Pelvic floor dysfunction and polycystic ovary syndrome

Objectives: To compare the prevalence of pelvic floor muscle dysfunction (PFMD) in patients with and without polycystic ovary syndrome (PCOS); to test PFMD in women with different PCOS phenotypes. Methods: This was a case-control study of 202 women who were recruited in an infertility clinic in Hormozgan, Iran: PCOS (n=103) and control groups who were healthy women whose husbands were diagnosed with male infertility (n=99). According to the presence or absence of menstrual dysfunction (M), hyperandrogenism (HA) and polycystic ovaries on ultrasonoghraphy (PCO), patients with PCOS were divided into three phenotypes: HA+PCO, M+PCO and M+HA+PCO. PFMD was assessed by the Pelvic Floor Distress Inventory-20 (PFDI-20. Results: The reported PFMD symptoms were higher in PCOS (P=0.05) than the non-PCOS group. The mean PFDI score in the HA+M+PCO was higher compared to other phenotypes, although the difference did not reach significance level (P>0.05). The mean LH level was higher in HA+M+PCO than the two other phenotypes. There was a significant positive correlation between LH level and PFDI score (P<0.04). Conclusion: The findings suggest that a high level of LH may cause PFMD. Further studies are needed to determine the precise role of LH levels and potential treatment options in women with PCOS and PFMD. Keywords: polycystic ovary syndrome, pelvic floor distress inventory, pelvic floor muscle dysfunctio

Unusual sites of bone involvement in Langerhans cell histiocytosis: a systematic review of the literature

Background: Langerhans cell histiocytosis (LCH) is a rare disease that originates from the uncontrolled proliferation and accumulation of bone marrow-derived immature myeloid dendritic cells. Dendritic cells are a type of histiocyte that play an important role in the human immune system and are found in the bone, skin, stomach, eyes, intestines, and lungs. Objective: This systematic review aimed to collect and report published case reports of rare bone disease caused by LCH to avoid misdiagnoses or delays in diagnosis. Methods: We systematically searched Scopus, PubMed, Embase, and Web of Sciences from August 1, 2000 to December 31, 2019. Studies reporting cases of LCH with rare bone involvement were included. Results: We identified 60 articles including 64 cases. Of the identified cases, 31 (48.4) involved children, and 33 (51.6) involved adults. Additionally, 46.9 (30 individuals) were from Asian countries. The mean age of the children was 7.6 ± 4.3 years and that of the adults was 36 ± 12 years. The findings indicated that unifocal bone involvements were the most prevalent form of the disease (68.7), and, overall, the skull and chest wall were the most commonly affected bones in both adults and children. The spine and long bones were the second most commonly affected bones in children, and the spine and jaw were the second most commonly affected bones in adults. Pain and swelling were the most frequent presenting signs among the investigated cases, and loss of consciousness, myelopathy, nerve palsy, visual loss, torticollis and clicking sounds were rare signs. Osteolytic lesions were the most frequent radiologic feature (62.5), and intracranial hemorrhage, fluid�fluid level, dura and intracranial extension and pathologic fractures were rare radiological features. Total excision, curettage and observation in the unifocal group of patients and systemic chemotherapy in the other groups (i.e., multifocal and multisystem) were the most frequent management approaches. The recovery rates of the unifocal and multifocal groups were 77.3 and 81.8, respectively, while that of the multisystem group was 55.5. The rates of recurrence and mortality in the multisystem group were 11 and were higher than those in the other groups. Conclusions: LCH is a rare disease that can affect any organ in the human body. However, bone is the most commonly involved organ, and rare bone involvements may be the first or only symptom of the disease due to the rarity of such lesions; a lack of familiarity with them may result in misdiagnosis or delayed diagnosis. © 2021, The Author(s)

Exercise and cognitive function: a hypothesis for the association of type II diabetes mellitus and Alzheimer's disease from an evolutionary perspective

The association of type II diabetes mellitus (DM2) with Alzheimer's disease (AD) has received considerable attention in recent years. In the present paper, a hypothesis for this association from an evolutionary perspective, with emphasis on the close interplay between exercise and cognitive function, will be advanced in order to provide a biological rationale for the notion that the fundamental metabolic features of DM2 act in the brain over a protracted time span to induce the neuropathological characteristics of Alzheimer's disease thereby producing cognitive impairment. It is hoped that this hypothesis puts the association of DM2 and AD on firm conceptual grounds from a biological perspective and offers directions for further research

Short-Term Environmental Enrichment Enhances Adult Neurogenesis, Vascular Network and Dendritic Complexity in the Hippocampus of Type 1 Diabetic Mice

Background: Several brain disturbances have been described in association to type 1 diabetes in humans. In animal models, hippocampal pathological changes were reported together with cognitive deficits. The exposure to a variety of environmental stimuli during a certain period of time is able to prevent brain alterations and to improve learning and memory in conditions like stress, aging and neurodegenerative processes. Methodology/Principal Findings: We explored the modulation of hippocampal alterations in streptozotocin-induced type 1 diabetic mice by environmental enrichment. In diabetic mice housed in standard conditions we found a reduction of adult neurogenesis in the dentate gyrus, decreased dendritic complexity in CA1 neurons and a smaller vascular fractional area in the dentate gyrus, compared with control animals in the same housing condition. A short exposure-10 days- to an enriched environment was able to enhance proliferation, survival and dendritic arborization of newborn neurons, to recover dendritic tree length and spine density of pyramidal CA1 neurons and to increase the vascular network of the dentate gyrus in diabetic animals. Conclusions/Significance: The environmental complexity seems to constitute a strong stimulator competent to rescue th

Investigating the stress management status in middle-aged women in bushehr based on a transtheoretical model

Aims The present study aimed to investigate the relationship between self-efficacy, decision-making balance, and change processes with stress management in middle-aged women. Instrument & Methods This cross-sectional study was performed in 2019 on 600 middle-aged women covered by Bushehr Comprehensive Health Services Centers. The method of sampling was stratified. Data was gathered by demographic questionnaire and TTM based questionnaire, including self-efficacy, decisional balance (perceived barriers and benefits), processes of change, and stage of changes. Data were analyzed using ANOVA and Tukey post hoc test in SPSS 20 software. Findings The lowest and highest mean stress management scores were in the women in pre-contemplation (13.64±3.79) and maintenance (22.58±4.10), respectively. The mean score of self-efficacy in the women during the stages of change from pre-contemplation (15.71±6.80) to maintenance (33.06±5.09) was upward, and this average score in the stages of pre-contemplation, contemplation, and preparation was significantly lower than the stages of action and maintenance (p<0.001). Regarding processes of change, consciousness-raising, dramatic relief, environmental reevaluation, self-evaluation, social liberation, self-liberation, stimulus control, counter conditioning, helping relationships, and reinforcement management are significantly lower pre-contemplation and contemplation than action and maintenance (p<0.001). Conclusion The results indicate the importance of TTM constructs in advancing individuals to higher levels of change. Based on this, it is recommended to design and implement educational interventions based on TTM to improve stress management behaviors. Copyright© 2021, the Authors | Publishing Rights, ASPI. This open-access article is published under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License which permits Share (copy and redistribute the material in any medium or format) and Adapt (remix, transform, and build upon the material) under the Attribution-NonCommercial terms

Vitamin D and bone minerals status in the long�term survivors of childhood acute lymphoblastic leukemia

Background: Low vitamin D and diminished bone minerals with the potential for fractures are one of the nonapparent late effects of acute lymphoblastic leukemia (ALL). Chemotherapy and radiation were known as two important risk factors. We evaluated these late effects in ALL survivors who were treated with chemotherapy or chemo plus cranial radiation therapy. Methods: In a case�control study, 33 of ALL survivors who were treated with chemotherapy (Group A), and 33 subjects who were treated with chemoplus cranial radiation (Group B) were compared against 33 matched age, sex, and pubertal stage of their healthy siblings (Group C). Standard anthropometric data were collected as well as Tanner staging for puberty, number of fractures since treatment, serum calcium (Ca), phosphorus (P), magnesium (Mg), alkaline phosphatase, parathyroid hormone, and 25�hydroxyvitamin D (25(OH) D). The independent t�test, one�way ANOVA, Chi�square test, and Tukey�s test were used to analyze the data. Results: The findings indicated that the mean serum levels of 25(OH) D in ALL survivors (i.e. Groups A and B) with age mean score of 11.2 years and 12.3 years, average treatment length: 3.25 years and average time after treatment completion: 4 years, was lower compared to the controls group (12.94 ± 6.69, 14.6 ± 8.1, 20.16 ± 10.83, respectively, P 0.05). Other clinical and laboratory parameters had no significant differences between the survivors and control. Vitamin D deficiency (<20 ng/ml) was observed in 27 of group A and 24 of group B and vitamin D insufficiency (20�30 ng/ml) in 72.7 and 69.6 survivors of Group A and B and 48.5 of controls group (P = 0.003). Conclusions: ALL treatment is associated with the increase in prevalence of vitamin D insufficiency in the childhood ALL survivors and since the low vitamin D level potentially increases the risk of low bone density, subsequent malignancies, and cardiovascular disease in the survivors, close follow�up of such patients are highly recommended to prevent the stated complications. © 2015, Reisi N

The impact of accreditation on nurses' perceptions of quality of care in Iran and its barriers and facilitators

Background: Iran national hospital accreditation was initiated as a government and mandatory program in 2012. The aim of this study was to examine the impact of accreditation on nurses' perceptions of quality of care and to determine those barriers and facilitators needed for effective implementation of accreditation. Methods: A cross-sectional survey conducted in 43 tertiary public hospitals in 5 metropolises, Iran, which successfully passed national accreditation surveys. Participants included nurses with at least 5-year work experience. Overall response rate was 76, with 1312 of 1706 valid responses included in the data analysis. A questionnaire was applied using a 5-point Likert scale ranging from 1 �strongly disagree� to 5 �strongly agree�. In addition, the questionnaire included 2 open-ended questions allowing the respondent to identify barriers and facilitators to the process of for improving accreditation implementation. The relationship between the quality of results and the independent variables was tested using multiple regression analysis. Results: The scales measuring benefits of accreditation had the highest mean score followed by strategic quality planning, education and training, and staff involvement. Regression analysis indicated that leadership, commitment, and support; education and training; rewards and recognition; and staff involvement were factors affecting quality results. Barriers encountered included financial and capital resources, staff, institutional, and patients. Hospital accreditation has a positive impact on quality of care. Conclusions: The findings of this study provide valuable information to policymakers and hospital managers on which to base the process of accreditation and its requirements, and to help reap its benefits. © 2018 John Wiley & Sons, Ltd

The impact of accreditation on nurses' perceptions of quality of care in Iran and its barriers and facilitators

Background: Iran national hospital accreditation was initiated as a government and mandatory program in 2012. The aim of this study was to examine the impact of accreditation on nurses' perceptions of quality of care and to determine those barriers and facilitators needed for effective implementation of accreditation. Methods: A cross-sectional survey conducted in 43 tertiary public hospitals in 5 metropolises, Iran, which successfully passed national accreditation surveys. Participants included nurses with at least 5-year work experience. Overall response rate was 76, with 1312 of 1706 valid responses included in the data analysis. A questionnaire was applied using a 5-point Likert scale ranging from 1 �strongly disagree� to 5 �strongly agree�. In addition, the questionnaire included 2 open-ended questions allowing the respondent to identify barriers and facilitators to the process of for improving accreditation implementation. The relationship between the quality of results and the independent variables was tested using multiple regression analysis. Results: The scales measuring benefits of accreditation had the highest mean score followed by strategic quality planning, education and training, and staff involvement. Regression analysis indicated that leadership, commitment, and support; education and training; rewards and recognition; and staff involvement were factors affecting quality results. Barriers encountered included financial and capital resources, staff, institutional, and patients. Hospital accreditation has a positive impact on quality of care. Conclusions: The findings of this study provide valuable information to policymakers and hospital managers on which to base the process of accreditation and its requirements, and to help reap its benefits. © 2018 John Wiley & Sons, Ltd