The Effect of Educating Health Promotion Strategies on Self-Care Self-Efficacy in Patients Undergoing Kidney Transplantation: A Double Blind Randomized Trial

Background: Self-care self-efficacy in patients with end stage renal disease, waiting for kidney transplantation, probably decreases due to facing new conditions and side effects of treatment. Objectives: The current study was conducted to investigate the effect of educating health promotion strategies on self-care self-efficacy in patients undergoing kidney transplantation. Patients and Methods: A double blind randomized clinical trial was conducted on 52 patients undergoing kidney transplantation in Baqiyatallah Hospital in 2012. Patients were randomly assigned into intervention and control groups. The questionnaire of Strategies Used by People to Promote Health (SUPPH) was employed to measure self-care self-efficacy. At first, the two groups filled the questionnaire. Then, the intervention group was trained regarding health promotion strategies within 4 sessions before the transplantation. The control group was trained according to routine protocol of the transplantation unit. Then, the two groups were followed up for two months, and reassessed at the end of the first and second months after the transplantation. The data were analyzed by descriptive and analytic statistics including independent samples T test, Chi square and repeated measures ANOVA. Results: In the intervention group, the mean of total self-care self-efficacy was 106.96 ± 25.1 at first, and changed to 135.81 ± 9.65 and 111.19 ± 12.45 after the first and second post-test respectively (P = 0.001). In the control group, the mean of total self-care self-efficacy was 112.73 ± 14.33 at first, and changed to 118.58 ± 17.59 and 108.73 ± 15.93 after the first and second post-test respectively (P = 0.001). Significant differences were observed between the two groups in the first post-test regarding total score of self-care self-efficacy (P = 0.001) and dimensions of reduction of stress (P = 0.001), enjoying life (P = 0.01), and coping (P = 0.001). The mean scores of the intervention group were higher than those of the controls in all domains of self-care self-efficacy in the second post-test. However, the difference was only significant in decision-making dimension (P = 0.04). Conclusions: Educating health promotion strategies was effective in improving self-care self-efficacy in patients undergoing kidney transplantation. Establishment of a holistic caring program is suggested to integrate the pre-transplantation educations with a continual post discharge follow-up

The Perceived Threat in Adults with Leukemia Undergoing Hematopoietic Stem Cell Transplantation

Background: Leukemia and hematopoietic stem cell transplantation (HSCT) create physical, psychological, social, and spiritual distresses in patients. Understanding this threatening situation in adults with leukemia undergoing HSCT will assist health care professionals in providing holistic care to the patients. Objectives: The aim of the present study was exploring the perceived threat in adults with leukemia undergoing HSCT. Patients and Methods: This article is part of a longitudinal qualitative study which used the grounded theory approach and was conducted in 2009-2011. Ten adults with acute leukemia scheduled for HSCT were recruited from the Hematology–Oncology Research Center and Stem Cell Transplantation, Shariati Hospital in Tehran, Iran. A series of pre-transplant and post-transplant in-depth interviews were held in the hospital’s HSCT wards. Totally, 18 interviews were conducted. Three written narratives were also obtained from the participants. The Corbin and Strauss approach was used to analyze the data. Results: Perceived threat was one of the main categories that emerged from the data. This category included four subcategories, "inattention to the signs and symptoms", "doubt and anxiety", "perception of danger and time limitation" and "change of life conditions", which occurred in linear progression over time. Conclusion: Suffering from leukemia and experiencing HSCT are events that are uniquely perceived by patients. This threatening situation can significantly effect perception of patients and cause temporary or permanent alterations in patients' lives. Health care professionals can help these patients by deeper understanding of their experiences and effective interventions

Effects of Peer Education and Orientation Tour on Anxiety in Patient Candidates for Coronary Angiography

Background: Coronary angiography is a stressful procedure for most patients. The physiological responses caused by anxiety during coronary angiography increase the likelihood of dysrhythmia, coronary artery spasm, and rupture. Objectives: This study compared the effects of peer education and an orientation tour on anxiety in patients who were candidates for coronary artery angiography. Patients and Methods: This single blind quasi-experimental study was conducted in 2014. A total of 177 patients who were candidates for coronary artery angiography were divided into three groups: a peer education group, an orientation tour group, and a control group. The patients in the peer education group were trained by a peer educator, and the patients in in the orientation tour group were trained by the researcher, who worked in the angiography unit. The DASS-21 questionnaire was used to measure the patients’ anxiety levels before the intervention and two hours before undergoing the coronary angiography. The data were analyzed using a Chi-square test, analysis of variance, the Kruskal-Wallis, Wilcoxon, Mann-Whitney U tests, and an interquartile range. Results: The three groups did not significantly differ regarding the mean anxiety scores before the intervention. However, a significant difference was observed between the mean anxiety scores of the three groups after the intervention (P = 0.0001). In the peer education group, the mean anxiety score was 5.34 ± 2.52 and decreased to 3.69 ± 2.87 after the intervention (P = 0.0001). In the orientation tour group, the mean anxiety was 5.53 ± 3.49, which and changed to 3.10 ± 2.22 (P = 0.0001). However, the mean anxiety score significantly increased in the control group (5.66 ± 2.94 vs. 6.53 ± 3.43, P = 0.017). Conclusions: Both methods of peer education and orientation tour decreased the anxiety levels in patients undergoing coronary artery angiography. Therefore, these approaches should be carried out according to the hospital condition and facilities

Unusual Indolent Course of a Chronic Active Epstein-Barr Virus-Associated Natural Killer Cell Lymphoproliferative Disorder

Natural killer (NK) cell lymphoproliferative disorders are uncommon and the Epstein-Barr virus (EBV) plays an important aetiological role in their pathogenesis. We report a 20-year-old male with a chronic active EBV infection associated with a NK cell lymphoproliferative disorder which had an unusual indolent course. He presented to the Sultan Qaboos University Hospital in Muscat, Oman, in December 2011 with a history of intermittent fever and coughing. Examinations revealed generalised lymphadenopathy, hepatosplenomegaly, leukocytosis, transaminitis, diffuse bilateral lung infiltrates and bone marrow lymphocyte involvement. A polymerase chain reaction (PCR) test revealed a high EBV viral load in the peripheral blood cells. The patient received a course of piperacillin-tazobactam for Klebsiella pneumoniae, but no active treatment for the lymphoproliferative disorder. However, his lymphocyte count, serum lactate dehydrogenase and liver enzymes dropped spontaneously. In addition, EBV PCR copies fluctuated and then decreased significantly. He remained clinically asymptomatic over the following four years.

Genotoxicity and acute and subchronic toxicity studies of a standardized methanolic extract of Ficus deltoidea leaves

OBJECTIVE: Ficus deltoidea leaves have been used in traditional medicine in Southeast Asia to treat diabetes, inflammation, diarrhea, and infections. The present study was conducted to assess the genotoxicity and acute and subchronic toxicity of a standardized methanol extract of F. deltoidea leaves. METHODS: Sprague Dawley rats were orally treated with five different single doses of the extract and screened for signs of toxicity for two weeks after administration. In the subchronic study, three different doses of the extract were administered for 28 days. Mortality, clinical signs, body weight changes, hematological and biochemical parameters, gross findings, organ weights, and histological parameters were monitored during the study. Genotoxicity was assessed using the Ames test with the TA98 and TA100 Salmonella typhimurium strains. Phytochemical standardization was performed using a colorimeter and high-performance liquid chromatography. Heavy metal detection was performed using an atomic absorption spectrometer. RESULTS: The acute toxicity study showed that the LD50 of the extract was greater than 5000 mg/kg. In the subchronic toxicity study, there were no significant adverse effects on food consumption, body weight, organ weights, mortality, clinical chemistry, hematology, gross pathology, or histopathology. However, a dose-dependent increase in the serum urea level was observed. The Ames test revealed that the extract did not have any potential to induce gene mutations in S. typhimurium, either in the presence or absence of S9 activation. Phytochemical analysis of the extract revealed high contents of phenolics, flavonoids, and tannins. High-performance liquid chromatography analysis revealed high levels of vitexin and isovitexin in the extract, and the levels of heavy metals were below the toxic levels. CONCLUSION: The no-observed adverse effect level of F. deltoidea in rats was determined to be 2500 mg/kg

Single synapse glutamate imaging reveals multiple levels of release mode regulation in mammalian synapses

Mammalian central synapses exhibit vast heterogeneity in signaling strength. In order to understand the extent of this diversity, how it is achieved, and its functional implications, characterization of a large number of individual synapses is required. Using glutamate imaging, we characterized the evoked release probability and spontaneous release frequency of over 24,000 individual synapses. We found striking variability and no correlation between action potential-evoked and spontaneous synaptic release strength, suggesting distinct regulatory mechanisms. Subpixel localization of individual evoked and spontaneous release events reveals tight spatial regulation of evoked release and enhanced spontaneous release outside of evoked release region. Using on-stage post hoc immune-labeling of vesicle-associated proteins, Ca(2+)-sensing proteins, and soluble presynaptic proteins we were able to show that distinct molecular ensembles are associated with evoked and spontaneous modes of synaptic release

The Correlation Between Prolonged Corrected QT Interval with the Frequency of Respiratory Arrest, Endotracheal Intubation, and Mortality in Acute Methadone Overdose

Corrected QT interval (QTc) prolongation is long considered as a predisposing factor for the occurrence of torsade de pointes (TdP) and sudden cardiac arrest in methadone maintenance treatment. We aimed to elucidate the correlation between QTc prolongation and in-hospital death, respiratory arrest, and endotracheal intubation in acute methadone-intoxicated patients presenting to the emergency department and to assess the value of QTc in predicting these outcomes. A prospective cross-sectional study with a convenience sample of patients with acute methadone overdose was done. Participants were 152 patients aged 15–65 with negative urinary dipstick test for cyclic antidepressants, no history of other QTc-prolonging conditions and co-ingestions, no severe comorbidities affecting the outcomes, and positive urinary dipstick results for methadone. QTc intervals were measured and calculated in triage-time electrocardiogram (ECG). Death was correlated with QTc (P = 0.014) and length of ICU admission (P < 0.001). In multivariable analysis, death was independently associated only with length of ICU admission [odds ratio (OR) 95 % confidence intervals (95 % CI) 1.36 (1.14–1.61)]. Intubation and respiratory arrest were independently associated with QTc interval [OR (95 % CI) 1.03 (1.02–1.04) and 1.02 (1.01–1.03), respectively]. The receiver operating characteristics curves drawn to show the ability of QTc to predict death, intubation, and respiratory arrest showed thresholds of 470, 447.5, and 450 ms with sensitivity (95 % CI) and specificity (95 % CI) of 87.5 (47.3–99.7), 86.8 (74.7–94.5), and 77.3 (62.2–88.5), respectively. Our study showed that QTc is a potential predictor for adverse outcomes related to acute methadone intoxication. The correlations shown in this study between triage-time QTc and in-hospital respiratory arrest or intubation in methadone overdose may be of clinical value, whether these outcomes are hypothesized to be a reflection of background TdP or intoxication severity. © 2014, Springer Science+Business Media New York

Non-Invasive Haemoglobin Estimation in Patients with Thalassaemia Major

Objectives: This study aimed to validate pulse CO-oximetry-based haemoglobin (Hb) estimation in children and adults with thalassaemia major (TM) and to determine the impact of different baseline variables on the accuracy of the estimation. Methods: This observational study was conducted over a five-week period from March to April 2012. A total of 108 patients with TM attending the daycare thalassaemia centre of a tertiary care hospital in Muscat, Oman, were enrolled. Spot (Sp) Hb measurements were estimated using a Pronto-7® pulse CO-oximetry device (Masimo Corp., Irvine, California, USA). These were compared to venous samples of Hb using the CELL-DYN Sapphire Hematology Analyzer (Abbott Diagnostics, Abbott Park, Illinois, USA) to determine the reference (Ref) Hb levels. A multivariable linear regression model was used to assess the impact of baseline variables such as age, gender, weight, height, Ref Hb and blood pressure on the Hb estimations. Results: Of the 108 enrolled patients, there were 54 males and 54 females with a mean age of 21.6 years (standard deviation [SD] = 7.3 years; range: 2.5–38 years). The mean Ref Hb and Sp Hb were 9.4 g/dL (SD = 0.9 g/dL; range: 7.5–12.3 g/dL) and 11.1 g/dL (SD = 1.2 g/dL; range: 7.5–14.7 g/dL), respectively. The coefficient of determination (R2) was 21% with a mean difference of 1.7 g/dL (SD = 1.1 g/dL; range: −0.9–4.3 g/dL). In the multivariable model, the Ref Hb level (P = 0.001) was the only statistically significant predictor. Conclusion: The Pronto-7® pulse CO-oximetry device was found to overestimate Hb levels in patients with TM and therefore cannot be recommended. Further larger studies are needed to confirm these results

Aged garlic has more potent antiglycation and antioxidant properties compared to fresh garlic extract in vitro

Protein glycation involves formation of early (Amadori) and late advanced glycation endproducts (AGEs) together with free radicals via autoxidation of glucose and Amadori products. Glycation and increased free radical activity underlie the pathogenesis of diabetic complications. This study investigated whether aged garlic has more potent antiglycation and antioxidant properties compared to fresh garlic extract in vitro in a cell-free system. Proteins were glycated by incubation with sugars (glucose, methylglyoxal or ribose) ±5–15 mg/mL of aged and fresh garlic extracts. Advanced glycation endproducts were measured using SDS-PAGE gels and by ELISA whereas Amadori products were assessed by the fructosamine method. Colorimetric methods were used to assess antioxidant activity, free radical scavenging capacity, protein-bound carbonyl groups, thiol groups and metal chelation activities in addition to phenolic, total flavonoid and flavonol content of aged and fresh garlic extracts. Aged garlic inhibited AGEs by 56.4% compared to 33.5% for an equivalent concentration of fresh garlic extract. Similarly, aged garlic had a higher total phenolic content (129 ± 1.8 mg/g) compared to fresh garlic extract (56 ± 1.2 mg/g). Aged garlic has more potent antiglycation and antioxidant properties compared to fresh garlic extract and is more suitable for use in future in vivo studies