Unlocking therapeutic symphonies:Innovations in clinical decision support for drug-disease interactions in kidney transplantation

Introduction: Drug-disease interactions (DDSIs) are associated with increasing morbidity, mortality, and healthcare costs. These interactions are preventable if recognized and managed properly. Medication safety is critical in kidney transplant patients due to polypharmacy, co-morbidities, and susceptibility to adverse events. Clinical decision support systems (CDSSs) can play a key role therein. Therefore, this study aims to report on the process of developing an innovative, patient-centered, context-aware CDSS for managing DDSIs in kidney recipients. Material and Methods: Clinically important DDSIs were identified in the medications of patients at a kidney transplant outpatient clinic. Subsequently, rules for their detection and management were extracted based on pharmacology references and clinical expertise. A CDSS was developed and piloted following recommendations on medication CDSS design principles. Results: The knowledge base for this CDSS was developed with clinical context sensitivity. We defined priority levels for alerts, established associated display rules, and determined necessary actions based on the transplantation clinical workflow. The DDSI-CDSS correctly detected 37 DDSIs and displayed nine warnings and 28 cautionary alerts for the medications of 113 study patients (32.7% DDSI rate). The system fired three warnings for diltiazem in bradyarrhythmia, and two for each of the following medications and underlying diseases: aspirin in asthma, erythropoietin alfa in hypertension, and gemfibrozil in gall bladder disease. The potential consequences of the identified DDSIs were GI complications (17%), deterioration of the existing disease/condition (6.1%), and an increased risk of arrhythmias (2.6%), thrombosis (2.6%), and hypertension (1.7%). Complying with system alerts and recommendations would potentially prevent all these DDSIs. Conclusion: This study delineates the process of developing an evidence-based DDSI-CDSS for kidney transplantation, laying the groundwork for future advancements. Our results underscore the clinical significance of these interactions and emphasize the imperative for their accurate and timely detection, particularly in these vulnerable patients.</p

Mental Health Status and its Related Factors in Elderly People Residing in Nursing Homes of Mashhad, Iran

Background: Iranian society is facing the phenomenon of aging and attention to this vulnerable group is necessary. The aim of this study was to assess mental health status and its related factors among elderly people living in nursing homes in Mashhad. Methods: This cross- sectional study was conducted in 2015 on 203 over 60 years old elderly people living in Mashhad nursing homes. Data were collected through a demographic information questionnaire and general health questionnaire (GHQ-28). Data analysis was performed through SPSS19 and using Chi-square, Independent t- test, Mann-Whitney and Logistic Regression. Results: The mean of the GHQ-28 score was 27.24±9.94. Based on the GHQ-28 cut off-point, 130 (%64) of the participants had mental health problems. Mental health had a significant relationship with having chronic diseases (P=0.005), the number of their visitings (P=0.03) and somehow with the number of returnings to home (P=0.05). But, there was no significant relation between mental health score and age, gender, marital status, education, number of children, having an independent income or salary and length of stay in nursing homes (P<0.05). Conclusion: The elderly people living in nursing homes of Mashhad do not have a good mental health status. Since having chronic diseases, the number of their visitings and returnings to home are the most important determinants of their mental health, their families and health policy makers should pay more attention to these items

Effect of Breast Oketani-massage on Neonatal Weight Gain: A Randomized Controlled Clinical Trial

Background: The most important factor affecting weight gain after birth is the type and mode of neonatal feeding. The most suitable nutrition is exclusive breastfeeding. However, breastfeeding can be accompanied with some difficulties, such as breast engorgement, which results in neonatal feeding complications. Breast Oketani-massage therapy is proposed as a treatment for breast engorgement. Aim: This study aimed to determine the effect of breast Oketani-massage therapy on neonatal weight gain among lactating women with breast engorgement. Method: This randomized controlled clinical trial was conducted on 100 postpartum (i.e., on the first five days of childbirth) women admitted to the Midwifery Clinic and Gynecology and Obstetric Department of Imam Reza Hospital, Mashhad, Iran, due to breast engorgement from August to November 2016. The subjects were divided into two groups, namely Oketani massage and routine care training, through random block allocation. The data were collected regarding neonatal weight gain before and after the intervention and analyzed in SPSS (version 20) using repeated measures ANOVA. Results: The results revealed no significant difference between the two groups in terms of neonatal weight gain on within days 1-5 day before the intervention (P=0.17). However, a statically significant difference was observed between the two groups in this regard 14 and 28 days post-intervention (

The Relationship between Cormic Index and Mode of Delivery

Background & aim: The risks of maternal mortality and morbidity associated with cesarean delivery are three and two times higher than vaginal delivery, respectively. The majority of cesarean sections are due to failure to progress in labor. One of the common risk factors for failure to progress is small maternal body size. Cormic index is an indicator of body composition assessment, which estimates trunk and leg length. In this study, we aimed to investigate the relationship between Cormic index and mode of delivery. Methods: This descriptive, cross-sectional study was performed on 170 pregnant women referred to Omolbanin Hospital of Mashhad, Iran. Standing and sitting heights were measured at the onset of active phase of labor. Cormic index was calculated as sitting height/standing height×100. Mode of delivery was followed and recorded. Kruskal-Wallis and Bonferroni-corrected Mann-Whitney tests were performed, using SPSS version 16. Results: The mean Cormic index was 52.04±2.85. There was a significant relationship between mode of delivery and Cormic index, sitting and standing heights, and leg length measures. However, there was no significant relationship between body mass index and mode of delivery. Conclusion: Our findings indicated that mode of delivery is associated with Cormic index. With high Cormic indices (long trunk and short legs) the rate of assisted delivery rose compared to vaginal and cesarean deliveries

Effect of Attachment Training on Paternal-fetal Attachment

Background & aim: Paternal-fetal attachment develops an emotional relationship between father and his infant which can affect their future interactions. Therefore, the present study aimed to determine the effect of attachment training on paternal-fetal attachment. Methods: This clinical trial was conducted in Karmandan and 22 Bahman health centers in Mashhad in 2015. The participants of the study consisted of 60 randomly-selected fathers whose wives `gestational age was 28 to 32 weeks. The intervention group received three 120-min sessions of attachment training once a week in the forms of group discussion, lectures, question and answer, film screenings, and educational booklet. Data collection was performed by means of two questionnaires, named personal and fertility characteristics questionnaire and Weaver Cranley paternal-fetalattachment questionnaire. Two groups were assessed before, immediately after, and 3 weeks after intervention (follow-up) by paternal-fetal attachment questionnaire. Data analysis was performed in SPSS (version 22) using the Chi-square, independent t-test, Fisher, Mann-Whitney U test, and repeated measure tests. P Results: The results of repeated measures showed that mean scores of paternal-fetal attachment was not significantly different between the control and intervention groups before training (P=0.527) However, paternal-fetal attachment significantly increased at post-test (P=0.069) and follow-up (P=0.006) in the experimental group. Conclusion: Attachment training increases paternal-fetal attachment; therefore, pregnancy care programs should include training sessions for fathers

The prevalence of metabolic syndrome increases with serum hs-CRP concentration in individuals without a history of cardiovascular disease: a report from a large Persian cohort

BACKGROUND: Metabolic syndrome (MetS) is defined by a clustering of cardiovascular (CV) risk factors and is associated with a heightened inflammatory state. A raised serum high-sensitivity C-reactive protein (hs-CRP), a marker of inflammation, is also known to associate with CV risk. We have investigated the relationship between the presence of MetS and serum hs-CRP concentration in a large representative Persian population cohort without a history of cardiovascular disease (CVD). METHODS: The MASHAD study population cohort comprised 9 778 subjects, who were recruited from the city of Mashhad, Iran, between 2007 and 2008. Several cardiovascular risk factors were measured in this population without CVD. Individuals were categorized into quartiles of serum hs-CRP concentration: 1st quartile - 0.72 (0.59-0.85) [median (range)] mg/L, 2nd quartile - 1.30 (1.14-1.4) mg/L, 3rd quartile - 2.29 (1.92-2.81) mg/L and 4th quartile - 6.63 (4.61-11.95) mg/L respectively. The prevalence of MetS in each quartile was determined using either International Diabetes Federation (IDF) or Adult Treatment Panel III (ATPIII) criteria. RESULTS: The prevalence of MetS was highest in the 4th quartile for serum hs-CRP [1220 subjects (50.0%)], and significantly higher than that in the 1st quartile (reference group) [634 subjects (25.9%)] (p<0.001). A positive smoking habit [OR, 1.47 (1.26-1.70), p<0.001] and the presence of either MetS-IDF [OR, 1.35 (1.18-1.55), p<0.001] or Mets-ATPIII [OR, 1.40 (1.18-1.50), p<0.001] were strong predictors of a 4th quartile for serum hs-CRP concentration. CONCLUSIONS: There was a significant association between high levels of serum hs-CRP and the presence of MetS among individuals without a history of CVD in our Persian cohort

Mammography in Rural Areas of Iran: A Qualitative Study for Designing a Social Marketing Intervention

Introduction: Breast cancer is the most common cancer leading to death in women. So, early detection and treatment of it is very important and increase the patient survival. Mammography is one of the most effective methods for diagnosis of the breast cancer. We aimed to study for designing a social marketing intervention in rural areas of Bojnourd, Iran to propagate using mammography among women. Method: In this qualitative study, 46 women in four focus group discussions (FGD) discussed their views and ideas about mammography. All discussions were voice-recorded and written by two note takers. Using ATLAS.ti5.2 software, the collected data were analyzed. Results: Five main themes including mammography in general, barriers to doing mammography, appropriate communication methods and channels and opinion leaders for them to do this exam, were extracted. Conclusion: Designing a social marketing-based intervention can be useful for propagation of using mammography among women. Keywords: Breast cancer, Mammography, Qualitative study, Social marketing, Rural wome

Relationship between serum anti-heat shock protein 27 antibody levels and obesity

Background Heat shock protein 27 (HSP27) is an intracellular molecular chaperone that is expressed at high levels following the exposure of cells to environmental stressors such as heat, toxins, and free radicals. High levels of HSP antigens and antibody titers have been reported in several conditions including cardiovascular disease and cancers. We measured serum anti-HSP27 antibody levels in 993 subjects and assessed the associations between serum anti-HSP27 antibody levels and demographic characteristics including coronary risk factors. Methods A total of 993 subjects were recruited as part of the Mashhad Stroke and Heart Atherosclerotic Disorders (MASHAD) cohort study. Demographic, clinical, and biochemical parameters and serum anti-HSP27 antibody titers were determined in all the subjects. Results Serum anti-HSP27 antibody levels increased with increasing age in men. No significant differences in levels were detected between men and women. Serum anti-HSP27 antibody levels were significantly higher in obese subjects than in nonobese subjects (P = 0.046); however, no significant influence of smoking status was observed. Moreover, serum anti-HSP27 antibody titers were positively associated with age, body mass index, waist/hip ratio, the presence of diabetes mellitus, nonsmoking habit, serum triglycerides, cholesterol, and high-sensitivity c-reactive protein. Conclusion We have found that serum anti-HSP27 antibody titers are related to several cardiovascular risk factors, necessitating further studies on the value of this emerging marker for risk stratification

A novel splice site variant in the LDLRAP1 gene causes familial hypercholesterolemia

Background: familial hypercholesterolemia (FH), a hereditary disorder, is caused by pathogenic variants in the LDLR, APOB, and PCSK9 genes. This study has assessed genetic variants in a family, clinically diagnosed with FH. Methods: A family was recruited from MASHAD study in Iran with possible FH based on the Simon Broom criteria. The DNA sample of an affected individual (proband) was analyzed using whole exome sequencing, followed by bioinformatics and segregation analyses. Results: A novel splice site variant (c.345-2A>G) was detected in the LDLRAP1 gene, which was segregated in all affected family members. Moreover, HMGCR rs3846662 g.23092A>G was found to be homozygous (G/G) in the proband, probably leading to reduced response to simvastatin and pravastatin. Conclusion: LDLRAP1 c.345-2A>G could alter the phosphotyrosine-binding domain, which acts as an important part of biological pathways related to lipid metabolism

Comparative Study of Hearing Impairment among Healthy and Intensive Care unit Neonates in Mashhad, North East Iran.

INTRODUCTION According to World Health Organization (WHO) 2001 statistics, hearing disorders are the most common congenital disease, and the incidence rate among high-risk newborns is as much as ten times as high as that in healthy neonates. However, 78% of screening test failures are well-baby nursery babies. The Joint Committee on Infants' Hearing (JCIH) has emphasized the importance of early diagnosis and treatment in neonates with hearing impairments in order to preserve their maximum linguistic skills. The aim of our study was to compare the prevalence of hearing loss among babies in the neonatal intensive care unit (NICU) and the rooming-in unit (RIU). MATERIALS AND METHODS Neonates born in three hospitals in Mashhad between 2008 to 2010 were studied prospectively and screened for auditory disorders using the oto acoustic emission (OAE) test at the time of discharge and 3 weeks later. To confirm hearing loss, the auditory steady state response (ASSR) test was used among those participants who failed both OAE tests. RESULTS Two-thousand and sixty-three neonates from the NICU were screened and compared with a control group consisting of 8,724 neonates from the RIU or the well-baby nursery. At the end of the study, hearing impairment as confirmed by failure in the ASSR test was diagnosed in 31 neonates (26 in the control group [0.30%] and five in the NICU group [1.94%]). CONCLUSION In our study, the prevalence of hearing disorders among NICU neonates was 6.5-times greater than that among babies from the RIU or well-baby unit. This observation demonstrates the importance of universal screening programs particularly for high-risk population neonates