Stem cells and exosomes: as biological agents in the diagnosis and treatment of polycystic ovary syndrome (PCOS)

A typical condition of the female reproductive system is polycystic ovary syndrome (PCOS). Hyperinsulinemia, insulin resistance, obesity, and hyperandrogenism are just a few of the metabolic abnormalities linked to this disease. Type 2 diabetes, hypertension, and cardiovascular disease are further issues related to PCOS. One consequence of this syndrome for which numerous treatment procedures have been developed is infertility. Metformin and clomiphene, two common allopathic medications used to treat PCOS, both have drawbacks and are ineffective. It is vital to seek novel therapeutic modalities to address these constraints. Exosomes (EXOs) are a particular class of extracellular vesicles that cells release, and they are known to play a significant role in mediating intercellular communication. A wide range of cargo, including lipids, proteins, mRNA, miRNAs, and numerous other noncoding RNAs, are contained in the nanoscale lipid bilayer exosomes. The cytokine effects of stem cells and EXOs derived from them enable the defense against metabolic diseases like PCOS. Moreover, EXO microRNAs can potentially be employed as biomarkers in the detection and management of PCOS. In this study, the potential of stem cells and exosomes are specifically investigated in the diagnosis and treatment of PCOS as one of the diseases of the female reproductive system

Optimizing Outpatient Medication Management: The Impact of Clinical Pharmacists on Identifying and Addressing Drug-Related Problems

Medication Therapy Management Services (MTMS) are effective strategies to reduce Drug-Related Problems (DRPs) and associated healthcare costs. Given the high prevalence of DRPs in outpatient settings and the lack of an effective process to detect such problems in Iran, we decided to evaluate the type and number of DRPs identified by clinical pharmacists in a university-affiliated Pharmacotherapy Clinic in Khuzestan province, South of Iran. In this cross-sectional study, 150 eligible outpatients were included. At a university-affiliated pharmacotherapy clinic, pharmacy students took patients' histories and referred them to clinical pharmacists for DRP evaluation and detection. Appropriate interventions were then implemented in collaboration with patients and their healthcare providers to resolve the problems. Approximately 3.56 DRPs per patient were identified during a nine-month study period. The most prevalent DRPs were lack of education or information (32.40% [174/537]), undertreated indications (17.31% [93/537]), and patient compliance (15.27% [82/537]). Clinical pharmacists detected 537 DRPs, implemented 525 interventions, and performed 0.977 interventions per DRP. The provision of information (57.52% [302/525]) and change of therapy (21.71% [114/525]) were the most frequent types of clinical pharmacist interventions. This study revealed deficiencies and limitations in our healthcare services, resulting in a significant prevalence of DRPs. Implementing pharmaceutical care practice models, such as Pharmacotherapy Clinics, where clinical pharmacists integrate their experience and knowledge in a patient-centered manner, is the most effective method for preventing and managing these issue

The Relationship between Iranian EFL Learners’ Autonomy and their Vocabulary Learning Strategies with a Focus on Gender

The purpose of the present study was to investigate the relationship between Iranian EFL learners’ use of vocabulary learning strategies and their autonomy with a focus on the gender. To meet this objective, 82(39 males and 43 females) sophomore and junior students majoring in English Language Teaching who had passed at least 45 credits at Tabriz Azad University, in Iran were asked to take part in the study by filling the questionnaires on learner autonomy (LAQ) and vocabulary learning strategies (VLSQ). After discarding incomplete questionnaires, 70 acceptable cases were used in the statistical analysis. Correlation analysis indicated a statistically significant and positive relationship between Iranian EFL learners’ use of vocabulary learning strategies and their autonomy for both male and female students. The findings can have some pedagogical implications for teachers

Design of a Fixed-Order Robust Controller Using Loop Shaping Method for Damping Inter-Area Oscillations in Power Systems

The inter-area oscillations are common in power system and can occur due to the changes in the load or generation power especially in long transmission lines. This paper presents the design of a robust fixed-order loop shaping controller to damp out the inter-area oscillations and to enhance the stability of the power system. The proposed loop shaping method is based on the shaping of the open-loop transfer function in the Nyquist diagram through minimizing the quadratic error between the actual and the desired open loop transfer functions in the frequency domain. The proposed method is robust with respect to multi-model uncertainty. Despite other robust controller design methods, the proposed approach deals with the entire system i.e. there is no need to reduce the system and still leads to a lower order controller. The proposed method is applied on the two area four machine system under different load conditions and different wind generations. The effectiveness and robustness of the proposed method in damping inter-area oscillations are validated using case studies

Validating a drug-related problems classification system in outpatient setting in Iran

Objective: Medication Therapy Management service (MTMs) has been introduced to improve cooperation among pharmacists and other healthcare professionals in the management of chronic diseases, drug therapy, and patients on polypharmacy. One part of MTMs is detection and resolution of possible drug-related problems (DRPs). Nowadays, numerous DRPs classification systems are available, but due to some defects none of them are currently accepted and implemented universally. The purpose of this study is to design and validate a comprehensive system for classification and documentation of possible DRPs for the Iranian patients. Methods: In this methodological study, four classification systems were studied, and their differences were reviewed, compared. Ultimately, a comprehensive documentation system was developed and tested for validity using experts' opinions. Findings: A comprehensive list of 53 DRPs under eight categories was developed and examined for validity. After collecting the data and validity assessment, questions with content validity ratio of <0.4 and content validity index of <70% were excluded and modified. Finally, with the exclusion and modification of eight DRPs, a modified DRPs list was created. Conclusion: According to the universality and validity assessment and based on consensus of 20 experts, this DRPs list can be used to regulate the standard operation procedure of outpatient clinics in Iran, and could act toward standardization of this service

Identification of drug-related problems followed by clinical pharmacist interventions in an outpatient pharmacotherapy clinic

What is known and objective: Pharmacotherapy is an essential strategy for the treatment of many medical conditions especially chronic disease and often involves multiple medications being used simultaneously. Increasing the use of medications may pose some challenges to safe and effective drug therapy and if not identified and prevented by the pharmacists eventually can lead to drug-related problems (DRPs). The present study aimed to examine the incidence of DRPs in Iranian patients and to evaluate patients’ adherence to the clinical pharmacist interventions as well as the physicians’ acceptance of these recommendations. Methods: This study was conducted in a university-affiliated outpatient pharmacotherapy clinic over a 22-month period. Patients aged 18 years and older with at least one chronic disease receiving at least four medications were included in the study. The patients were interviewed by a clinical pharmacist for comprehensive medication review. DRPs were identified using the DOCUMENT classification system. Recommendations were provided by the clinical pharmacist including interventions involving patient and/or physician to resolve DRPs. The patients were followed up after 2 weeks to evaluate their compliance and physician acceptance of clinical pharmacist recommendations. Results and discussion: Two hundred patients were included in this study. Overall, 875 DRPs were identified with an average of 4.37 per patient. The most prevalent DRPs were related to patient education or information (22.8%), undertreated indications (17.4%) and patient compliance (17.2%). The most common drugs associated with DRPs were alimentary and metabolism (22.2% of DRPs) followed by the cardiovascular system (19.2%) and nervous system (9.6%) medications. The DRP incidence correlated with gender only and was higher in females (p = 0.019). The clinical pharmacist provided 912 interventions with an average of 4.56 and 1.04 interventions per patient and per DRPs respectively. Patient education (41.3%), medication initiation or discontinuation (24.5%), and non-pharmacological interventions (12.9%) were the most common clinical pharmacist interventions. Out of 912 interventions, 665 were followed up, out of which 427 were patient dependent and 228 involved physicians. The patient’s compliance with clinical pharmacist recommendations was 81.2%. The physician acceptance rate of the recommendations was 44.1%. What is new and conclusion: The study shows that especially designed services such as pharmacotherapy clinics running by clinical pharmacists are necessary to detect and resolve DRPs in an effective way. The high compliance rate of the patients indicates patients’ confidence in the clinical pharmacist services provided in the pharmacotherapy clinic. The low acceptance rate of the physicians highlights the need to improve interprofessional collaboration between clinical pharmacists and physicians in an outpatient setting.</p

Paraneoplastic acute eosinophilic pneumonia due to carotid angiosarcoma: A rare case

Key Clinical Message This case report emphasizes that we should analyze a patient's signs and symptoms as a whole rather than relying exclusively on a common pattern to diagnose the condition and indicates that thorough histological investigation and sample collection are needed to accurately diagnose this malignancy. Abstract Angiosarcoma is a rare, fatal, and poorly understood malignant tumor of vascular endothelial cells which is a challenging disease to diagnose in the clinical settings and requires early diagnosis to achieve a favorable prognosis. Paraneoplastic syndromes associated with angiosarcoma can include hypercoagulability, thrombocytopenia, anemia, fever, weight loss, and night sweats. In some cases, the paraneoplastic syndrome can be the first sign of the underlying malignancy. Here, we present a 47‐year‐old individual with angiosarcoma over the right scapula accompanied by hemoptysis and other pulmonary complaints whom at first was thought to be metastatic polmunary involvement. However, the patient's dramatic response to corticosteroids, in addition to further imaging and paraclinical studies, led us to an acute eosinophilic pneumonia (AEP) diagnosis which is an eosinophilic infiltrations of alveolar spaces. The patient received chemotherapy for angiosarcoma and radiation, since the brachial nerve network was disrupted, leaving the tumor unresectable. After 3 years of continuous follow‐up, the patient is now completely cured

The Evaluation of the possible effect of positive end expiratory pressure (PEEP) on pharmacokinetics of phenytoin in patients with acute brain injury under mechanical ventilation

Preliminary data suggests that vital physiologic support measures and free fraction of phenytoin are altered following head trauma. Therefore, we conducted a prospective, randomized controlled study to determine the correlation of albumin concentration and unbound phenytoin plasma concentration following head injury. Ten adult head trauma patients in the neurosurgical intensive care unit receiving phenytoin for the seizure prophylactic treatment were studied for their free and total plasma phenytoin concentration in peak and trough times and their respective albumin concentration. Free and total phenytoin levels were determined by both liquid chromatography and florescence polarization immunoassay (Eclair) of plasma samples after ultrafiltration and deproteinization. No significant difference was found in the plasma concentration measured with HPLC or FPIA while a marked correlation was noted between plasma albumin and free phenytoin concentration (r2=0.85). The total and free phenytoin concentrations were not significantly correlated (r2=0.60). A remarkable difference (P<0.05) was noticed when doses in patients were adjusted on the basis of total plasma phenytoin and calculated plasma phenytoin adjusted for serum albumin. Therefore, therapeutic monitoring in neurosurgical patients receiving phenytoin should be performed on the basis of pharmacologically active component (free fraction), rather than total phenytoin which is presently performed in the clinics.8 page(s

Alterations of blood IL-8, TGF-β 1 and nitric oxide levels in relation to blood cells in patients with acute brain injury

Background: Acute brain injury (ABI) disrupts homeostasis in tissue brain. Inflammation has an important contributory role in the pathogenesis of the disease and blood cell count alteration has been shown. The clinical course is variable, and the factors or markers available for predicting survival or the functional situation of these patients are limited. Aim: The aim of this study was to measure the serum levels of interleukin (IL)-8, transforming growth factor (TGF)-β1 and nitric oxide (NO) in patients with ABI (at days 1, 2, 3 and 7) and to study their relationships to blood cell counts. Methods & results: A total of 25 patients were included in the study and 15 healthy subjects were chosen as a control group. Expression of IL-8 and TGF-β1 and production of NO were higher in ABI patients at each of the time points as compared with the control group. In the case of TGF-β1, the increase at time points 3 and 7 was greater than time points 1 and 2. White blood cells were increased significantly (12130 ± 1372 cells/µl; p < 0.01). A huge decrease in platelet counts was also observed (202 ± 14 cells/µl; p < 0.01). Interestingly, no significant correlation was found between the serum levels of these mediators and blood cell counts (mainly considered leukocytes and platelets). Discussion & conclusion: This study shows dramatic increase in the serum levels of three important mediators involved in inflammation and progression of ABI. We showed that there is no correlation between the serum levels of these mediators, leukocytes and platelets and probably they act independently from each other.7 page(s