Effects of Computerized Decision Support Systems on Management of Atrial Fibrillation: A Scoping Review

Background: Potential role of computerized decision support system on management of atrial fibrillation is not well understood. Objectives: To systematically review studies that evaluate the effects of computerized decision support systems and decision aids on aspects pertaining to atrial fibrillation. Data sources: We searched Medline, Scopus and Cochrane database. Last date of search was 2016, January 10. Selection criteria: Computerized decision support systems that help manage atrial fibrillation and decision aids that provide useful knowledge for patients with atrial fibrillation and help them to self-care. Data collection and analysis: Two reviewers extracted data and summarized findings. Due to heterogeneity, meta-analysis was not feasible; mean differences of outcomes and confidence intervals for a difference between two Means were reported. Results: Seven eligible studies were included in the final review. There were one observational study without controls, three observational studies with controls, one Non-Randomized Controlled Trial and two Randomized Controlled Trials. The interventions were three decision aids that were used by patients and four computerized decision support systems. Main outcomes of studies were: stroke events and major bleeding (one article), Changing doctor-nurse behavior (three articles), Time in therapeutic International Normalized Ratio range (one article), decision conflict scale (two articles), patient knowledge and anxiety about stroke and bleeding (two articles). Conclusions: A computerized decision support system may decrease decision conflict and increase knowledge of patients with atrial fibrillation (AF) about risks of AF and AF treatments. Effect of computerized decision support system on outcomes such as changing doctor-nurse behavior, anxiety about stroke and bleeding and stroke events could not be shown.We need more studies to evaluate the role of computerized decision support system in patients with atrial fibrillation

Histological study of liver and pancreas in adult Otolithes ruber in Bushehr, Iran

In this study, the digestive systems of 10 adult Otolithes ruber specimens from Bushehr province water, south-west Iran were removed and the livers and pancreases were fixed in formalin 10%. The routine procedures of preparation of tissues were followed and the paraffin blocks were cut at 6 microns, stained with H&E and studied under light microscope. The results of microscopic studies showed that liver as the largest accessory organ surrounds the pancreatic tissue in the fish. Liver was found to be a lobulated organ encircling the pancreas among its lobules. Hepatic tissue of the fish was found to be similar to many other bony fishes. Hepatocytes included glycogen and fat vacuoles that located around the hepatic sinusoids. Pancreas as a mixed gland microscopically, was composed of lobules consisting of serous acini (exocrine portion) and langerhans islets (endocrine portion). Pancreatic lobules are usually found as two rows of acini which a large blood vessel located in between

Relationship between C-reactive protein and carotid artery intima media thickness in polycystic ovarian syndrome patients

Objective: To determine relationship between CRP (C-reactive protein) concentration and CIMT (carotid artery intima media thickness) in young PCOS (polycystic ovary syndrome) females. Design: Cross-sectional Setting: Infertility outpatient clinic Patients: 70 PCOS patients (20-39 years old) and 70 healthy subjects as control. Interventions: CIMT was measured by Doppler ultrasound. Main outcome measure: Relationship between increased CRP level and CIMT. Results: Mean (±SD) serum CRP level was higher in PCOS patents (5.2 ± 2.8 mg/dL) in comparison to controls (4.9 ± 1.7 mg/dL), but the difference was not statistically significant (P= 0.482). However, mean (±SD) CIMT was significantly higher in PCOS group (0.65 ± 0.11 mm) compared to controls (0.59 ± 0.21 mm); P= 0.016. Although with increased CRP level, CIMT increased in PCOS patients, the relationship was not statistically significant (P= 0.065, r= 0.886). Also there was a relationship between age and CIMT but it was not statistically significant (P= 0.07, r= 0.215). However, relationships between CIMT and BMI (P= 0.04, r= 0.571) and between CIMT and waist circumference (P= 0.028, r= 0.36) were statistically significant. Based on regression analysis serum CRP level (P= 0.055, 95 CI= 1.589-73.713) and BMI (P= 0.051, 95 CI= 1.379-2.412) were independent variables which affected CIMT. Conclusion: CRP was elevated in PCOS patients compared to controls, but the difference was not statistically significant. Therefore, measuring CRP in PCOS patients should be interpreted with keeping in mind other CVD risk factors in these patients such as fasting blood sugar, lipid profile, and most importantly BMI

Outcomes of the National Head and Neck Cancer Awareness and Screening Campaign in Oman

Objectives: The prognosis of head and neck cancer (HNC) depends substantially on disease stage at the time of diagnosis. Unfortunately, the majority of HNC patients present at relatively late stages. In Oman, a national screening campaign was conducted to increase public awareness of HNC and encourage early detection. This study aimed to report the outcomes of that campaign. Methods: The campaign took the form of biannual events conducted at a tertiary care centre and in public malls in Muscat, Oman from April 2015 to July 2019. Data were collected from participants using the Head and Neck Cancer Alliance screening form. Otolaryngologists and oral maxillofacial surgeons performed a thorough physical evaluation of the head and neck region. Results: Of the 1,500 individuals visiting the hospital and malls during the campaign events, a total of 509 agreed to undergo screening (response rate: 33.9%). Of these, 12.8% had positive screening results and 5.9% required further evaluation. However, none of the cases with suspicious findings were found to be malignant after a thorough evaluation. Overall, 16.9% of the participants were aware of the early signs of HNC; in addition, 5.5% knew how to perform an oral self-examination. Conclusion: Screening is a simple and safe method for the prevention and early detection of HNC. Mass screening and public awareness programmes may help to reduce the burden of this disease in Oman.Keywords: Head and Neck Cancer; Early Detection of Cancer; Mass Screening; Knowledge; Health Risk Behaviors; Oman

Noninvasive temporal detection of early retinal vascular changes during diabetes

Diabetes associated complications, including diabetic retinopathy and loss of vision, are major health concerns. Detecting early retinal vascular changes during diabetes is not well documented, and only few studies have addressed this domain. The purpose of this study was to noninvasively evaluate temporal changes in retinal vasculature at very early stages of diabetes using fundus images from preclinical models of diabetes.Non-diabetic and Akita/+ male mice with different duration of diabetes were subjected to fundus imaging using a Micron III imaging system. The images were obtained from 4 weeks- (onset of diabetes), 8 weeks-, 16 weeks-, and 24 weeks-old male Akita/+ and non-diabetic mice. In total 104 fundus images were subjected to analysis for various feature extractions. A combination of Canny Edge Detector and Angiogenesis Analyzer plug-ins in ImageJ were utilized to quantify various retinal vascular changes in fundus images. Statistical analyses were conducted to determine significant differences in the various extracted features from fundus images of diabetic and non-diabetic animals. Our novel image analysis method led to extraction of over 20 features. These results indicated that some of these features were significantly changed with a short duration of diabetes, and others remained the same but changed after longer duration of diabetes. These patterns likely distinguish acute (protective) and chronic (damaging) associated changes with diabetes. We show that with a combination of various plugging one can extract over 20 features from retinal vasculature fundus images. These features change during diabetes, thus allowing the quantification of quality of retinal vascular architecture as biomarkers for disease progression. In addition, our method was able to identify unique differences among diabetic mice with different duration of diabetes. The ability to noninvasively detect temporal retinal vascular changes during diabetes could lead to identification of specific markers important in the development and progression of diabetes mediated-microvascular changes, evaluation of therapeutic interventions, and eventual reversal of these changes in order to stop or delay disease progression

Microglia activation is essential for BMP7-mediated retinal reactive gliosis

Our previous studies have shown that BMP7 is able to trigger activation of retinal macroglia. However, these studies showed the responsiveness of Müller glial cells and retinal astrocytes in vitro was attenuated in comparison to those in vivo, indicating other retinal cell types may be mediating the response of the macroglial cells to BMP7. In this study, we test the hypothesis that BMP7-mediated gliosis is the result of inflammatory signaling from retinal microglia

Temporal diabetes-induced biochemical changes in distinctive layers of mouse retina

To discover the mechanisms underlying the progression of diabetic retinopathy (DR), a more comprehensive understanding of the biomolecular processes in individual retinal cells subjected to hyperglycemia is required. Despite extensive studies, the changes in the biochemistry of retinal layers during the development of DR are not well known. In this study, we aimed to determine a more detailed understanding of the natural history of DR in Akita/+ (type 1 diabetes model) male mice with different duration of diabetes. Employing label-free spatially resolved Fourier transform infrared (FTIR) chemical imaging engaged with multivariate analysis enabled us to identify temporal-dependent reproducible biomarkers of the individual retinal layers from mice with 6 weeks,12 weeks, 6 months, and 10 months of age. We report, for the first time, the nature of the biochemical alterations over time in the biochemistry of distinctive retinal layers namely photoreceptor retinal layer (PRL), inner nuclear layer (INL), and plexiform layers (OPL, IPL). Moreover, we present the molecular factors associated with the changes in the protein structure and cellular lipids of retinal layers induced by different duration of diabetes. Our paradigm provides a new conceptual framework for a better understanding of the temporal cellular changes underlying the progression of DR