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Heart failure with preserved ejection fraction in coronavirus disease 2019 patients: the promising role of diuretic therapy in critically ill patients
Get PDFThe impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on diastolic function is less known. We describe a 46-year-old man with a history of mild hypertension who presented to the emergency department with fever, cough, and myalgia for 2 days. The patient was tested positive for SARS-CoV-2. He was admitted and started on a combination of antiviral and antimicrobial therapy. He developed respiratory distress 2 days later, and O2 saturation declined. Blood tests showed an increased N-terminal pro-B type natriuretic peptide (NT-proBNP) level, and echocardiography showed normal left ventricular ejection fraction and E/e� ratio of 16. Computed tomography scan showed interstitial pulmonary oedema and prominent peripheral pulmonary vascular markings. Given these findings, heart failure with preserved ejection fraction (HFpEF) was considered. Low-dose diuretic was started, and fluid administration was restricted, resulting in a decrease in NT-proBNP level, clinical and haemodynamic stabilization, and improved oxygenation. This case highlights the occurrence of HFpEF in coronavirus disease 2019. © 2021 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology
Letter to the editor on: F. Campostrini et al. Association between acute histopathological changes of rectal walls and late radiation proctitis following radiotherapy for prostate cancer
No full textImproved efficiency of genome editing by constitutive expression of Cas9 endonuclease in genetically-modified mice
Get PDFDespite its convenience and precision, CRISPR-based gene editing approaches still suffer from off-target effects and low efficiencies, which are partially rooted in Cas9, the nuclease component of the CRISPR/Cas9 system. In this study, we showed how mouse genome editing efficiency can be improved by constitutive and inheritable expression of Cas9 nuclease. For this goal, a transgenic mouse line expressing the Cas9 protein (Cas9-mouse) was generated. For in vitro assessment of gene editing efficiency, the Cas9-mice were crossed with the EGFP-mice to obtain mouse embryonic fibroblasts (MEF) expressing both EGFP and Cas9 (MEFCas9-EGFP). Transfection of these cells with in vitro transcribed (IVT) EGFP sgRNA or phU6-EGFPsgRNA plasmid led to robust decrease of Mean Fluorescent Intensity (MFI) to 8500 ± 1025 a.u. and 13,200 ± 1006 a.u. respectively. However, in the control group, in which the MEFEGFP cells were transfected with a pX330-EGFPsgRNA plasmid, the measured MFI was 16,800 ± 2254 a.u. For in vivo assessment, the Cas9-zygotes at two pronuclei stage (2PN) were microinjected with a phU6-HhexsgRNA vector and the gene mutation efficiency was compared with the wild-type (WT) zygotes microinjected with a pX330-HhexsgRNA plasmid. The analysis of born mice showed that while the injection of Cas9-zygotes resulted in 43.75 Hhex gene mutated mice, it was just 15.79 for the WT zygotes. In conclusion, the inheritable and constitutive expression of Cas9 in mice provides an efficient platform for gene editing, which can facilitate the production of genetically-modified cells and animals. © 2021, King Abdulaziz City for Science and Technology
Persistent hiccups in a patient with mild congenital factor V deficiency and COVID-19; clinical and laboratory finding of a rare bleeding disorder
No full textOveruse of brain CT scan for evaluating mild head trauma in adults
No full textIntroduction: CT scan is crucial in evaluating head trauma. However, its inappropriate use will cause unnecessary radiation exposure to patient and financial burden to health systems. Our aim is appraising amount of brain CT scans performed in our Emergency Department (ED) for evaluating mild head trauma which are not indicated according to four standardized guidelines as well as analyzing contributing factors. Methods: This was a descriptive prospective study. We included randomly selected adult patients under 75 years old with minor head trauma evaluated by brain CT scan at our ED. For all patients, we completed a checklist including demographic data, mechanism of trauma, specialty of the requesting physician, and whether the patient meets the brain CT guidelines criteria. Brain CT overuse was defined as scans performed for patients without criteria of any of the standardized guidelines. Results: We evaluated 170 patients. The mean age of patients was 38.38 ± 19.73 years old. The most common mechanism of trauma was falling (37.6). The overall brain CT scan overuse was 15.3. Most of the overused scans were performed in younger patients, and patient�s age was inversely correlated to overuse. There was no significant difference based on the mechanism of trauma and the specialty of requesting physician. Discussion: Our study accentuates the high frequency of brain CT scan overuse, leading to unnecessary radiation exposure and financial burden on healthcare systems. We emphasize that using a guideline for requesting brain CT scan can eliminate unnecessary scans along with detecting patients with important decisive damages. © 2020, American Society of Emergency Radiology
A study of the communication skills in health care and the role of demographic variables (a case study of the nurses at the Educational, Therapeutic and Research Center of Imam Reza Hospital, Kermanshah, Iran in 2018)
No full textPurpose: Nurses, as facilitators in hospitals, should be equipped with communication skills towards the realization of this goal. The present study aimed to investigate the status of communication skills in health care and the role of nurses� demographic variables at the Educational, Therapeutic, and Research Center of Imam Reza Hospital, Kermanshah, Iran in 2018. Methods: In this descriptive�analytic study, the statistical population was 926 nurses working at the Educational, Therapeutic, and Research Center of Imam Reza Hospital affiliated to Kermanshah University of Medical Sciences, Kermanshah, Iran in 2018. Moreover, the random sampling was used as the sampling method. As for data collection, a two-part questionnaire, containing the demographic questions and the Queendom Communication Skills Test, was used. Furthermore, the independent t-test and one-way ANOVA using SPSS Statistical Software Version 22.0 were used for data analysis. Results: The results of the present study demonstrated that the mean and standard deviation of the total score of communication skills measured 2.70 ± 0.43. The results also indicated that assertiveness and understanding verbal and nonverbal messages had the highest and lowest mean scores (3.20 ± 0.64 and 2.30 ± 0.58 respectively). Further, there was a significant relationship between the mean scores of communication skills and variables such as marital status, employment background, department, work shift, and type of employment (P < 0.05). Conclusions: The results of the present study revealed that nurses� knowledge of communication skills was moderate. Therefore, it is recommended that courses on communication skills training be considered in their continuing education and on-the-job training, with the aim of improving the quality of nursing care. © 2019, Springer-Verlag GmbH Germany, part of Springer Nature
Static magnetic field halves cryoinjuries of vitrified mouse COCs, improves their functions and modulates pluripotency of derived blastocysts
No full textThis study was performed with the aim of evaluating the influence of static magnetic field (SMF) of 60 mT on mouse Cumulus Oocytes Complexes (COCs) vitrification. The COCs were vitrified in the presence (VitSMF+) and absence of SMF (VitSMF�). Along with these groups, non-vitrified or fresh COCS, which exposed (nVitSMF+) and non-exposed (nVitSMF�) to magnetic field, were also considered. Survival and viability rates and mitochondrial activity as well as ultrastructure of oocytes were examined by trypan blue Staining (TBS), Annexin-PI Staining, JC1 staining and transition electron microscopy, respectively. Following in vitro fertilization (IVF) and embryo development, gene expression was carried out through qRT-PCR at blastocyst (BL) stage. The survival rate in VitSMF+ and VitSMF� decreased meaningfully in comparison with nVitSMF� (P < 0.05), but there was no significant difference between SMF+ and SMF� groups. The mitochondrial activity in VitSMF� was significantly reduced compared to the nVitSMF� group (P < 0.05), however its value in VitSMF+ returned to the control level. Ultrastructural study demonstrated that SMF could protect the COCs from cryoinjuries and reduced damaged features in ooplasm of the vitrified oocytes. There was no significant difference in fertilization rate. Although, BL formation was the highest rate in the VitSMF+ group, it was just substantially higher than the non-vitrified groups (P < 0.05). The significant changes of Oct4, Cdx2 and Nanog genes expression due to vitrification (VitSMF�) or SMF (nVitSMF+) treatments (P < 0.05) as compared to control (nVitSMF�), returned to the natural level after using SMF in vitrified derived blastocysts (VitSMF+). Totally based on the results, it is clear that static magnetic field improves mitochondrial potential activity and ultrastructure of mouse vitrified COCs. In addition, SMF enhances the embryo cleavage rate to blastocyst stage and modulates pluripotency in blastocyst embryos derived from vitrified COCs. © 2021 Elsevier Inc
The effect of synbiotic on glycemic profile and sex hormones in overweight and obese breast cancer survivors following a weight-loss diet: A randomized, triple-blind, controlled trial
No full textBackground: The investigation was designed to assess the effects of synbiotic supplementation on glycemic profile, insulin-like growth factor-1 (IGF-1) and sex hormones in overweight and obese postmenopausal breast cancer survivors (BCSs) who had hormone-receptor-positive breast cancer. Methods: This randomized, triple-blind, placebo-controlled trial was conducted on 76 overweight and obese BCSs aged 57.43 (5.82) years. All participants were given a specified low calorie diet and were randomly assigned into two groups to intake 109 CFU/day of synbiotic supplement (n = 38) or placebo (n = 38) for 8 weeks. Body composition, physical activity, glycemic profile, IGF-1, estradiol, testosterone and dehydroepiandrosterone sulfate (DHEA-S) were measured at baseline and after 8 weeks. Results: A significant reduction in serum insulin (median change (Q1, Q3) from baseline of �1.05 (�2.36, 0.32) μIU/mL; P = 0.006) and insulin resistance (HOMA-IR) (mean change (SD) from baseline of �4.0 (0.9); P = 0.007) were seen over the 8 weeks in the synbiotic group. However, no significant changes were observed in serum insulin, fasting plasma glucose, HbA1c, HOMA-IR, IGF-1, estradiol, testosterone, DHEA-S and sex hormone binding globulin between-groups at the end of the intervention. Conclusions: Overall, as the 8-week synbiotic consumption compared with placebo had insignificant-reducing effects on glycemic profile, IGF-1 and sex hormones among overweight and obese postmenopausal BCSs, synbiotics may exert considerable beneficial consequences, which need to be further assessed in future clinical trials. Trial registration: IRCT, IRCT2015090223861N1. Registered 02 February 2017, http://www.irct.ir: IRCT2015090223861N1. © 2020 Elsevier Ltd and European Society for Clinical Nutrition and Metabolis
Combination Therapy of Killing Diseases by Injectable Hydrogels: From Concept to Medical Applications
No full textThe complexity of hard-to-treat diseases strongly undermines the therapeutic potential of available treatment options. Therefore, a paradigm shift from monotherapy toward combination therapy has been observed in clinical research to improve the efficiency of available treatment options. The advantages of combination therapy include the possibility of synchronous alteration of different biological pathways, reducing the required effective therapeutic dose, reducing drug resistance, and lowering the overall costs of treatment. The tunable physical properties, excellent biocompatibility, facile preparation, and ease of administration with minimal invasiveness of injectable hydrogels (IHs) have made them excellent candidates to solve the clinical and pharmacological limitations of present systems for multitherapy by direct delivery of therapeutic payloads and improving therapeutic responses through the formation of depots containing drugs, genes, cells, or a combination of them in the body after a single injection. In this review, currently available methods for the design and fabrication of IHs are systematically discussed in the first section. Next, as a step toward establishing IHs for future multimodal synergistic therapies, recent advances in cancer combination therapy, wound healing, and tissue engineering are addressed in detail in the following sections. Finally, opportunities and challenges associated with IHs for multitherapy are listed and further discussed. © 2020 Wiley-VCH Gmb