Effects of photobiomodulation laser on a laser-induced choroidal neovascularization model

Age-related macular degeneration is the leading cause of irreversible vision loss in the developed world. Late-stage age-related macular degeneration is classified into two basic sub-types: dry (atrophic) and wet (neovascular). The neovascular subtype accounts for the majority of severe vision loss from age-related macular degeneration. It is characterised by abnormal angiogenesis in the choroid/retina with associated haemorrhage and leakage at the macula. Inflammation and ischaemia are pathogenic components of neovascular age-related macular degeneration and overexpression of vascular endothelial growth factor is a key molecular driver. The current treatment of neovascular age-related macular degeneration involves repeated intravitreal injections of anti-vascular endothelial growth factor agents that block the pro-angiogenic pathway. Although repeat intravitreal injection of anti-vascular endothelial growth factor agents has revolutionized the management of neovascular age-related macular degeneration, often stabilizing or improving vision, it is associated with an enormous economic burden and is not without potentially significant complications. In addition, ongoing macular fibrosis limits its efficacy in a substantial proportion of individuals. Adjunctive treatments that improve visual outcomes and/or reduce the intravitreal injections burden are clinically and economically desirable. Photobiomodulation laser has the potential to target the up-stream hypoxic and pro-inflammatory drive associated with neovascular age-related macular degeneration. It has pleotropic effects on cell survival and energy metabolism. It is believed that the biological effects of photobiomodulation are mediated through increased activity of cytochrome c oxidase, the rate‐limiting enzyme in the mitochondrial electron transport chain. Photobiomodulation stimulates adenosine triphosphate production and in various disease models has been shown to mitigate oxidative stress-induced inflammation. This study investigated the efficacy of photobiomodulation therapy in a laser-induced rat model of neovascular age-related macular degeneration and attempted to elucidate the potential anti-inflammatory and anti-angiogenic mechanisms that may be influenced by this novel therapeutic laser treatment. Initially, the laser-induced choroidal neovascularization model was optimized and, subsequently, two energy settings of photobiomodulation laser were applied to the developed model. Neovascular membranes were quantified using complimentary methods comprising immunohistochemistry for new vessel antigens, spectral domain optical coherence tomography and fluorescein angiography. Analyses were performed to ascertain if treatment successfully reduced the size of the neovascular membrane and the degree of vessel leakage, and thus, improved the tissue outcome. The immune cell response and level of vascular endothelial growth factor in retinal tissues were analyzed to elucidate a mechanism for the observed effects of photobiomodulation treatment in the choroidal neovascularization model. Pre-treatment with photobiomodulation laser significantly reduced the size and volume of the neovascular membranes and promoted normalization of vascular barrier function. These observations were not associated with alterations in vascular endothelial growth factor levels; however, there was evidence that photobiomodulation treatment was associated with modulation of resident retinal microglia and Müller cell inflammatory activation, as well as reduction in infiltration of vascular-derived leukocyte populations. However, the alternative anti-angiogenic pathway mediated by photobiomodulation was not elucidated. The findings in this thesis motivate further translational research investigating the role of adjuvant photobiomodulation laser therapy in conjunction with routine intravitreal anti-vascular endothelial growth factor injection treatment in clinical neovascular age-related macular degeneration.Thesis (M.Phil.) -- University of Adelaide, School of Medicine, 202

The effect of bacterial cellulose nanocrystals on the shear bond strength of resin modified glass ionomer cement to dentin

The present study aimed to investigate the effect of bacterial cellulose nanocrystals (BCNC) on the shear bond strength (SBS) of resin modified glass ionomer cement (RMGIC) to dentin. A total of 48 freshly extracted intact third molars were randomly di

Effect of vitamin D supplementation on inflammatory markers and total antioxidant capacity in breast cancer women using a machine learning technique

Aim: This study aimed to establish a learning system using an artificial neural network (ANN) to predict the effects of vitamin D supplementation on the serum levels of vitamin D, inflammatory factors, and total antioxidant capacity (TAC) in women with breast cancer. Methods: The data set of the current project was created from women with breast cancer who were referred to the Shafa State Hospital of Patients with Cancers in Ahvaz city, Iran. Modeling was implemented using the data set at the serum levels of vitamin D, tumor necrosis factor-α (TNF-α), transforming growth factor β (TGF-β), and TAC, before and after vitamin D3 supplement therapy. A prediction ANN model was designed to detect the effects of vitamin D3 supplementation on the serum level changes of vitamin D, inflammatory factors and TAC. Results: The results showed that the ANN model could predict the effect of vitamin D3 supplementation on the serum level changes of vitamin D, TNF-α, TGF-β1, and TAC with an accuracy average of 85%, 40%, 89.5%, and 88.1%, respectively. Conclusions: According to the findings of the study, the ANN method could accurately predict the effect of vitamin D3 supplementation on the serum levels of vitamin D, TNF-α, TGF-β1, and TAC. The results showed that the proposed ANN method can help specialists to improve the treatment process more confidently in terms of time and accuracy of predicting the influence of vitamin D supplementation on the factors affecting the progression of breast cancer (https://www.irct.ir/ identifier: IRCT2015090623924N1)

Gastric phytobezoars as a very unusual cause of gastric outlet obstruction

Bezoars are collections of indigestible foreign material found in the gastrointestinal tract. Phytobezoars are the most common among the types of bezoars. Treatment of phytobezoars is categorized into four types: chemical dissolution, endoscopic removal, adjuvant prokinetics, and surgery. Complications from phytobezoars can include gastric outlet obstruction (GOO), ileus, ulcerations, gastrointestinal bleeding, and perforation. Herein, we present an 86-year-old woman with refractory postprandial vomiting. Then, exploratory laparotomy was performed and the diagnosis was gastric phytobezoar. Phytobezoars-induced GOO is rare and its diagnosis is still a challenge

Adaptation of Clinical Practice Guideline for Colorectal Cancer Screening in People with Average Risk in Isfahan Province

Background: Colorectal cancer (CRC) is the third most common cancer among adults in Iran. The aim of colorectal cancer screening is to reduce the cancer burden in the population by diagnosing the disease in its early stages. Methods: We adapted this guideline for the moderate CRC risk population for Isfahan to determine how to screen them and when to start and end the CRC screening. This guideline was developed by clinical appraisal and review of the evidence, available clinical guidelines, and in consultation with members of the Isfahan Chamber of Iranian association of gastroenterology and hepatology. Results: In screening people with average risk for CRC who use personal resources and personally pay all the costs, colonoscopy is recommended as the first choice to be done every 10 years. In case of negative colonoscopy, we recommend FIT test to prevention of interval cancer every 5 years. In screening of people with average risk of CRC, FIT is suggested to be done every 2 years as a first-choice method test for those who use public resources and do not pay for this service personally. In screening individuals with average risk for CRC, g-FOBT is not recommended as the first method of choice. Repeating positive guaiac test is not recommended and if positive, colonoscopy is suggested

Assessing the online outpatient booking system

Background: Appointment scheduling is considered as one of the important aspects of patient flow management. Today, the advent of Internet into the realm of health care has paved the way for employing an internet-based booking system for visiting physicians. Therefore, this study aimed at assessing the online outpatient booking system in Iranian hospitals. Methods: The present study was an applied descriptive study. In this study, all outpatient appointment booking websites in Iranian hospitals were evaluated. The methods of outpatients booking in the hospitals (N = 598) were determined based on information available at their active websites. Finally, 31 active online booking systems were identified and investigated using a localized checklist, including 59 items in 6 sections. Results: The results showed that only 13.03% of Iranian hospitals had an active online booking system. All the online booking systems had a weak quality based on the total score percentage (17.10%). The highest score percentages were related to sections of online security features (45%) and details of health insurance (42%), while the clinical data section received the lowest score (7.25%). The most frequent item was the patient’s name in the patient demographics section (27 websites). Conclusions: The outpatient appointment system in Iranian hospitals is done more traditionally through walk-ins to the health centers. The online outpatient booking systems have poor quality. Hence, codification and communication of national standards for designing hospital websites, periodical evaluation of appointment booking websites by ministry of health, and survey of the users of this method can enhance the qualitative level of these websites

Medical Students\' Satisfaction of Clinical Informationist Educational Program

Introduction: Determination of learners' education satisfaction is one of the most significant criteria for assessing the performance of health educational systems. The study was conducted to evaluate the medical students' satisfaction from clinical informationist educational program. Methods: To conduct this study a quasi-experimental posttest design was embraced. The sample was included 30 medical students that were selected by the Convenience time based sequential sampling method. Educational intervention of clinical informationist was done for 10 days. The Clinical Informationist along with the medical student participated in the clinical round, noted the clinical questions and teaching how to search for questions. After clinical round, the Clinical Informationist held a workshop about databases every day. Data were collected by a questionnaire and analyzed by the descriptive statistics and using Excel 2016 software. Results: The average score of medical students' satisfaction was 4.34(±0/551) for content of program, 4.32(±0/659) for educator, 3.85(±0/470) for educational methods and 3.64(±0/872) for educational facilities. The interest of medical students was 50% very high, 40% high and 10% moderate in tendency for implementing and continuing of the educational program. Conclusion: The overall medical students' satisfaction has been increased in terms of content, educator, method and facilities in the clinical informationist educational program

Geographical information system-based prevalence analysis of children’s leukemia in southwest Iran

Background. Climatic and geomorphological characteristics of a region are vital factors in the regional spread of diseases. Geographic Information System (GIS) is a useful tool for studying cancer epidemiology. This study was conducted with the aim of investigating the prevalence of childhood leukemia in Khuzestan based on 10-year GIS data of temperature, wind speed and dust level. Methods. The medical characteristics of all cases of leukemia in children admitted to Bagai 2 Ahvaz Hospital, which were diagnosed with leukemia for the first time. We collected what was diagnosed. Results. Five hundred and twelve children had acute lymphoblastic leukemia (ALL) and 100 children had acute myeloblastic leukemia (AML). The year 2015 had the highest and the year 2018 the lowest ALL rate. The peak of AML was in 2013 and the lowest was in 2018. Central cities had the highest mean particulate matter, temperature, wind speed, and the highest rate of leukemia. Conclusion. The results show that dust, temperature and wind speed are related to the prevalence of childhood leukemia in Khuzestan, Iran. Practical Implications. A wide range of environmental and genetic factors can play a role in the occurrence of cancer, so additional studies are needed to confirm the effect of particles and environmental factors such as temperature and dust on the occurrence of cancer