Ectopic Varices and Collaterals Development after Band Ligation Treatment in a Patient with Portal Hypertension

Esophageal and gastric varices may complicate the course of cirrhosis as a direct consequence of portal hypertension. Variceal hemorrhage has been reported to occur in 25–40% of patients with cirrhosis [Gastroenterol Clin North Am 1992;21:149–161]. Occasionally, varices develop at sites other than the esophagus and are detected either when they bleed or incidentally during upper or lower endoscopy [Eur J Gastroenterol Hepatol 2006;18:1155–1160; Digestion 2000;61:149–150]. Endoscopic treatment is often unsuccessful in these cases, and traditional treatment is usually surgical, while it has been suggested that bleeding can also be controlled by a transjugular intrahepatic portosystemic shunt (TIPS) [Endoscopy 1995;27:626–627]. Moreover, esophageal band ligation may interfere with the collateral web. We here report a case of an ectopic duodenal varix and the development of a large collaterals web that appeared after band ligation

Organizational epistemology

Diese Arbeit stellt ein Begriffs-Instrumentarium zur Verfügung um (1) Wissen in Organisationen beschreiben zu können und um (2) allgemeine Bedingungen für erfolgreiche, organisationale Wissenserzeugung vorgeben zu können. Das vorgestellte theoretische Rahmenwerk wird erkenntnistheoretisch begründet und richtet sich an Wissenschafter/innen wie an Praktiker/innen. (1) Eine Theorie organisationalen Wissens wird vorgestellt, die Begriffe zur Verfügung stellt um Wesen, Typen, Relevanz, Anwendung und Erzeugung von Wissen in Organisationen zu verstehen. Von philosophischen Grundlagen ausgehend, wird organisationales Wissen als das Erzeugen von „organisationalen Unterscheidungen“ auf den drei Ebenen „Repräsentation“, „Bedeutung“, und „Handeln“, verstanden. Ausserdem werden die zwei Typen „propositionales Wissen“ (z.B. Regeln oder Routinen) und „narratives Wissen“ (z.B. Erzählungen oder Best-Practices) vorgestellt. Wissenserzeugung wird als offener Prozess („Werden“, „becoming“) verstanden, der sich in temporär-stabilen Ergebnissen entäußert („Sein“, „being“). (2) Ergänzend wird eine „Organisationale Epistemologie“ vorgeschlagen, die einen normativen Zugang zu Wissenserzeugung einnimmt. Inspiriert durch erkenntnistheoretische Reflexionen wird eine Sichtweise vorgeschlagen, die eine Differenz zwischen Glauben und Wissen („belief and knowledge“), zwischen blosse organisationale Unterscheidung und organisationales Wissen, einführt. Eine Differenz, die in Organisationstheorien bisher kaum Beachtung fand. Durch Rückgriff auf eine philosophische „soziale Epistemologie“ („social epistemology“) werden die drei Richtlinien „Ermöglichen“ („enable“), „Beschränken“ („constrain“) und „Reflektieren“ („reflect“) vorgestellt und auf Organisationen angewandt. Letztere plädieren für eine offene und reflexive Umgebung organisationaler Wissenserzeugung („organizational spaces of knowledge creation“), die entlang der Ziele und Strukturen der Organisation ausgerichtet werden soll. (1) und (2) werden anhand zahlreicher Beispiele aus der Praxis erläutert, sowie im Rahmen einer detaillierten Fallstudie (aus dem Unternehmen „Seven-Eleven Japan“) angewandt.This inquiry presents a theoretical toolkit on the topic of organizational knowledge. It provides concepts (1) to describe knowledge in organizations, and (2) to prescribe the general conditions for successful organizational knowledge creation. It is rooted in philosophical-epistemological reflections on the nature of knowledge and addressed to researchers and practitioners both-alike. (1) A theory of organizational knowledge is outlined which provides concepts to understand nature, relevance, application, and creation of knowledge in organizations. Departing from a philosophical grounding, knowledge is located within „distinction-making“ on the three levels of „representation“, „meaning“, and „action“. Additionally, the two general types of „propositional knowledge“ (e.g. rules, or routines) and „narrative knowledge“ (e.g. stories, or best practices) are presented. Knowledge creation is summarized as open-ended process („becoming“) which results in temporarily stable outcomes („being“). (2) Supplementary, a normative theory of „organizational epistemology“ is developed. Driven by epistemological reflections, a view is presented which acknowledges the crucial difference between beliefs and knowledge, between mere organizational distinctions and successful organizational knowledge; a difference which has widely been neglected by organizational studies so far. Drawing from a „social epistemology“ the three guidelines „enabling“, „constraining“, and „reflecting“ are discussed and shifted to organizations. Those guidelines call for an open and reflective space of knowledge creation, aligned with goals and structures of the organization. Both (1) and (2) are demonstrated along numerous examples, connected to field-studies, and applied to one main use-case at the company „Seven-Eleven Japan“

Refractory Port Wine Stains (PWS): Long Pulsed Alexandrite Laser as an Option

INTRODUCTION: Port wine stains (PWS) are congenital vascular malformations. Pulsed dye laser (PDL) is the treatment of choice till now, although many lesions do not respond completely. One of possible options is long pulsed alexandrite laser. Some literatures confirmed its efficacy. The aim of the present study is to determine the efficacy of this laser as an option in treating refractory PWS in Iranian patients.METHODS: Patients with refractory PWS lesions that did not respond to at least six PDL sessions were included if they had no history of Isotretinoin consumption in past year, history of keloid or hypertrophic scar formation, active infection in laser site and if they were not pregnant. All patients signed an informed consent. Alexandrite laser with fluencies from 36-40J/Cm2, 12 mm spot size, 3 ms pulse duration and dynamic cooling device tuned to 50/50 ms was used in three successive sessions to treat lesions. All patients photographed before each session and after 8 weeks from the last sessions. Then, pictures were rated by two blinded dermatologist rater to determine degree of response based of visual analog scaling from score 1(below 25% response) to score 4 (more than 75% response).RESULTS: A total of 20 patients comprised of 12 males and 8 females with mean age of 23 years were included. 35% (7 patients) had score of 1, 35% (7 patients) had score of 2, 25% (5 patients) had score of 3 while one patient (5%) reached score 4. No serious side effect was observed. There was no significant relationship with age, gender and size of lesions and response rate.CONCLUSION: It seems that considering a conservative approach, long pulsed alexandrite laser may be an effective option in treating refractory PWS lesions. Although future studies with higher sample size using higher fluences are required to confirm these results

Clinical Study Suppression of Face Perception during Saccadic Eye Movements

Lack of awareness of a stimulus briefly presented during saccadic eye movement is known as saccadic omission. Studying the reduced visibility of visual stimuli around the time of saccade-known as saccadic suppression-is a key step to investigate saccadic omission. To date, almost all studies have been focused on the reduced visibility of simple stimuli such as flashes and bars. The extension of the results from simple stimuli to more complex objects has been neglected. In two experimental tasks, we measured the subjective and objective awareness of a briefly presented face stimuli during saccadic eye movement. In the first task, we measured the subjective awareness of the visual stimuli and showed that in most of the trials there is no conscious awareness of the faces. In the second task, we measured objective sensitivity in a two-alternative forced choice (2AFC) face detection task, which demonstrated chance-level performance. Here, we provide the first evidence of complete suppression of complex visual stimuli during the saccadic eye movement

Crystallization of Spiritual Awakening in Patients with COVID-19: A Hermeneutic Study

Background: World health organization (WHO) declared the outbreak of Coronavirus disease 2019 (COVID-19) a public health emergency in January 2020, and on March 11, 2020, the organization called it a pandemic. Despite causing problems, the COVID-19 epidemic leads to the spiritual and existential transformation of people. The phenomenology of the lived spiritual experiences of patients with a history of COVID-19 was the aim of this research. Materials and Methods: This qualitative study was conducted with a hermeneutic phenomenology approach. Data was collected between November 2022 and May 2023. The data were collected with a semi-structured in-depth interview with 14 qualified patients, and the interviews were implemented and analyzed with the phenomenological approach of Dickelman et al., 1989. Data collection and analysis were done simultaneously. Results: The analysis of data related to 4 patients with a history of COVID-19 in the age range of 39 to 79 who had a history of hospitalization in a Hospital in Tehran, the capital city of Iran, showed that their spiritual changes can be divided into three themes of spiritual emotions, spiritual knowledge and spiritual growth and excellence and a structural pattern of crystallization of spiritual awakening. Conclusion: According to the results, the period of illness has helped their growth and excellence; their flexibility and deeper understanding of their place in the world changed their attitudes and values and caused their personal growth and excellence. The research results emphasize the role of spirituality in providing knowledge, insight, and increasing spiritual knowledge to patients

The Predictive Roles of Self-efficacy, Illness Perception, and Social Support in Self-care of Patients With Heart Failure

Background: As a chronic disease, heart failure (HF) is a growing problem that not only impacts patients but also their family members and friends. Self-care is the main part of HF treatment. Despite the significance of determining variables involved in self-care, the relationships of self-efficacy, illness perception, and social support with self-care and the predictive roles of these variables in the treatment of HF have not been investigated. Objectives: The present study was aimed at exploring the predictive roles of self-efficacy, illness perception, and social support in self-care of patients with heart failure. Methods: In this predictive correlation study, 149 patients with HF were selected through convenience sampling from Tabriz Research Treatment Centre of Heart in 2016. To collect data, a demographic information questionnaire, self-care behaviour scale, general self-efficacy (GSE), brief illness perception questionnaire (Brief-IPQ), and social support scale were used. To analyse data, SPSS software version 16, descriptive statistics, Pearson correlation coefficient, and multiple stepwise regression analyses were employed. Results: Out of 149 subjects, 102 (68%) participants were male, and 47 (32%) of them were female. The mean and standard deviation of samples’ age were (64.40±10.32) ranging from 37 to 88 years. Most of participants were married (82%). The mean scores were as follows: Self-care (40.66±13.16), self-efficacy (45.81±22.03), illness perception (56.05±18.24), and social support (49.09±6.74). Data analysis demonstrated significant correlations between illness perception and self-care (p<0.001, r=0.649), self-efficacy and self-care (p<0.001, r=-0.678), social support and self-care (p<0.001, r=-0.518), and age and self-care (p<0.001, r=-0.506). The standardized coefficient of illness perception was (β=0.274), social support was (β=-0.237), self-efficacy was (β=-0.230), and age was (β=-0.211). In addition, 56% of self-care variance is explained by age, social support, self-efficacy, and illness perception. Conclusion: All of the investigated variables were found to have a predictive role in self-care. Illness perception was recognized as the most effective factor in predicting self-care. Hence, illness perception can be used to explain 27% of self-care ability of patients with HF

Risk Factors Associated with Neonatal Jaundice: A Cross-Sectional Study from Iran

BACKGROUND: Neonatal jaundice is one of the main causes of the patient's admission in the neonatal period and is potentially linked to morbidity.AIM: This study aimed to determine the possible risk factors for neonatal jaundice.METHODS: We investigated the case of infants who were admitted to the neonatal department of Ziyaeian hospital and Imam Khomeini Hospital for jaundice. Simple random sampling was used to evaluate variables related to maternal and neonatal predisposing factors based on the medical records and clinical profiles. All variables in this study were analysed using SPSS software.RESULTS: In this study, about 200 mothers and neonates were examined. Our findings depicted that mother's WBC, Hb, PLT, and gestational age were associated with jaundice (P &lt; 0.05). Furthermore, there were significant relationships between different degrees of bilirubin with TSH, T4 levels and G6PD (P &lt; 0.05). In fact, TSH, T4 levels and G6PD were found to be linked to neonatal hyperbilirubinemia. The risk factors for jaundice in our study population comprise some predisposing factors such as WBC, Hb, PLT, gestational age, TSH, and T4 levels, as well as G6PD. Neonates at risk of jaundice are linked to some maternal and neonatal factors that can provide necessary interventions to reduce the burden of the disease. Therefore, identification of associated factors can facilitate early diagnosis, and reduce subsequent complications.CONCLUSION: Neonatal jaundice should be considered as the main policy in all health care settings of the country. Therefore, identification of factors affecting the incidence of jaundice can be effective in preventing susceptible predisposing factors in newborns and high-risk mothers

Maternal risk factors for neonatal jaundice: a hospital-based cross-sectional study in Tehran

Diagnosis and timely treatment of neonatal jaundice is critical to preventing its dangerous side effects. Knowing the predisposing factors of neonatal jaundice is still a serious debate, which can be effective in controlling jaundice and the primary problem. The aim of this study was to evaluate maternal risk factors that contribute to the Hyperbilirubinemia among newborns admitted to Imam Khomeini and Ziaeean hospitals during 2015. We collected random samplings for the current study. Medical records for all newborns with jaundice were examined for risk factors associated with Hyperbilirubinemia. All variables were analyzed by SPSS software, version 19. Chi-square test and T-test were applied to evaluate qualitative and quantitative data, respectively. Our findings revealed that maternal age, weight, BMI, WBC, Hb, PLT, birth in the first pregnancy, numbers of pregnancies and prolonged delivery were significantly associated with bilirubin levels. Preventing the risk correlated with maternal factors or identifying neonates with these risk factors is important in effective management of infants. Therefore, the evaluation of neonatal jaundice in health care services should always be considered as a fundamental policy

Pimecrolimus cream in repigmentation of vitiligo

Background: Vitiligo is a chronic disease that mostly affects children and young adults. Nowadays many treatment options are available; however, most of them have limited efficacy and in most cases would result in undesirable complications. Objective: To determine the extent of repigmentation according to the location of the lesions after applying topical cream pimecrolimus 1 in vitiligo patients. Materials and Methods: Thirty consecutive patients with vitiligo lesions affecting less than 20 of body surface area without any previous history of spontaneous repigmentation were treated with pimecrolimus cream 1 twice daily for 12 weeks. The extent of repigmentation in vitiligo lesions was determined in each patient after 6 and 12 weeks. Results: Moderate to excellent response (repigmentation >26) was observed in 6.6 and 25.9 of vitiligo lesions 6 and 12 weeks after treatment, respectively. More responsive lesions were located on the trunk, face and elbow (85.7, 75 and 70). Conclusion: Pimecrolimus cream 1 results in repigmentation in vitiligo in different extents according to the location of the lesion; however, to clearly prove its efficacy as monotherapy or in combination with other available treatment options, double-blind placebo-controlled studies are essential. Copyright © 2007 S. Karger AG