Effects of L-asparginase administration on anticoagulant proteins and platelet function in patients with acute lymphoblastic leukemia

Introduction: Acute lymphoblastic leukemia is one the most common malignancies in children and adolescents. L-asparginase (L-ASP) is one of the leading medications in treatment of ALL. L.ASP interferes with the synthesis of some coagulation proteins and therefore causing disturbance in normal coagulation. In this study, the effects of L-ASP on anticoagulant proteins (protein C, protein S, and antithrombin III) and platelet function were assessed. Material and methods: This was a before-after study on 41 patients with ALL who refered to Mahak hospital (Tehran, Iran). Before and after the injection of L.ASP, a bleeding time test was performed based on Ivy method. Protein C and protein S performance was assessed by turbidometry and antithrombin III performance was evaluated by chromogenic method. Results: 48.8 of patients were female. Mean (±SD) of age was 4.0±7.2. A significant reduction in the mean amount of protein C, antithrombin III and bleeding time was recorded. However, the reduction in protein S was not significant. No patient showed the symptoms of thrombosis. Conclusion: The results of this study showed that L. ASP drug reduced coagulation proteins (except the protein S). This decrease along with other concomitant genetic factors can lead to thrombosis in some patients with ALL during induction therapy

Mapping geographical inequalities in childhood diarrhoeal morbidity and mortality in low-income and middle-income countries, 2000–17 : analysis for the Global Burden of Disease Study 2017

Background Across low-income and middle-income countries (LMICs), one in ten deaths in children younger than 5 years is attributable to diarrhoea. The substantial between-country variation in both diarrhoea incidence and mortality is attributable to interventions that protect children, prevent infection, and treat disease. Identifying subnational regions with the highest burden and mapping associated risk factors can aid in reducing preventable childhood diarrhoea. Methods We used Bayesian model-based geostatistics and a geolocated dataset comprising 15 072 746 children younger than 5 years from 466 surveys in 94 LMICs, in combination with findings of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017, to estimate posterior distributions of diarrhoea prevalence, incidence, and mortality from 2000 to 2017. From these data, we estimated the burden of diarrhoea at varying subnational levels (termed units) by spatially aggregating draws, and we investigated the drivers of subnational patterns by creating aggregated risk factor estimates. Findings The greatest declines in diarrhoeal mortality were seen in south and southeast Asia and South America, where 54·0% (95% uncertainty interval [UI] 38·1–65·8), 17·4% (7·7–28·4), and 59·5% (34·2–86·9) of units, respectively, recorded decreases in deaths from diarrhoea greater than 10%. Although children in much of Africa remain at high risk of death due to diarrhoea, regions with the most deaths were outside Africa, with the highest mortality units located in Pakistan. Indonesia showed the greatest within-country geographical inequality; some regions had mortality rates nearly four times the average country rate. Reductions in mortality were correlated to improvements in water, sanitation, and hygiene (WASH) or reductions in child growth failure (CGF). Similarly, most high-risk areas had poor WASH, high CGF, or low oral rehydration therapy coverage. Interpretation By co-analysing geospatial trends in diarrhoeal burden and its key risk factors, we could assess candidate drivers of subnational death reduction. Further, by doing a counterfactual analysis of the remaining disease burden using key risk factors, we identified potential intervention strategies for vulnerable populations. In view of the demands for limited resources in LMICs, accurately quantifying the burden of diarrhoea and its drivers is important for precision public health

Best herbs for managing diabetes: a review of clinical studies

Diabetes mellitus is a public health problem which leads to serious complications over time. Experimentally, many herbs have been recommended for treating diabetes. In most cases, however, the recommendations are based on animal studies and limited pieces of evidence exist about their clinical usefulness. This review focused on the herbs, the hypoglycemic actions of which have been supported by three or more clinical studies. The search was done in Google Scholar, Medline and Science Direct databases using the key terms diabetes, plants, herbs, glucose and patients. According to the clinical studies, Aegle marmelos, Allium cepa, Gymnema sylvestre, Momordica charantia, Ocimum sanctum, Nigella sativa, Ocimum sanctum, Panax quinquefolius, Salacia reticulate, Silybum marianum and Trigonella foenum-graecum have shown hypoglycemic and, in some cases, hypolipidemic activities in diabetic patients. Among them, Gymnema sylvestre, Momordica charantia, Silybum marianum and Trigonella foenum-graecum have acquired enough reputation for managing diabetes. Thus, it seems that physicians can rely on these herbs and advise for the patients to improve management of diabetes

The global burden of cancer attributable to risk factors, 2010–19: a systematic analysis for the Global Burden of Disease Study 2019

BACKGROUND: Understanding the magnitude of cancer burden attributable to potentially modifiable risk factors is crucial for development of effective prevention and mitigation strategies. We analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to inform cancer control planning efforts globally. METHODS: The GBD 2019 comparative risk assessment framework was used to estimate cancer burden attributable to behavioural, environmental and occupational, and metabolic risk factors. A total of 82 risk–outcome pairs were included on the basis of the World Cancer Research Fund criteria. Estimated cancer deaths and disability-adjusted life-years (DALYs) in 2019 and change in these measures between 2010 and 2019 are presented. FINDINGS: Globally, in 2019, the risk factors included in this analysis accounted for 4·45 million (95% uncertainty interval 4·01–4·94) deaths and 105 million (95·0–116) DALYs for both sexes combined, representing 44·4% (41·3–48·4) of all cancer deaths and 42·0% (39·1–45·6) of all DALYs. There were 2·88 million (2·60–3·18) risk-attributable cancer deaths in males (50·6% [47·8–54·1] of all male cancer deaths) and 1·58 million (1·36–1·84) risk-attributable cancer deaths in females (36·3% [32·5–41·3] of all female cancer deaths). The leading risk factors at the most detailed level globally for risk-attributable cancer deaths and DALYs in 2019 for both sexes combined were smoking, followed by alcohol use and high BMI. Risk-attributable cancer burden varied by world region and Socio-demographic Index (SDI), with smoking, unsafe sex, and alcohol use being the three leading risk factors for risk-attributable cancer DALYs in low SDI locations in 2019, whereas DALYs in high SDI locations mirrored the top three global risk factor rankings. From 2010 to 2019, global risk-attributable cancer deaths increased by 20·4% (12·6–28·4) and DALYs by 16·8% (8·8–25·0), with the greatest percentage increase in metabolic risks (34·7% [27·9–42·8] and 33·3% [25·8–42·0]). INTERPRETATION: The leading risk factors contributing to global cancer burden in 2019 were behavioural, whereas metabolic risk factors saw the largest increases between 2010 and 2019. Reducing exposure to these modifiable risk factors would decrease cancer mortality and DALY rates worldwide, and policies should be tailored appropriately to local cancer risk factor burden

Coping Styles of Stroke Survivors based on Patients’ Demographic Features

Abstract: Background & Aims: stroke is a stressful event associated with numerous physical, psychological, social and economical problems that can complicate the balance of different life aspects, but after a period of time, patients try to benefit from different coping styles to reduce their problems and retain to a normal life. The aims of this study were to investigate coping strategies used by stroke survivors, and to identify their distribution based on demographic factors. Methods: In this cross-sectional descriptive study, all stroke patients in Kerman city were considered as study population. Finally, ninety-five patients were selected by convenience sampling method and based on the study inclusion criteria. Data were gathered by demographic questionnaire and Folkman & Lazarus Coping Questionnaire. The severity of symptoms was measured by National Institutes of Health Stroke Scale (NIHSS). Data analysis was performed by using descriptive and referential statistics (t-test, ANOVA) and through SPSS 16 software package. Results: Maximal means were achieved for seeking social support and planned problem solving, while minimal means were achieved for escape-avoidance and self controlling. There were significant relationships between coping styles and some demographic features such as age, level of education and severity and duration of the disease (P<0.05). Gender did not have a role on use of coping styles. Conclusion: According, to the results of this study, stroke survivors use problem-focused coping strategies more than emotion- focused coping strategies. The results of this study in regard to the relationship of age and educational level with the adopted coping style and using emotion-focused coping strategies by patients with more severe disease should be considered in the patients; treatment planning and process. Keywords: Stroke, Psychological adaptation, Demograph

Comparing the levels of hospital’s social accountability: Based on ownership

Background and objective: Social accountability is an effective strategy for improving the quality and performance of health-care service providers. This research aimed to compare the social accountability levels of hospitals based on the kind of their ownership. Material and methods: This applied research was conducted in 2016. Research population included hospitalized patients in different selected hospitals located in Golestan province, Iran. 361 patients were selected as the study sample by applying Kochran's sample size formula in 95 confidence interval. The Persian version of a standardized questionnaire made by World Health Organization was used for measuring the social accountability. Data were analyzed in SPSS. Findings: The total mean rate of social accountability in the private hospital was the highest (135.55 ± 15.55). There was a significant difference in social accountability rate among studied hospitals based on the kind of their ownership (p <.001). Taking the kind of ownership into account, there was a significant difference among the hospitals in the all components of the social accountability in favor of the private hospital (p <.05). Conclusion: The social accountability has better status in the private hospital than that of social security and teaching ones. © 2017, © 2017 Informa UK Limited, trading as Taylor & Francis Group

Investigating the relationship between organizational justice, job satisfaction, and intention to leave the nursing profession: A cross-sectional study

Aims: This study aims to test a hypothetical model linking various dimensions of organizational justice to the job satisfaction and nurses' intention to leave the profession based on the theoretical assumptions of the Alexander model of voluntary turnover. Design: A cross-sectional survey. Methods: This study was conducted on 317 inpatient ward nurses of six teaching hospitals in Tehran, Iran during 1 September 2017�14 November 2018. Clinical nurses were recruited by a multistage random sampling. Data were collected using structured questionnaires of organizational justice, job satisfaction, and nurses' intention to leave. Data were analysed by structural equation modelling using Amos 22 statistical program. Results: The structural equation model demonstrated adequate fit and the hypothesized correlations were partially supported. The findings suggested that the distributive justice (p <.001; β = 0.24) and interactional justice (p <.001; β = 0.44) could indirectly affect the nurses' intention to leave the nursing profession via the direct impact on job satisfaction, while job satisfaction had a significant, negative effect on the nurses' intention to leave (p <.001; β = �0.71). Conclusions: According to the results, the model fit was acceptable, suggesting the validity of the final model. Furthermore, distributive and interactional justice could reduce the intention to leave the nursing profession by influencing the job satisfaction of the clinical nurses. Impact: This was one of the first studies to determine the aspects of justice that must be further emphasized by healthcare managers to increase the job satisfaction of nurses and their retention in healthcare systems. The findings indicated that fair interactions have a greater impact on job satisfaction and retention of nurses than procedural and distributive justice. The results of this study provide valuable references for nursing managers to increase the job satisfaction of nurses and their retention in healthcare settings. © 2020 John Wiley & Sons Lt

Classic Konno-Rastan procedure: Indications and results in the current era

Diffuse or unresectable subaortic stenosis is difficult to treat and needs aggressive resection to effectively relieve the obstruction. Anterior aortoventriculoplasty, known as the Konno-Rastan procedure, has been shown to effectively tackle the problems encountered in diffuse subaortic stenosis. A retrospective study was carried out on patients who had undergone a Konno-Rastan procedure at our institution from March 1997 to November 2003. There were 26 patients (16 males and 10 females). The mean age at operation was 12.8 ± 7 years. The mean follow-up period was 30.4 ± 14.5 months. Only mechanical valves were used in this group of patients. The overall 30-day mortality was 11.5 (3 patients). The mean preoperative peak systolic gradient decreased significantly from 91.3 ± 39.3 to 28.1 ± 17.7 mm Hg. Four patients developed permanent complete heart block and 2 had a residual ventricular septal defect in late follow-up. The classic Konno-Rastan procedure using a mechanical valve can be performed with acceptable morbidity and mortality in this difficult group of patients

Efficacy and safety of rituximab in children with steroid-and cyclosporine-resistant and steroid- and cyclosporine-dependent nephrotic syndrome

Introduction. There is evidence of the effectiveness of rituximab in treatment of nephrotic syndrome in children. The present study aimed to assess safety and the therapeutic effectiveness of rituximab in steroid- and cyclosporine-resistant pediatric nephrotic syndrome. Materials and Methods. Forty-three children with steroid- and cyclosporine-resistant or steroid- and cyclosporine-dependent noncongenital nephrotic syndrome were included in the study to receive intravenous rituximab, 375 mg/m2/wk, for 4 weeks. The children were followed up for 2 years. Effectiveness was defined as remission of proteinuria in response to rituximab. Side effects of rituximab were monitored. Results. Overall, 23 (57.1) of the children had steroid- and cyclosporine-resistant nephrotic syndrome, of whom 8 (34.8) revealed complete response and 3 (13) revealed partial response. Seven children (16.7) had late-resistant nephrotic syndrome, of whom 6 (85.7) revealed complete response and none revealed partial response. Ten children (26.2) had steroid- and cyclosporine-dependence all of whom revealed complete response to rituximab. Complete response rate was significantly higher in those with drug-dependent pattern than the other groups (P = .002). There was no association between response to rituximab and pathological basis of disease. Side effects were found in 4 patients as leukopenia in 2, alopecia in 1, and eosinophilia in 1. Conclusions. Rituximab is effective for children with nephrotic syndrome with high efficacy and well tolerability, especially in those with steroid- and cyclosporine-dependent nephrotic syndrome. © 2018, Iranian Society of Nephrology. All rights reserved