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Changes in Physiological Levels of Cortisol and Adrenocorticotropic Hormone upon Hospitalization Can Predict SARS-CoV-2 Mortality: A Cohort Study
No full textThere is some indication that coronavirus disease 2019 (COVID-19) causes hypothalamic-pituitary-adrenal axis insufficiency. However, being on glucocorticoids makes it difficult to fully investigate this axis, especially in patients with severe COVID-19. We aimed to discover if there was a connection between blood total cortisol and adrenocorticotropic hormone (ACTH) levels and mortality in patients with COVID-19. In Iran, 154 hospitalized patients with COVID-19 were studied in a prospective cohort study. ACTH and cortisol levels in the blood were measured on the first or second day of hospitalization. Most patients (52.6 vs. 47.4) were men over 50 years old (55.8), and 44.4 had an underlying illness. Serum cortisol and plasma ACTH medians were 15.6 (mu g/dl) and 11.4 (pg/ml), respectively. 9.09 of the patients died. Cortisol levels were substantially lower in those who died (11.3 mu g/dl) than in patients who were discharged (16.7 mu g/dl, P < 0.01), while ACTH levels were unaffected. The most important factors determining mortality, according to the logistic model, were blood cortisol levels, the existence of an underlying disease, and the use of a mechanical ventilator. Cortisol levels that rose by one-unit correlated with a 26 lower risk of mortality. Comorbidities and mechanical ventilation increased the risk of death by 260 and 92 times, respectively. It can be concluded that in patients with COVID-19, a low cortisol level is linked to a high risk of mortality. Patients may sometimes have relative primary adrenal insufficiency. To judge and decide on therapeutic interventions, more reliable and long-term follow-up studies are required
Molecular characterization of Trichomonas infections in women of Ilam City, southwestern Iran
No full textTrichomoniasis is a sexually transmitted infection (STI) caused by the flagellated protozoan Trichomonas vaginalis. Little information is available on the epidemiology and genetic diversity of T. vaginalis in Ilam City, southwestern Iran. A descriptive cross-sectional investigation was carried out between July 2017 and December 2018 on the suspected women patients referred to eight gynecology clinics of Ilam City for probable Trichomonas infection. They were undergone a set of clinical, parasitological, and molecular examinations. During clinical consultation, posterior vaginal fornix secretions and urine samples were gathered from the participants. For the reasons such as physical conditions and cultural and religious constraints, most of participating women, especially young girls due to their virginity, preferred to give urine samples instead of vaginal discharge. The presence of Trichomonas was diagnosed by microscopic examination and molecular detection using conventional PCR targeting ITS1-rDNA. A total of 1765 suspected individuals were examined clinically via vaginal secretions (495 specimens) and urine samples (1270 specimens). Of them, 21 (1.18) cases, including 13 vaginal secretions and 8 urine samples, were positive for Trichomonas infection by microscopy. Slightly more than half of the patients (11/21, 52.4) complained of vulvar itching, burning, and frequent urination. Cervical lesions, patchy erythema, and vaginal discharge were recorded in 28.6, 23.8, and 19 of the patients respectively. All patients with positive microscopic identification were confirmed by amplification of 450-bp fragment of ITS1-rDNA. Phylogenetic analysis revealed a high rate of genetic homogeneity in which all our isolates together with homologous sequences from China, Philippines, Austria, and USA were clustered within the same clade. A statistically significant relationship was recorded between the patients positive for trichomoniasis and the presence of chronic disease (e.g., diabetes, immune system deficiency)
Examination of influence of social media education through mobile phones on the change in physical activity and sedentary behavior in pregnant women: a randomized controlled trial
No full textBackground Nowadays because of some necessities and demands for virtual and remote education, a new model of health approach through mobile-phones is widely used to deal with improving physical activity and its beneficial effect on pregnancy. There are a small number of studies for showing this importance and the efficacy of such methods, so this study was aimed to determine the influence of social networking through mobile phones on changing the physical activity behavior in pregnant women. Methods This randomized controlled trial was conducted with parallel groups on 90 pregnant women referring to Urmia health centers in 2018-2019. The participants from various social and economic backgrounds were included. The participants were randomly assigned to a control and a treatment group. Demographic and Pregnancy Physical Activity Questionnaire (PPAQ) questionnaires were filled. In addition to routine cares, the treatment group received educational intervention through social network within 16 training sessions related to physical activity and nutrition in 8 weeks. Results The mean weight in both control and treatment groups changed significantly during the study, but in different trends (P < 0.001, Mean Difference (MD) = 4.43). At the beginning of the study, control and treatment groups were not different in terms of daily physical activity level (P = 0.17, MD = 0.62), meanwhile, there was a statistically significant difference at the end of intervention in the level of daily physical activity (P < 0.001, MD = 0.69). Comparison of both groups, based on different categories of activity level at the end of the treatment, showed a non-significant difference in sedentary activities (P = 0.89, MD = 0.46), but the intervention led to a significant difference based on the other level of activities; light (P < 0.001, MD = 51.94), moderate (P < 0.001, MD = 46.87), and sever (P = 0.05, MD = 1.07). Conclusion Educational intervention based on social networks through mobile phones had an effective role in behavior change in physical activity during pregnancy
Preferences of people in choosing a family physician in rural areas: a qualitative inquiry from Iran
No full textBackground: Creating a stable and long-term relationship called 'longitudinality' between the population and general practitioners is crucial for the family physician program. The constant change of family physicians (FPs) can deteriorate longitudinality. This study aims to reveal what factors people usually consider when choosing a new FP or changing their current FP. Method: A qualitative study with a thematic analysis approach was carried out in Ilam province, Iran, in 2019. Purposeful sampling with a maximum variation strategy was followed to select the key informants. We did 34 interviews with following groups: patients (rural residents); FPs; and experts from Iran Health Insurance Organization, Ilam University of Medical Sciences, and Health Network Development Center. Data were analyzed using a thematic analysis to identify and contextualize the preferences of people in choosing a FP in rural areas. All the processes related to data coding and emerging themes were carried out using MAXQDA 2012 software. Results: The content of the interviews was categorized into 2 main themes, 6 sub-themes, and 39 codes. The first theme was 'family physician characteristics' including four sub-themes: general behaviors, social and physical characteristics, professional expertise, and pharmaceutical prescriptions. The second theme was 'health center' consisting of two sub-themes including location and physical features and properties of the health center. Conclusion: Some of the factors extracted from the interviews may have a different effect on the choice of people with different demographics. For instance, patients may have different ideas about the age, gender, years of medical practice, and finally, language and origin of the birthplace of FPs. Quantitative studies are needed to rank the factors identified in this study according to their significance for choosing FP and reveal patients' preferences for each factor
SARS-CoV-2 triggering autoimmune diseases
No full textAutoimmunity, hyperstimulation of the immune system, can be caused by a variety of reasons. Viruses are thought to be important environmental elements that contribute to the development of autoimmune antibodies. It seems that viruses cause autoimmunity with mechanisms such as molecular mimicry, bystander activation of T cells, transient immunosuppression, and inflammation, which has also been seen in post-Covid-19 autoimmunity. Infection of respiratory epithelium by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) dysregulates the immune response, triggers both innate and acquired immunity that led to the immune system's hyperactivation, excessive cytokine secretion known as "cytokine storm, " and finally acute respiratory distress syndrome (ARDS) associated with high mortality. Any factor in the body that triggers chronic inflammation can contribute to autoimmune disease, which has been documented during the Covid-19 pandemic. It has been observed that some patients produce autoantibody and autoreactive CD4(+) and CD8(+) T cells, leading to the loss of self-tolerance. However, there is a scarcity of evidence defining the precise molecular interaction between the virus and the immune system to elicit autoreactivity. Here, we present a review of the relevant immunological findings in Covid-19 and the current reports of autoimmune disease associated with the disease
Obesity and gut-microbiota-brain axis: A narrative review
No full textIntroduction Obesity is a major health problem that is associated with many physiological and mental disorders, such as diabetes, stroke, and depression. Gut microbiota has been affirmed to interact with various organs, including the brain. Intestinal microbiota and their metabolites might target the brain directly via vagal stimulation or indirectly through immune-neuroendocrine mechanisms, and they can regulate metabolism, adiposity, homoeostasis and energy balance, and central appetite and food reward signaling, which together have crucial roles in obesity. Studies support the concept of bidirectional signaling within the gut-brain axis (GBA) in the pathophysiology of obesity, mediated by metabolic, endocrine, neural, and immune system mechanisms. Materials and methods Scopus, PubMed, Google Scholar, and Web of Science databases were searched to find relevant studies. Results The gut-brain axis (GBA), a bidirectional connection between the gut microbiota and brain, influences physiological function and behavior through three different pathways. Neural pathway mainly consists of the enteric nervous system (ENS) and vagus nerve. Endocrine pathway, however, affects the neuroendocrine system of the brain, particularly the hypothalamus-pituitary-adrenal (HPA) axis and immunological pathway. Several alterations in the gut microbiome can lead to obesity, by modulating metabolic pathways and eating behaviors of the host through GBA. Therefore, novel therapies targeting the gut microbiome, i.e., fecal microbiota transplantation and supplementation with probiotics and prebiotics, can be a potential treatment for obesity. Conclusion This study corroborates the effect of gut microbiome on physiological function and body weight. The results show that the gut microbiota is becoming a target for new antiobesity therapies
Pathologic findings of acantholytic squamous cell carcinoma coexisting with cutaneous cryptococcosis in a Houbara bustard (Chlamydotis undulata)
No full textA 2-year-old Asian Houbara bustard was presented with a solitary well-defined, firm cutaneous mass on the hock region. Grossly, the mass protruded from the surface was located on the hairless and unpigmented areas of the right hock joint with ulceration and dried hemorrhagic foci. On microscopic examination, ulceration, hemorrhage, as well as hyperkeratosis were observed. Large round, oval to polygonal neoplastic cells extended into the dermis were arranged to form cords, trabeculae, islands or glandularlike structures without keratin pearls. These pseudoglandular structures were composed of pseudolumina containing acantholytic and detached tumor cells. Necrosis of the neoplastic cells was accompanied by infiltration of inflammatory cells particularly heterophils. Unlike pleomorphic tumor cells, mitosis count was almost frequent. No evidence of other abnormalities and tumor metastasis was found. These gross and microscopic features appeared to be suggestive of a rare histologic variant of squamous cell carcinoma (SCC
Survey of the patients' perspectives and preferences in adopting telepharmacy versus in-person visits to the pharmacy: a feasibility study during the COVID-19 pandemic
No full textBackground Following the coronavirus disease 2019 (COVID-19) pandemic, the health authorities recommended the implementation of strict social distancing and complete lockdown regulations to reduce disease spread. The pharmacists quickly adopted telemedicine (telepharmacy) as a solution against this crisis, but awareness about this technology is lacking. Therefore, the purpose of this research was to explore the patients' perspectives and preferences regarding telepharmacy instead of traditional in-person visits. Methods An electronic questionnaire was designed and sent to 313 patients who were eligible for the study (from March to April 2021). The questionnaire used five-point Likert scales to inquire about motivations for adopting telepharmacy and in-person visits, their perceived advantages and disadvantages, and the declining factors of telepharmacy. Finally, the results were descriptively analyzed using SPSS 22. Results Of all 313 respondents, a total of 241 (77) preferred appointments via telepharmacy while 72 (23) preferred in-person services. There was a significant difference between the selection percentage of telepharmacy and in-person services (chi-square 91.42; p < 0.0001). Preference bout the telepharmacy system versus in-person visits to the pharmacy was associated with factors such as "reducing the incidence of contagious disease" (4.41; +/- 0.78), "spending less time receiving pharmaceutical services" (4.24; +/- 0.86)), and "traveling a shorter distance for receiving pharmaceutical services" (4.25; +/- 0.86). "Reducing costs" (90.87), "saving time" (89.21), and "reducing the incidence of contagious disease" (87.13) were the most important reasons for choosing telepharmacy services. Also, "face-to-face communication with the pharmacist" (25), "low internet bandwidth" (25), and "reduction of patients' anxiety and the increase of their peace of mind" (23.61) were the most important reasons for choosing in-person visits. Conclusion Survey data indicate that most participants are likely to prefer the use of telepharmacy, especially during crises such as the current COVID-19 pandemic. Telepharmacy can be applied as an important means and a crucial service to lessen the load on healthcare organizations and expand drug supply shelters in pharmacies. However, there are still substantial hurdles to overcome in order to successfully implement the telemedicine platform as part of mainstream practice
Implementation of a Case Presentation Program for Clinical Nutrition Students
No full textBackground and AimsTo implement a training method increase clinical nutritionists' knowledge and make doctors more familiar with this specialty. MethodsThe study was conducted in an internship course of all third semester clinical nutrition students. At first, conventional training was presented for students, and then, in the same duration, case presentation training program was implemented. The presentations were filmed and uploaded to the Internet, and the link was placed on the hospital's website. At the end of the 2 phases, the students were asked to answer the survey questionnaire. Additionally, consultation report sheets were evaluated and scored by 2 physicians. Number of consultation requests was also recorded in 2 study phases. ResultsThe mean satisfaction score was statistically higher in the case presentation training program than in the conventional program. All the students recommended similar case report program courses for the students in the future. Although the mean consultation report score was not statistically different between the two training programs, case presentation program resulted in significantly better scores in 4 items of nutrition focused physical examinations, assessment of malnutrition, assessment of related laboratory tests, and food-drug interactions. Number of consultation requests was significantly increased during the case presentation program training compared to the conventional training from 194 to 272 (P < 0.001). ConclusionFrom the students' perspective, the case-based learning report was preferred to the conventional method. From the physicians' viewpoint, the answer to the counseling sheets was more complete and helpful
Emergency Response to a Hospital Fire: A Report From the Field
No full textAs the most important centers providing medical services during disasters and emergencies, hospitals have special structural complexities. Furthermore, the hospitals are exposed to many intrinsic and extrinsic hazards, including fire. On November 28, 2018, at 9:25 am (local time), a fire started in Ayatollah Taleghani Hospital of Ilam, affiliated with Ilam University of Medical Sciences, Iran. Immediately, to save patients' lives and prevent injuries to them, the horizontal and then vertical evacuation was performed to transfer patients to other hospitals by helping the support organizations. No physical injuries or deaths were reported in this incident. The results of this case study showed that hospitals should be sufficiently prepared to respond effectively to accidents and disasters, so it is needed to prepare and practice response programs and train hospital staff and managers