The Relation between the Caring Stress and the Caregivers’ Anxiety in Cancer Patients’ Family

The purpose of this research was to ascertain the relationship between the caring stress and the caregivers’ anxiety in cancer patients’ family. The research method was correlation and the statistical population consisted of all family caregivers of cancer patients of Mahak Institute in 96 with the total number of 4400. By using the available sampling method, 384 people were sampled and evaluated by the care pressure questionnaire (CBI) and the God existential anxiety scale. The results of Toosi statistical analysis of correlation coefficient and regression represented that there is a relationship between caring stress and existential anxiety in family caregivers of cancer patients. So, patients' companions can become anxious because of caring for a long time

Magnesium Sulfate Effect on the Clinical Course and GCS of Patients with a Severe Diffuse Axonal Injury

Based on a number of studies, magnesium sulfate (MgSO4) given after a diffuse axonal injury has gained attention as a useful neuroprotective agent .The present study was conducted to examine if magnesium sulfate has a therapeutic efficacy and safety in patients with a severe diffuse axonal injury. Adult patients admitted within 1 hour of a closed Traumatic Brain Injury (TBI) with a severe diffuse axonal injury that met eligibility criteria were randomized into two groups. Our treatment guidelines consisted of an initial loading dose of 50 mg/kg magnesium sulfate and then 50 mg/kg QID up to 24 hours after the trauma. The outcome measures were mortality, GCS, and motor function scores which were assessed up to 2 months after the trauma. Magnesium showed a significant positive effect on GCS 2 months (P=0.03).  Among those in MgSO4 group, motor functioning score improved more than control group but this was not statistically significant (P = 0.51). At the end, we have demonstrated that administration of magnesium sulfate can have neuroprotective role following severe DAI.

P2P Network Trust Management Survey

Peer-to-peer applications (P2P) are no longer limited to home users, and start being accepted in academic and corporate environments. While file sharing and instant messaging applications are the most traditional examples, they are no longer the only ones benefiting from the potential advantages of P2P networks. For example, network file storage, data transmission, distributed computing, and collaboration systems have also taken advantage of such networks.The reasons why this model of computing is attractive unfold in three. First, P2P networks are scalable, i.e., deal well (efficiently) with both small groups and with large groups of participants. In this paper, we will present a summary of the main safety aspects to be considered in P2P networks, highlighting its importance for the development of P2P applications and systems on the Internet and deployment of enterprise applications with more critical needs in terms of security. P2P systems are no longer limited to home users, and start being accepted in academic and corporate environments

Strategic Analysis of Maternal Health Program Evaluation System for Providing Improvement Strategies using Internal-External Environment Assessment Technique in Iran

Background: Maternal health program plays an important role in community health, so this study was conducted to analyze the strategic system of maternal health program evaluation for providing improvement strategies using internal-external environment assessment technique in Iran. Methods: This qualitative study was conducted using the internal-external environment assessment technique. The required data were collected using a qualitative semi-structured questionnaire. The items included the strengths, weaknesses, opportunities, threats, and proposed strategies for improving the performance of the evaluation system. The study experts comprised of 40 health professionals with least 10 years of experience in the maternal health program. They were working in the field of population and family health in the health deputies of Iran medical sciences' universities. The provided points of views by the experts were categorized and reported based on the contents and the internal-external environment assessment matrix was used to develop the strategy.   Results: This study resulted in a comprehensive strategic analysis of the positive and negative points in the internal and external environment of maternal health program evaluation system. The proposed strategies by experts were categorized in 7 main domains under the topics of strengthening the monitoring and evaluation tools, enhancing the monitoring and evaluation process, reforming the clinical information system, establishing a national independent evaluation organization, strengthening the motivation of human resources, enhancing the internal and external coordination, and procuring of the sustainable financial and physical resources. Conclusion: The results indicate that there are important internal weaknesses and external threats in this evaluation system, but they can be overcome by designing and implementing the appropriate promotion strategies

Microscopic Transsphenoidal Surgery for Pituitary Adenomas in Children and Adolescents

Background & Aim: We described the presentation, management and subsequent treatment outcomes of children and adolescents diagnosed with a pituitary adenoma in a joint neuroendocrine setting followed up by a single service as well as assessing long-term outcomes in terms of endocrine status and neurology symptoms. Methods & Materials/Patients: A total of 21 participants with histologically verified pituitary adenoma between January 2011 and June 2014 were studied. Patients' data from clinical, radiological and pathological records were analyzed using SPSS (Version 16). Results: All these children and adolescents with pituitary adenomas were managed with microscopic transsphenoidal surgery. The most common symptom was Cushing (47.6%, n=10). The functional type (76.2%, n=16) was more than the non-functional. The post-operative control MRI of most of them was clear (90.5%, n=19). The lab control of most of them was normal (76.2%, n=16). Apoplexy was seen in 5 patients (33.8%). Gross-total resection (GTR; 100% tumor removal as judged by early post-operative imaging) was achieved in 19 cases. Only one of these patients showed evidence of radiologic recurrence. Conclusion: In our study, all patients underwent microscopic transsphenoidal surgery due to limitation of endoscopic approach in pediatric and avoided wide anatomical deficit. Doing a comparative study between these two approaches will bring about promising results

Hearing Status in Neonatal Hyperbilirubinemia by Auditory Brain Stem Evoked Response and Transient Evoked Otoacoustic Emission

Hyperbilirubinemia at neonatal period is one of the major deteriorating factors of the auditory system. If left untreated, it may cause certain cerebral damage. This study aims to evaluate the impact of hyperbilirubinemia on the hearing of neonate. This study was conducted on 35 newborn babies with jaundice (bilirubin more than 20 mg/dL). Auditory brainstem response (ABR) and transient evoked otoacoustic emission (TEOAE) tests were performed, after treatment and one year after. ABR test results indicated that 26 children (74.3%) had normal hearing but 9 (25.7%) suffered from an impairment. As for TEOAE test, 30 children (85.7%) passed whereas the remaining (14.3%) seemed to be failures. The comparative results of the two tests pointed to autonomic neuropathy /autonomic dysreflexia symptoms in 5 babies. Due to the high incidence of Autonomic neuropathy/autonomic dysreflexia among hyperbilirubinemic babies, screening in this regard seems reasonable. Our result emphasizes the necessity of more experiments on the afflicted areas

Occurrence of some common carbapenemase genes in carbapenem-resistant Klebsiella pneumoniae isolates collected from clinical samples in Tabriz, northwestern Iran

Abstract Objectives This study aimed to evaluate the antibiotic resistance patterns and prevalence of carbapenemase genes in Klebsiella pneumoniae isolates in different clinical samples from Tabriz city, northwestern Iran. Results This cross-sectional study was conducted in the Department of Microbiology, Islamic Azad University, Ahar Branch, Iran, in 2020. K. pneumoniae isolates were collected from different clinical samples, including blood, wounds, sputum, and urine. The isolates were identified using a series of standard bacteriological tests. Antibiotic resistance was determined by the disc diffusion method. The presence of bla VIM, bla NDM, bla KPC, bla OXA, and bla IMP genes were screened by polymerase chain reaction (PCR). A total of 100 non-duplicated K. pneumoniae isolates were collected from 57 urine samples, 27 blood samples, 13 wound samples, and 3 sputum samples. Overall, 70.0% of the samples were from inpatients, while 30.0% were from outpatients. The most resistance rate was related to ampicillin (94.0%), while the lowest resistance rate was related to imipenem (18.0%) and meropenem (20.0%). Overall, 25.0% of the isolates were carbapenem-resistant, of which 13.0% were resistant to both imipenem and meropenem. The PCR showed the total prevalence of 23.0% for carbapenemase genes, including 18.0% for bla KPC, 3.0% for bla VIM, 1.0% for bla IMP, and 1.0% for bla OXA gene. The bla NDM gene was not detected in any isolate. The prevalence of carbapenemase-producing K. pneumoniae isolates was relatively lower in northwestern Iran than in other regions of the country. However, special attention should be paid to the proper use of antibiotics, particularly carbapenems, to prevent further spread of antibiotic resistance and its related genes

Empagliflozin in Patients with Chronic Kidney Disease

Background The effects of empagliflozin in patients with chronic kidney disease who are at risk for disease progression are not well understood. The EMPA-KIDNEY trial was designed to assess the effects of treatment with empagliflozin in a broad range of such patients. Methods We enrolled patients with chronic kidney disease who had an estimated glomerular filtration rate (eGFR) of at least 20 but less than 45 ml per minute per 1.73 m(2) of body-surface area, or who had an eGFR of at least 45 but less than 90 ml per minute per 1.73 m(2) with a urinary albumin-to-creatinine ratio (with albumin measured in milligrams and creatinine measured in grams) of at least 200. Patients were randomly assigned to receive empagliflozin (10 mg once daily) or matching placebo. The primary outcome was a composite of progression of kidney disease (defined as end-stage kidney disease, a sustained decrease in eGFR to < 10 ml per minute per 1.73 m(2), a sustained decrease in eGFR of & GE;40% from baseline, or death from renal causes) or death from cardiovascular causes. Results A total of 6609 patients underwent randomization. During a median of 2.0 years of follow-up, progression of kidney disease or death from cardiovascular causes occurred in 432 of 3304 patients (13.1%) in the empagliflozin group and in 558 of 3305 patients (16.9%) in the placebo group (hazard ratio, 0.72; 95% confidence interval [CI], 0.64 to 0.82; P < 0.001). Results were consistent among patients with or without diabetes and across subgroups defined according to eGFR ranges. The rate of hospitalization from any cause was lower in the empagliflozin group than in the placebo group (hazard ratio, 0.86; 95% CI, 0.78 to 0.95; P=0.003), but there were no significant between-group differences with respect to the composite outcome of hospitalization for heart failure or death from cardiovascular causes (which occurred in 4.0% in the empagliflozin group and 4.6% in the placebo group) or death from any cause (in 4.5% and 5.1%, respectively). The rates of serious adverse events were similar in the two groups. Conclusions Among a wide range of patients with chronic kidney disease who were at risk for disease progression, empagliflozin therapy led to a lower risk of progression of kidney disease or death from cardiovascular causes than placebo