Effect of high intensity interval training on serum adiponectin and motor proficiency in student boys with attention deficit hyperactivity disorder

زمینه و هدف: سطوح غیرطبیعی آدیپونکتین سرم نه تنها در چاقی، دیابت نوع دو و مقاومت به انسولین، بلکه در اختلالات روانپزشکی نیز مشاهده شده است. اختلال بیش فعالی و نقص توجه (ADHD) یکی از شایع ترین اختلالات روانپزشکی کودکان و نوجوانان است. هدف تحقیق حاضر، بررسی تأثیر 6 هفته تمرین تناوبی پرشدت بر سطوح آدیپونکتین سرم و بهبود تبحر حرکتی در پسران نوجوان مبتلا به اختلال عدم توجه/ بیش فعالی بود. روش بررسی: در این پژوهش نیمه تجربی، تعداد 20 پسر نوجوان (میانگین سنی 3/5±7/12 سال) مبتلا به اختلال بیش فعالی/ نقص توجه به صورت تصادفی به دو گروه تمرین تناوبی پرشدت و کنترل تقسیم شدند. برنامه تمرینی 6 هفته ای شامل 3 جلسه در هفته، دوی 20 متر با تعداد تکرارهای 4 نوبت در هفته های اول و دوم؛ تعداد تکرارهای 5 نوبت در هفته های سوم و چهارم و تعداد تکرارهای 6 نوبت در هفته های پنجم و ششم بود. در ابتدا و پایان هفته ششم، سطح آدیپونکتین سرم و میانگین نمره تبحر حرکتی مورد ارزیابی قرار گرفت. برای ارزیابی اثربخشی تمرین از آزمون تی مستقل استفاده گردید. یافته ها: یافته های تحلیل آماری نشان داد که اجرای تمرین تناوبی پرشدت، سطوح آدپونکتین سرم (0040/=P) و میانگین نمره تبحر حرکتی (0/001P=) را به طور معنی داری در گروه تجربی افزایش داد. نتیجه گیری: به طور کلی، مطالعه حاضر نشان داد که فعالیت تناوبی پرشدت می تواند به عنوان یک روش موثر، تأثیر مثبتی بر کاهش وزن بدن، افزایش سطح آدیپونکتین سرم و بهبود مهارت حرکتی نوجوانان مبتلا به ADHD داشته باشد

The Effects of Spiritual Care on Anxiety in Adolescents with Cancer

Introduction: Anxiety is one of the psychological complications of cancer in adolescents and it is due to various factors. Since this complication leaves undesirable effects on physical and mental health and also on the adolescents’ quality of lives, one of the main nursing cares in adolescents with cancer is using various strategies to reduce the anxiety. Experience of living with cancer shows spirituality creates purpose and meaning in life for patients.Objectives: This study aimed to investigate the effects of spiritual care on anxiety in adolescents with cancer.Methods: This is a quasi-experimental study with one- group time-series design. 32 hospitalized adolescents were selected by purposeful sampling method based on the inclusion criteria. The spiritual care program was performed for adolescents in 6 sessions of 45 minutes class during their hospitalization. Data was collected by questionnaires of “personal and clinical characteristics” and “Speilberger State-Trait Anxiety Inventory”. The data were analyzed with the SPSS-19 software using descriptive and inferential statistical tests.Results: According to the results of this study, the difference between the mean score of pretest (55.96±11/34) and posttest (42.84±6/19) was significant. However the difference between mean scores of posttest and follow up (48.40±7/18) was not significant (P < 0.001).Conclusion: Implementation of spiritual care by nurses may affect the mental situation of adolescents with cancer and is a suitable method to reduce anxiety. Therefore it is necessary for nurses to use spiritual interventions during implementation of comprehensive nursing care.  Cite to Article: Torabi F, Sajjadi M, Nourian M, Borumandnia N, Shirinabadi Farahani A. The effects of spiritual care on anxiety in adolescents with cancer. Supportive and Palliative Care in Cancer 2016; in press

Influence of case definition on incidence and outcome of acute coronary syndromes

© 2016, BMJ Publishing Group. All rights reserved. Objective: Acute coronary syndromes (ACS) are common, but their incidence and outcome might depend greatly on how data are collected. We compared case ascertainment rates for ACS and myocardial infarction (MI) in a single institution using several different strategies. Methods: The Hull and East Yorkshire Hospitals serve a population of ∼560 000. Patients admitted with ACS to cardiology or general medical wards were identified prospectively by trained nurses during 2005. Patients with a death or discharge code of MI were also identified by the hospital information department and, independently, from Myocardial Infarction National Audit Project (MINAP) records. The hospital laboratory identified all patients with an elevated serum troponin-T (TnT) by contemporary criteria ( > 0.03 μg/L in 2005). Results: The prospective survey identified 1731 admissions (1439 patients) with ACS, including 764 admissions (704 patients) with MIs. The hospital information department reported only 552 admissions (544 patients) with MI and only 206 admissions (203 patients) were reported to the MINAP. Using all 3 strategies, 934 admissions (873 patients) for MI were identified, for which TnT was > 1 μg/L in 443, 0.04-1.0 μg/L in 435, =0.03 μg/L in 19 and not recorded in 37. A further 823 patients had TnT > 0.03 μg/L, but did not have ACS ascertained by any survey method. Of the 873 patients with MI, 146 (16.7%) died during admission and 218 (25.0%) by 1 year, but ranging from 9% for patients enrolled in the MINAP to 27% for those identified by the hospital information department. Conclusions: MINAP and hospital statistics grossly underestimated the incidence of MI managed by our hospital. The 1-year mortality was highly dependent on the method of ascertainment

Immunomodulatory interventions in myocardial infarction and heart failure: a systematic review of clinical trials and meta-analysis of IL-1 inhibition

Following a myocardial infarction (MI), the immune system helps to repair ischaemic damage and restore tissue integrity, but excessive inflammation has been implicated in adverse cardiac remodelling and development towards heart failure (HF). Pre-clinical studies suggest that timely resolution of inflammation may help prevent HF development and progression. Therapeutic attempts to prevent excessive post-MI inflammation in patients have included pharmacological interventions ranging from broad immunosuppression to immunomodulatory approaches targeting specific cell types or factors with the aim to maintain beneficial aspects of the early post-MI immune response. These include the blockade of early initiators of inflammation including reactive oxygen species and complement, inhibition of mast cell degranulation and leucocyte infiltration, blockade of inflammatory cytokines, and inhibition of adaptive B and T-lymphocytes. Herein, we provide a systematic review on post-MI immunomodulation trials and a meta-analysis of studies targeting the inflammatory cytokine Interleukin-1. Despite an enormous effort into a significant number of clinical trials on a variety of targets, a striking heterogeneity in study population, timing and type of treatment, and highly variable endpoints limits the possibility for meaningful meta-analyses. To conclude, we highlight critical considerations for future studies including (i) the therapeutic window of opportunity, (ii) immunological effects of routine post-MI medication, (iii) stratification of the highly diverse post-MI patient population, (iv) the potential benefits of combining immunomodulatory with regenerative therapies, and at last (v) the potential side effects of immunotherapies

Effective Factors on Theoretical Classes Attendance of Dentistry Students of Kerman University of Medical Sciences, Iran

Background & Objective: Classrooms are suitable environment for transferring teachers’ experiences to students and gaining a better understanding of educational contents. The students’ absence from theoretical classes has been one of the increasing and most important educational problems in medical universities in recent years. This study was performed to determine factors effective on theoretical class attendance according to the point of view of dentistry students of Kerman University of Medical Sciences, Iran, in 2012. Methods: This cross-sectional study was conducted on 150 students of the School of Dentistry, Kerman University of Medical Sciences, in 2012. Data collection tool was a questionnaire consisting of 2 parts: demographic characteristics and effective factors on theoretical class attendance questionnaire. The questionnaire consisted of 20 questions scored based on a 5-point Likert scale, from very effective to ineffective, and scores ranging from 0 to 80. Higher scores indicated more effective factors. Data were analyzed by SPSS software through linear regression analysis. Values of P < 0.05 were considered significant. Results: Of the 150 participants, 58.7% were female, 83.3% were single, and 61.3% were native students. The mean age of the participants was 20.7 ± 1.7 years. The mean score of the students was 58.24 ± 9.59. A significant statistical relationship was observed between area of residence, year of education, and sex of students and mean score of questionnaire. Among factors effective on theoretical class attendance, the highest score belonged to appropriate teaching method, teachers' scientific proficiency, students' interest in the related topic. However, taking part in the class as a duty and active involvement of students had the lowest scores. Conclusion: The findings of the present study showed that attendance in classes is affected by factors related to both teachers and students. However, appropriate teaching method, teachers' scientific proficiency, and students' interest in the related topic are the main factors which determine students' attendance in the classes. Keywords Effective factors Attendance Theoretical lessons Dentistry students Kerman (Iran

Immunomodulatory interventions in myocardial infarction and heart failure: a systematic review of clinical trials and meta-analysis of IL-1 inhibition.

Following a myocardial infarction (MI), the immune system helps to repair ischaemic damage and restore tissue integrity, but excessive inflammation has been implicated in adverse cardiac remodelling and development towards heart failure (HF). Pre-clinical studies suggest that timely resolution of inflammation may help prevent HF development and progression. Therapeutic attempts to prevent excessive post-MI inflammation in patients have included pharmacological interventions ranging from broad immunosuppression to immunomodulatory approaches targeting specific cell types or factors with the aim to maintain beneficial aspects of the early post-MI immune response. These include the blockade of early initiators of inflammation including reactive oxygen species and complement, inhibition of mast cell degranulation and leucocyte infiltration, blockade of inflammatory cytokines, and inhibition of adaptive B and T-lymphocytes. Herein, we provide a systematic review on post-MI immunomodulation trials and a meta-analysis of studies targeting the inflammatory cytokine Interleukin-1. Despite an enormous effort into a significant number of clinical trials on a variety of targets, a striking heterogeneity in study population, timing and type of treatment, and highly variable endpoints limits the possibility for meaningful meta-analyses. To conclude, we highlight critical considerations for future studies including (i) the therapeutic window of opportunity, (ii) immunological effects of routine post-MI medication, (iii) stratification of the highly diverse post-MI patient population, (iv) the potential benefits of combining immunomodulatory with regenerative therapies, and at last (v) the potential side effects of immunotherapies

The development and course of heart failure after a myocardial infarction

Introduction: Robust epidemiological data on the incidence of myocardial infarction (MI) are hard to find, but synthesis of data from a number of sources indicates that the average hospital in the UK should admit about two patients with a first MI and one recurrent MI per 1000 population per year. Although age-adjusted incidence may be declining, this may be offset by greater longevity in the general population. The incidence of acute coronary syndromes (ACS) is much higher. The incidence and outcome of both ACS and of MI will depend greatly on how data are collected. The cumulative incidence, persistence and resolution of heart failure (HF) after an MI in the general population are poorly described. Cardiac dysfunction subsequent to MI is a common cause for morbidity and mortality, however, there are few data on what proportion of longterm survivors of MI has important cardiac dysfunction and/or HF. The aim of this thesis is to describe the incidence and outcome of MI in the general population and in different age groups, explain the natural history and prognosis of HF after an MI both during the index admission and long-term (6 year) follow-up in relationship to the presence of HF and also to determine the utility of amino-terminal pro-brain natriuretic peptide (NT-proBNP) alone and in conjunction with other clinical data, as a marker of left ventricular systolic dysfunction (LVSD) and subsequent prognosis in long-term survivors of MI. Subgroup data according to age and anaemia will also be reported. Methods: Patients with a death or discharge diagnosis of MI in 1998 were identified from records of hospitals providing services to a local community of 560,000 people. Records were scrutinized to identify the development of HF, defined as symptoms and signs consistent with that diagnosis and treated with loop diuretics. HF was considered to have resolved if diuretics could be stopped without recurrent symptoms. Analyses were done on the whole population and then sub-groups by age (75 years) and anaemia status. Anaemia was defined according to WHO criteria (men haemoglobin (Hb)1 g below threshold), borderline (within 1g of threshold) and (>1g above threshold). In 2004, surviving patients were invited to attend for clinical assessment, an echocardiogram and measurement of NT-proBNP and were subsequently followed until 31st December 2009 using medical records. Also in 2005, another group of patients admitted with ACS to cardiology or general medical wards were identified prospectively by trained nurses from 1st January to 31st December 2005. Patients with a death or discharge code of MI were also identified by the hospital information department and from Myocardial Infarction National Audit Project (MINAP) records. Results: For the first cohort, 896 patients were identified of whom 54% had died by December 2005. During the index admission, 199 (22%) patients died, many with HF, and a further 182 (20%) patients developed HF that persisted until discharge, of whom 121 died subsequent to discharge. Of 74 patients with transient HF that resolved before discharge, 41 had recurrent HF and 38 died during follow-up. After discharge, 145 (33%) patients developed HF for the first time, of whom 76 died during follow-up. Overall, of 281 deaths occurring after discharge, of which 235(84%) were amongst patients who first developed HF. Of 896 patients, 311 were aged 75 years of whom, respectively, 24%, 57% and 82% had died by December 2005. During the index admission, by age group, 24 (8%), 68 (23%) and 107 (37%) patients died in each group, many with HF, and a further 37 (12%), 63 (21%) and 82 (29%) developed HF that persisted until discharge. After discharge, 53 (24%), 55 (40%) and 37 (47%) patients developed HF for the first time. Overall, of 51, 102 and 128 deaths occurring after discharge, 35 (70%), 93 (91%) and 107 (85%) were among patients who first developed HF. Of 855 patients with an available hemoglobin during index admission, 103 were anaemic, 280 were borderline and 472 were not anaemic based on the first available haemoglobin during the index admission. 300 patients had more than one measurement of haemoglobin, of which 125 (85 unchanged status from first assessment) had definite, 289 (237 unchanged) had borderline and 441 (424 unchanged) had no anaemia on the last available measurement. During the index admission, 77 patients (75%) with definite, 130 (46%) with borderline and 196 (42%) who had no anaemia on the first available haemoglobin developed HF, of whom 41 (53%), 50 (38%) and 60 (31%) died during the admission compared, respectively, to 7 (27%), 14 (9%) and 9 (3%) deaths in patients who did not develop HF. During a six year follow-up, 543 (64%) patients developed HF and 456 (53%) died. Amongst patients with HF during the index admission, the six year mortality rates in those with definite, borderline and no anaemia (last available index admission measurement) were, 90%, 84% and 64% (P=0.0001). In patients without HF on the index admission, 6-year mortality rates were 62%, 42% and 24% (P=0.0001). Anaemia (last available index admission measurement) predicted all-cause mortality independent of the presence of HF (p=0.055). 451 had died by 2004 and only 414 were available for follow-up, of whom 175 patients attended and had NT-proBNP measured. Of these, 51 (29%) patients had LVSD, 66 (38%) had NT-proBNP >50pmol/L (423pg/ml), 86 (49%) had one or the other and 31 (18%) had both. Patients with higher NT-proBNP were more likely to have HF (and be treated with diuretics), LVSD (and therefore treatment with ACE inhibitors), a dilated atrium, substantial mitral regurgitation and atrial fibrillation (and therefore treatment with warfarin and digoxin) (p=0.0001). Thirty six patients died during follow-up; 28 (42%) with an NT-proBNP >50pmol/L (423pg/ml) (77% of all deaths). ROC curves suggested that NT-proBNP 56pmol/L (474pg/ml) had the highest sensitivity (78%) and specificity (77%) for predicting death (AUC 0.78). Echocardiography added little to the prognostic information provided by NT-proBNP alone. In 2005, the prospective survey identified 1,731 admissions (1,439 patients) with ACS, of which 764 (704 patients) were for MI. The hospital information department reported only 552 admissions (544 patients) with MI and only 206 admissions (203 patients) were reported to MINAP. Using all three data-bases, 934 admissions (873 patients) for MI were identified, for which TnT was >1ug/L in 443, 0.04 to 1.0 in 435, 0.03ug/L but did not have ACS ascertained by any survey method. Of 873 patients with MI, 146 died during admission (17% versus 22% in the 1998 cohort) and 218 by one year. Conclusion: The incidence of ACS/MI is highly dependent on the methodology for case-ascertainment and the method used to identify cardiac damage (for instance the sensitivity of the troponin assay used). The development of HF precedes death in most patients who die in the short- or longer-term following an MI. The risk of developing HF and dying after an MI increases progressively with age and anaemia. In patients with a remote history of MI, elevated NT-BNP identifies patients with a high prevalence of LVSD. Regardless of age, most deaths are preceded by the development of HF. Anaemia is associated with a high mortality even in the absence of HF. Prevention of HF, by reducing the extent of myocardial damage and recurrent MI and by subsequent good management could have a substantial impact on prognosis

Comparing the effects of mHealth application based on micro-learning method and face-to-face training on treatment adherence and perception in haemodialysis patients: a randomised clinical trial

Objectives Comparing the effects of a mobile health (mHealth) application based on the micro-learning method with face-to-face training on treatment adherence and perception among patients undergoing haemodialysis.Design A single-blind randomised clinical trial.Setting A haemodialysis centre in Isfahan, Iran.Participants Seventy patients.Intervention Patients were trained individually for 1 month via the mHealth application or face-to-face training.Outcome measures Treatment adherence and perception in patients were measured and compared.Results The scores of treatment adherence in the mHealth and the face-to-face training groups were not significantly different at the pre-intervention stage (720.43±209.61 vs 702.861±181.47, p=0.693) and immediately after the intervention (1007.14±134.84 vs 947.86±124.46, p=0.060), while 8 weeks later, treatment adherence in the mHealth group was significantly higher than the face-to-face training group (1018.57±129.66 vs 914.29±126.06, p=0.001). The scores of both groups before the intervention did not differ in various dimensions of treatment adherence and perception (p&gt;0.05). Scores of these variables also elevated significantly after the intervention (p&lt;0.05).Conclusions The mHealth based on micro-learning and face-to-face training as interventions augmented treatment adherence and perception among the haemodialysis patients, but such improvements were detected much more in the patients trained with mHealth based on the micro-learning method than face-to-face training.Trial registration number IRCT20171216037895N5

Association of triage time Shock Index, Modified Shock Index, and Age Shock Index with mortality in Emergency Severity Index level 2 patients

BACKGROUND: Shock Index (SI) is considered to be a predictor of mortality in many medical and trauma settings. Many studies have shown its superiority to conventional vital sign measurements in mortality prediction. OBJECTIVES: The objectives were to compare mortality and intensive care unit admission prediction of triage time SI, Modified SI (MSI), and Age SI with each other and with triage time blood pressure in Emergency Severity Index (ESI) level 2 patients. METHODS: A retrospective medical record review was performed in the internal medicine emergency department of a general hospital in Kerman, Iran. Triage time vital signs were used to calculate the indices. Multivarible regression analysis was used to create the final model. RESULTS: A total of 1285 patients triaged to ESI level 2 were enrolled in the study. In the multivariate analysis, SI, MSI, and Age SI were found to be the only variables independently associated with mortality, whereas none of them were associated with intensive care unit admission. Sensitivity, specificity, and area under curve in the receiver operating characteristic curve for the model including SI, MSI, and Age SI were 60.8%, 65.4%, and 0.675, respectively. Sensitivity, specificity, and area under curve did not change significantly by excluding SI, MSI, or Age SI from the final model. CONCLUSION: In nontrauma adult patients, triage time SI, MSI, and Age SI are superior to blood pressure for mortality prediction in ESI level 2. They can be used alone or in combination with similar results, but their low sensitivity and specificity make them usable only as an adjunct for this purpose. Copyright © 2015 Elsevier Inc. All rights reserved

Quantiation of IL-4, IL-10 and IFN- Genes Expression after Immunization of Mice with CFP-10 and ESAT-6 Containing Vectors

ABSTRACT Background: Tuberculosis is a disease with high morbidity, caused mainly by Mycobaterium tuberculosis (M.tb.). DNA vaccines show a promising future due to their unique advantages over conventional methods. The early-secreted antigen target (ESAT)-6 and culture filtrate protein (CFP)-10 of M.tb. antigens have been identified as vaccine candidates against Mycobacteria and used as subunit vaccines, DNA or protein, in different studies. Objective: To investigate the potential of pcDNA3.1+ plasmid containing CFP-10 and ESAT-6 genes in induction of local immune responses after intramuscular injection in BALB/c mice. Methods: pcDNA 3.1+ CFP-10 and pcDNA3.1+ ESAT-6 plasmids were prepared and defined groups of mice were injected intramuscularly with the plasmids both separately and in combination. The RNA was extracted from muscles after one month and cDNA was made using RT-PCR. The expressions of IL-4, IL-10 and IFN-γ genes cytokines were evaluated using comparative real time PCR. Results: Expression of IL-4 and IL-10 increased in the injection site of the mice groups which received plasmids encoding ESAT-6 and CFP-10 individually or together. More than 10-fold increase in IFN-γ expression was found in samples taken from mice groups inoculated by plasmids encoding ESAT-6 and CFP-10 individually or together. Conclusion: pcDNA 3.1+ESAT-6 and pcDNA3.1+CFP-10 plasmids can increase the expression of IFN-γ in mice after immunization