survival time was analyzed using the Statistical Package for the Social Sciences (version 13.0).</p> <p>Results</p> <p>The numbers of macrophages, mature dendritic cells and cytotoxic T cells were significantly more in the tumor stroma than in the tumor islets. The number of macrophages in the tumor islets was positively associated with patient's survival time, whereas the number of macrophages in the tumor stroma was negatively associated with patient's survival time in both univariate and multivariate analyses. The number of mature dendritic cells in the tumor islets and stroma, tumor islets only, or tumor stroma only was positively associated with patient's survival time in a univariate analysis but not in a multivariate analysis. The number of cytotoxic T cells in the tumor islets and stroma was positively associated with patient's survival time in a univariate analysis but not in a multivariate analysis. The number of cytotoxic T cells in the tumor islets only or stroma only was not associated with patient's survival time.</p> <p>Conclusions</p> <p>The number of macrophages in the tumor islets or stroma is an independent predictor of survival time in NSCLC patients. Counting macrophages in the tumor islets or stroma is more useful in predicting patient's survival time than counting mature dendritic cells or cytotoxic T cells.</p

The presence of tumour-associated lymphocytes confers a good prognosis in pancreatic ductal adenocarcinoma: an immunohistochemical study of tissue microarrays

Background Tumour-associated lymphocytes (TALs) have been linked with good prognosis in several solid tumours. This study aimed to evaluate the prognostic significance of CD3, CD8 and CD20 positive lymphocytes in pancreatic ductal adenocarcinoma. Methods After histological re-evaluation of the tumours of 81 patients who underwent surgical resection for exclusively pancreatic ductal adenocarcinoma, tissue micro-arrays (TMA) were constructed and immunohistochemistry was performed for CD3, CD8 and CD20. The number of lymphocytes within specific tumour compartments (i.e. stromal and intratumoural) was quantified. X-tile software (Yale School of Medicine, CT, USA) was used to stratify patients into 'high’ and 'low’ for each of the lymphocytes stained and their association with survival. Receiver operating curves (ROC) were constructed to evaluate the association between the TALs, alone and in combination, with clinicopathological features. Results CD3 and CD8 positive lymphocytes were associated with grade of tumour differentiation. The presence of intratumoural CD3 positive cells was associated with improved survival (p = 0.028), and intratumoural and stromal CD3 in combination also correlated with improved survival (p = 0.043). When CD20 positive lymphocyte levels were high, survival improved (p = 0.029) and similar results were seen for CD20 in combination with intratumoural CD3 (p = 0.001) and stromal CD8 (p = 0.013). Conclusions This study has shown a correlation between the presence of TALs and survival in pancreatic ductal adenocarcinoma