Seroma formation after surgery for breast cancer

BACKGROUND: Seroma formation is the most frequent postoperative complication after breast cancer surgery. We carried out a study to investigate the effect of various demographic, clinical and therapeutic variables on seroma formation. PATIENTS AND METHODS: A retrospective cross sectional study of patients who underwent surgical therapy for breast cancer with either modified radical mastectomy (MRM) or breast preservation (BP) was carried out. The demographic data and clinical information were extracted from case records. Seroma formation was studied in relation to age, type of surgery, tumor size, nodal involvement, preoperative chemotherapy, surgical instrument (electrocautery or scalpel), use of pressure garment, and duration of drainage. The multiple logistic regression analysis was performed to estimate odds ratios. RESULTS: A total of 158 patients with breast cancer were studied. The mean age of the patients was 46.3 years (SD ± 11.9). Seventy-three percent underwent modified radical mastectomy and the remaining 27% received breast preservation surgery. Seroma occurred in 35% of patients. In multivariate logistic regression analysis an association of postoperative seroma formation was noted with modified radical mastectomy (OR = 2.83, 95% CI 1.01–7.90, P = 0.04). No other factor studied was found to significantly effect the seroma formation after breast cancer surgery. CONCLUSION: The findings suggest that the type of surgery is a predicting factor for seroma formation in breast cancer patients

Immersion of Mtwo nickel-titanium rotary files in antiseptic solution and fatigue resistance: Effects and analysis

Background and aims: Widely application of rotary files for endo treatment would force us to obtain an accurate understanding about the characteristics and drawbacks of these instruments. Therefore in this study, the effects of immersion of NiTi M2 rotary file in deconex and sodium hypochlorite solution on the cyclic fatigue resistance was investigated Material and methods: In this exprimental study, 45 NITI M2 rotary files were divided in three groups I) control (without any immersion), II) immestion in deconex for 5 min and III) immesrion in sodium hypochlorite for 5 min and their cyclic fatigue resistance was investigated by using testing device and NCFs were recorded. The obtained results were analysis by using Fisher's statistic and the mean comparisons were carried out by using Tukey Results: The results showed that immersion of NiTi M2 rotary files in streluating solutions provides negative and significant effects on the cycle fatigue resistance and the highest NCF was obtained in the control (890.046) and the lowest was obtained in the files immmersed in deconex (546,076). Therefore, it is suggested to used autocalve as substitution for immersion to strelize NiTi M2 rotary files.&nbsp

The Clinical Learning Environments of Undergraduate Nursing Students in Iran Context: A Cross-Sectional Multicenter Study

Background: Clinical environments are one of the most effective areas for acquiring the clinical skills of nursing students. Objectives: This study aimed to evaluate and compare the actual and preferential clinical learning environments. Methods: This cross-sectional study was conducted from March 1, 2019, to February 6, 2020 in Zanjan province. Samples included 380 nursing students who had the experience of one semester of internship were entered the study by stratified random sampling. Data collection tools were the Demographic Profile Questionnaire and Clinical Learning Environment Inventory (CLEI). The range of CLEI scores in both actual and preference learning environments is equal to 42-168. We analyzed data using SPSS software, version 22.0. We used descriptive and inferential statistics included independent t-test and one-way ANOVA to analyze the data. A significance level of 0.05 was considered. Results: The mean (SD) score of the actual clinical learning environment was 109.50(12.25), and the preferred learning environment was 131.08 (14.54). The difference between the two variables was statistically significant (t=22.39, P<0.001). There was a difference in the mean of some dimensions of the nursing students' preference and actual forms of clinical learning environment based on educational grade, different internships. Conclusion: There is a significant difference between the actual learning environment and students' expectations. This finding emphasizes the need for attention by managers and decision-makers in nursing education to change and improve the clinical learning environment

Genetics and immunodysfunction underlying Behçet’s disease and immunomodulant treatment approaches

Behçet’s disease (BD) is a chronic autoimmune condition primarily prevalent in populations along the Mediterranean Sea. The exact etiology of BD has not been fully explained yet, but the disease occurrence is associated with a genetic factor, human leukocyte antigen (HLA)-B51 antigen. Among the various immunodysfunctions that are found in BD, patients are increased neutrophil motility and superoxide production, as well as elevated production of tumor necrosis factor (TNF)-α and decreased production of interleukin (IL)-10. Elevated levels of inflammatory cytokines like IL-1 and IL-17 in BD have been found associated with aberrant expression of microRNA. Gene polymorphisms in BD patients have been observed in molecules involved in responses to pathogens that can ultimately modulate the host antimicrobial response. Moreover, several single nucleotide polymorphisms (SNPs) have been reported in genes encoding chemokines and adhesion molecules; many of these changes manifest as increases in vascular inflammation and vascular damage. Lastly, genetic and epigenetic changes have been suggested as involved in the pathogenesis of BD. Modifications in DNA methylation have been found in BD patient monocytes and lymphocytes, leading to adverse function of these cells. This review presents a comprehensive compilation of the literature with regard to the immunodysfunction underlying BD, as well as of the genetics, newly described clinical specifications and novel treatment strategies using immunomodulants based on the current understanding of BD

Mapping geographical inequalities in oral rehydration therapy coverage in low-income and middle-income countries, 2000–17

Abstract Background: Oral rehydration solution (ORS) is a form of oral rehydration therapy (ORT) for diarrhoea that has the potential to drastically reduce child mortality; yet, according to UNICEF estimates, less than half of children younger than 5 years with diarrhoea in low-income and middle-income countries (LMICs) received ORS in 2016. A variety of recommended home fluids (RHF) exist as alternative forms of ORT; however, it is unclear whether RHF prevent child mortality. Previous studies have shown considerable variation between countries in ORS and RHF use, but subnational variation is unknown. This study aims to produce high-resolution geospatial estimates of relative and absolute coverage of ORS, RHF, and ORT (use of either ORS or RHF) in LMICs. Methods: We used a Bayesian geostatistical model including 15 spatial covariates and data from 385 household surveys across 94 LMICs to estimate annual proportions of children younger than 5 years of age with diarrhoea who received ORS or RHF (or both) on continuous continent-wide surfaces in 2000–17, and aggregated results to policy-relevant administrative units. Additionally, we analysed geographical inequality in coverage across administrative units and estimated the number of diarrhoeal deaths averted by increased coverage over the study period. Uncertainty in the mean coverage estimates was calculated by taking 250 draws from the posterior joint distribution of the model and creating uncertainty intervals (UIs) with the 2·5th and 97·5th percentiles of those 250 draws. Findings: While ORS use among children with diarrhoea increased in some countries from 2000 to 2017, coverage remained below 50% in the majority (62·6%; 12 417 of 19 823) of second administrative-level units and an estimated 6 519 000 children (95% UI 5 254 000–7 733 000) with diarrhoea were not treated with any form of ORT in 2017. Increases in ORS use corresponded with declines in RHF in many locations, resulting in relatively constant overall ORT coverage from 2000 to 2017. Although ORS was uniformly distributed subnationally in some countries, within-country geographical inequalities persisted in others; 11 countries had at least a 50% difference in one of their units compared with the country mean. Increases in ORS use over time were correlated with declines in RHF use and in diarrhoeal mortality in many locations, and an estimated 52 230 diarrhoeal deaths (36 910–68 860) were averted by scaling up of ORS coverage between 2000 and 2017. Finally, we identified key subnational areas in Colombia, Nigeria, and Sudan as examples of where diarrhoeal mortality remains higher than average, while ORS coverage remains lower than average. Interpretation: To our knowledge, this study is the first to produce and map subnational estimates of ORS, RHF, and ORT coverage and attributable child diarrhoeal deaths across LMICs from 2000 to 2017, allowing for tracking progress over time. Our novel results, combined with detailed subnational estimates of diarrhoeal morbidity and mortality, can support subnational needs assessments aimed at furthering policy makers’ understanding of within-country disparities. Over 50 years after the discovery that led to this simple, cheap, and life-saving therapy, large gains in reducing mortality could still be made by reducing geographical inequalities in ORS coverage