Heart surgery waiting time: Assessing the effectiveness of an action

Background: Waiting time is an index assessing patient satisfaction, managerial effectiveness and horizontal equity in providing health care. Although heart surgery centers establishment is attractive for politicians. They are always faced with the question of to what extent they solve patient’s problems. Objectives: The objective of this study was to evaluate factors influencing waiting time in patients of heart surgery centers, and to make recommendations for health-care policy-makers for reducing waiting time and increasing the quality of services from this perspective. Patients and Methods: This cross-sectional study was performed in 2013. After searching articles on PubMed, Elsevier, Google Scholar, Ovid, Magiran, IranMedex, and SID, a list of several criteria, which relate to waiting time, was provided. Afterwards, the data on waiting time were collected by a researcher-structured checklist from 156 hospitalized patients. The data were analyzed by SPSS 16. The Kolmogorov Smirnov and Shapiro tests were used for determination of normality. Due to the non-normal distribution, non-parametric tests, such as Kruskal-Wallis and Mann-Whitney were chosen for reporting significance. Parametric tests also used reporting medians. Results: Among the studied variables, just economic status had a significant relation with waiting time (P = 0.37). Fifty percent of participants had diabetes, whereas this estimate was 43.58% for high blood pressure. As the cause of delay, 28.2% of patients reported financial problems, 18.6% personal problem and 13.5% a delay in providing equipment by the hospital. Conclusions: It seems the studied hospital should review its waiting time arrangements and detach them, as far as possible, from subjective and personal (specialists) decisions. On the other hand, ministries of health and insurance companies should consider more financial support. It is also recommend that hospitals should arrange preoperational psychiatric consultation for increasing patients’ emotionally readiness. © 2015, Iranian Red Crescent Medical Journal

Age-dependent dynamic electrophysiological field potential behavior of atrioventricular node during experimental AF in rabbit

Introduction: Electrophysiological studies have demonstrated a relationship between aging and atrioventricular (AV) nodal conduction and refractoriness. The aim of the present study was to determine the effects of nodal aging on dynamic AV nodal field potential recording during atrial fibrillation (AF) in rabbit. Methods: Two groups of male New Zealand rabbits (neonatal 2-week-olds and adult 12-week-olds, n=14 each group) were used in this study. Field potential recordings were executed by silver electrodes with a diameter of 100 μM. Pre-defined stimulation protocols of AF, zone of concealment (ZOC) and concealed conduction for determination of the electrophysiological properties of the AV-node were separately applied in each group. Results: Results of the study showed that mean ventricular rate (HH) during atrial fibrillation was smaller in the neonatal compared to the adult group (229.1 ± 8.3 versus 198.6 ± 13.1 msec, respectively). Also ventricular distribution conduction pattern showed two peaks in the adult and one peak in the neonatal group. Analyzing the zone of concealment in different rates and after concealed beat indicated that the zone of concealment in neonates were significantly smaller compared with adult rabbits and increasing zone of concealment, which is accompanied with increasing ventricular rate is abrogated in the neonatal group (5 ± 3.3, 12.2 ± 6.3 msec). Conclusion: The results of this study showed that the electrophysiological protective dynamic behavior of the AV node during atrial fibrillation is smaller in neonates compared to adults. Narrower zone of concealment, abrogation rate dependent trend of the zone of concealment and shorter nodal refractoriness can account for the specific nodal electrophysiological properties of neonatal rabbits

Role of nitric oxide on the electrophysiological properties of isolated rabbit atrioventricular node by extracellular field potential during atrial fibrillation

Introduction: The aim of the present study was to determine direct effects of NO modulation on protective electrophysiological properties of atrioventricular node (AV node) in the experimental model of AF in rabbit. Methods: Isolated perfused rabbit AV nodal preparations were used in two groups. In the first group (N=7), LNAME (50μM) was applied. In the second group (N=12), different concentrations of L - argenine (250 μM - 5000 μM) were added to the solution. Programmed stimulation protocols were used to quantify AV nodal conduction time, refractoriness and zone of concealment. AF protocol was executed by software with coupling intervals (ranging from 75–125 msec). Results: L-NAME had depressive effects on basic AV nodal properties. L-Arginine (250μM) had direct inhibitory effects on nodal conduction time, Wenckebach and refractoriness. Significant increases in the number of concealed beats were induced by L-Arginine (500 μM). Number of concealed beats were increased from 700.7±33.7 to 763±21 msec (P<0.05). Trend of zone of concealment prolongation in a frequency-dependent model was abrogated by Larginine (250, 5000 μM). Conclusion: NO at low concentration (in the presence of L-NAME) had facilitatory role on AV nodal properties, but at high concentration (in the presence of L-arginine) enhanced protective role of AV node during AF. Biphasic modulatory role of NO may affect protective behavior of AV node during AF. © 2011, Iranian Society of Physiology and Pharmacology. All rights reserved

Misclassification Risk and Uncertainty Quantification in Deep Classifiers

In this paper, we propose risk-calibrated evidential deep classifiers to reduce the costs associated with classification errors. We use two main approaches. The first is to develop methods to quantify the uncertainty of a classifier’s predictions and reduce the likelihood of acting on erroneous predictions. The second is a novel way to train the classifier such that erroneous classifications are biased towards less risky categories. We combine these two approaches in a principled way. While doing this, we extend evidential deep learning with pignistic probabilities, which are used to quantify uncertainty of classification predictions and model rational decision making under uncertainty.We evaluate the performance of our approach on several image classification tasks. We demonstrate that our approach allows to (i) incorporate misclassification cost while training deep classifiers, (ii) accurately quantify the uncertainty of classification predictions, and (iii) simultaneously learn how to make classification decisions to minimize expected cost of classification errors

Elucidating role of reactive oxygen species (Ros) in cisplatin chemotherapy: A focus on molecular pathways and possible therapeutic strategies

The failure of chemotherapy is a major challenge nowadays, and in order to ensure effective treatment of cancer patients, it is of great importance to reveal the molecular pathways and mechanisms involved in chemoresistance. Cisplatin (CP) is a platinum-containing drug with anti-tumor activity against different cancers in both pre-clinical and clinical studies. However, drug resistance has restricted its potential in the treatment of cancer patients. CP can promote levels of free radicals, particularly reactive oxygen species (ROS) to induce cell death. Due to the double-edged sword role of ROS in cancer as a pro-survival or pro-death mechanism, ROS can result in CP resistance. In the present review, association of ROS with CP sensitivity/resistance is discussed, and in particular, how molecular pathways, both upstream and downstream targets, can affect the response of cancer cells to CP chemotherapy. Furthermore, anti-tumor compounds, such as curcumin, emodin, chloroquine that regulate ROS and related molecular pathways in increasing CP sensitivity are described. Nanoparticles can provide co-delivery of CP with anti-tumor agents and by mediating photodynamic therapy, and induce ROS overgeneration to trigger CP sensitivity. Genetic tools, such as small interfering RNA (siRNA) can down-regulate molecular pathways such as HIF-1α and Nrf2 to promote ROS levels, leading to CP sensitivity. Considering the relationship between ROS and CP chemotherapy, and translating these findings to clinic can pave the way for effective treatment of cancer patients. © 2021 by the authors. Licensee MDPI, Basel, Switzerland

The prevalence of psychological co-morbidity in people with vitiligo: a systematic review and meta-analysis

Background: Vitiligo is a chronic disorder causing skin depigmentation with global prevalence varying from 0.2 to 1.8%. UK guidelines recommend assessment of psychological state during clinical evaluation of vitiligo. However, the prevalence of psychological co-morbidity in people with vitiligo has not been described. Objectives: We aimed to establish the prevalence of psychological symptoms or disorders in people with vitiligo and describe the outcome measures used. Methods: We performed a comprehensive search of MEDLINE, Embase, CINAHL and PsychInfo to identify observational studies assessing the prevalence of psychological symptoms or disorders (December 2016). DerSimonian and Lard random-effects models were utilized to estimate the overall pooled prevalence. Results: We identified 29 studies with 2530 people with vitiligo. Most studies included a measure of either depression (n=25) or anxiety (n=13).The commonest tools were the Hospital Anxiety and Depression Scale and the Centre for Epidemiology Studies Depression Scale. Ten studies provided information on thirteen other psychological outcomes. Pooled prevalence using depression-specific and anxiety-specific questionnaires was 0.29 (95%CI 0.21, 0.38) and 0.33 (95%CI 0.18, 0.49) respectively. Prevalence was lower for clinically diagnosed depression (0.21; 95%CI 0.15, 0.28) and anxiety (0.15; 95%CI 0.06, 0.24). When non-specific tools were used the prevalence remained similar for depression (0.27; 95%CI 0.08, 0.46) but increased for anxiety (0.46; 95% CI 0.39, 0.52). High heterogeneity was observed. Conclusions: A range of psychological outcomes are common in people with vitiligo. The prevalence of anxiety was influenced by type of screening tool, suggesting validation of psychological outcome screening tools in the field of dermatology

Impact of alternative solid state forms and specific surface area of high-dose, hydrophilic active pharmaceutical ingredients on tabletability

YesIn order to investigate the effect of using different solid state forms and specific surface area (TBET) of active pharmaceutical ingredients on tabletability and dissolution performance, the mono- and dihydrated crystalline forms of chlorothiazide sodium and chlorothiazide potassium (CTZK) salts were compared to alternative anhydrous and amorphous forms, as well as to amorphous microparticles of chlorothiazide sodium and potassium which were produced by spray drying and had a large specific surface area. The tablet hardness and tensile strength, porosity, and specific surface area of single-component, convex tablets prepared at different compression pressures were characterized. Results confirmed the complexity of the compressibility mechanisms. In general it may be concluded that factors such as solid-state form (crystalline vs amorphous), type of hydration (presence of interstitial molecules of water, dehydrates), or specific surface area of the material have a direct impact on the tabletability of the powder. It was observed that, for powders of the same solid state form, those with a larger specific surface area compacted well, and better than powders of a lower surface area, even at relatively low compression pressures. Compacts prepared at lower compression pressures from high surface area porous microparticles presented the shortest times to dissolve, when compared with compacts made of equivalent materials, which had to be compressed at higher compression pressures in order to obtain satisfactory compacts. Therefore, materials composed of nanoparticulate microparticles (NPMPs) may be considered as suitable for direct compaction and possibly for inclusion in tablet formulations as bulking agents, APIs, carriers, or binders due to their good compactibility performanceSolid State Pharmaceutical Cluster (SSPC), supported by Science Foundation Ireland under Grant No. 07/SRC/B1158

"Lymph node revealing solution: A prospective study on 35 patients with colorectal carcinomas "

Lymph node dissection is of prime importance for accurate staging of colorectal carcinomas. Since a great number of small lymph nodes are missed in the traditional method, several fat clearing solutions have been introduced for easier detection of smaller lymph nodes. In this study we evaluated the efficacy of a new fat clearing solution so-called lymph node revealing solution (LNRS) in colectomy specimens of patients with colorectal carcinoma from year 2000 till 2002, thirty five colectomy specimens with less than 4 metastatic lymph nodes received in the pathology department of IKMC, were selected and re-evaluated using the LNRS. By using this solution 456 additional lymph nodes and 16 more metastatic lymph nodes were detected resulting in upstaging of 3 patients from Duke’s B to C. In all patients categorized as Nx (regional lymph nodes not assessed) by the traditional method, lymph nodes were detected after employment of LNRS. The mean diameter of dissected lymph nodes was significantly smaller than the traditional method (0.268 versus 0.429, P&lt;0.000001). LNRS in comparison with previous solutions is inexpensive, rapid and easy to use. We propose use of this solution in all Duke’s B and patients with no lymph node detection by traditional method