The use of laser photobiomodulation as pre-anesthetic tissue management technique in reducing injection pain in children.

BACKGROUND: One of the main goals for pediatric dentists is to offer a painless anesthesia experience. Laser photobiomodulation is among the suggested strategies to decrease injection pain. So, this study aimed to assess the impact of laser photobiomodulation on local anesthesia (LA) injection pain in children and its effect on the efficacy of LA during pulpotomy and SSC procedures. METHODS: The research was carried out as a randomized controlled clinical trial with two parallel group design. It involved 64 cooperative healthy children, age range from 5 to 7 years, each having at least one maxillary molar indicated for pulpotomy. Children were randomly allocated to one of the two groups based on the pre-anesthetic tissue management technique used: test group received laser photobiomodulation, while control group received topical anesthetic gel. Pain during injection, pulpotomy, and SSC procedures was assessed using physiological measures (Heart Rate (HR)), subjective evaluation (modified Face-Pain-Scale (FPS), and objective analysis (Sound-Eye-Motor scale (SEM)). RESULTS: A total of 64 children with mean age 6.23 ± 0.78 participated in this research. The mean HR scores were significantly lower in the laser PBM group during buccal and palatal infiltration injections. The SEM mean scores were significantly lower in the laser PBM group during both injections. For the FPS scale, the number of children who recorded satisfaction during injection was significantly higher in laser PBM group. There was no statistically significant difference in mean HR as well as in SEM and FPS scores between the two groups during pulpotomy and SSC procedures. Comparisons between the two study groups were performed using independent samples t- and Mann-Whitney U tests. Significance was set at p value < 0.05. CONCLUSION: Laser photobiomodulation is a promising non-pharmacological pre-anesthetic tissue management technique in children that offered less painful injection compared to topical anesthetic gel without compromising the effectiveness of LA. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05861154. Registered on 16/5/2023.

The hidden curriculum of gatekeeping: Dismissal experiences of health service psychology trainees.

Health service psychology (HSP) programs, encompassing clinical, counseling, and school psychology, play a pivotal role in shaping the U.S. health care workforce. Practicum and internship sites are critical gatekeepers within this training. However, there is limited empirical evidence available regarding the prevalence of clinical dismissal and its consequences for affected trainees. To bridge these gaps in our understanding of clinical dismissal during HSP training, Study 1 conducted an analysis of a quantitative survey involving training directors (N = 123) from HSP academic programs. The results revealed that 28% of programs reported at least one trainee having been dismissed from a practicum or internship site within the past seven years, with an overrepresentation of racial minority and international trainees. In addition, PsyD programs (56%) exhibited a significantly higher likelihood of having dismissed trainees compared to PhD programs (23%) over the same period. In Study 2, qualitative interview data were collected from ten trainees who had experienced dismissal during their HSP training. Using the Consensual Qualitative Research method, we identified six distinct domains, each comprising unique categories and subcategories: Antecedents to dismissal, reasons for dismissal, process of dismissal, chain reactions, trainee impact, and recommendations. Taken together, this mixed-method study highlights that clinical dismissal is not an uncommon occurrence in HSP training and raises significant concerns about the current implementation process. We illuminate structural issues and offer recommendations to improve the process of clinical dismissal within the HSP field. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The International Society of Thrombosis and Hemostasis (ISTH) criteria in intensive care units.

BACKGROUND: Disseminated Intravascular Coagulation (DIC) has been assessed by the International Society of Thrombosis and Hemostasis (ISTH) 2001 and the ISTH 2018-modified version. More investigations are needed to assess usability and visibility of those DIC scoring systems in the intensive care units (ICU). AIMS: This study investigated the predictive performance of the ISTH-Overt DIC versions of 28-day mortality in ICUs compared to SOFA as a gold standard assessment tool of sepsis. METHODS: A retrospective design (2015-2017) included 220 adult patients enrolled from medical and surgical ICUs in two major hospitals in Jordan. We calculated ISTH-Overt DIC scores and SOFA score on time of DIC diagnosis. Overt DIC was categorized based on a score of ≥ five for ISTH DIC 2001; and ≥ 4 for ISTH DIC 2018. Provided, a score > 12 was categorized as Multiple-Organ- Dysfunction-Syndrome (MODS) for Sequential Organ Failure Assessment (SOFA) score. Then, 28-day mortality follow-up was performed. RESULTS: More than half of sample died before 28-days of follow-up. The analysis of Receiver Operating Characteristic (ROC) showed that higher scores of ISTH DIC 2001(≥ 5), ISTH DIC 2018 (≥ 4), and SOFA score (>12) were highly associated with 28-day mortality. The ISTH DIC 2001 and SOFA score were superior on the modified ISTH 2018 in predicting 28-day mortality, with an Area Under the Curve (AUC) of (0.724 vs. 0.822 vs. 0.507, respectively). Yet, the accuracy of the SOFA score was better than the ISTH DIC 2001. CONCLUSION: This study suggests that ISTH DIC 2001 score is helpful when applied on medical and surgical ICU Jordanian populations. It showed better results compared to the Modified ISTH DIC 2018 in mortality prediction, regardless of the underlying diseases.

Patient Denial of Myocardial Infarction in the Prehospital Phase: Prevalence and Correlates.

BACKGROUND: Limited knowledge exists regarding patients' denial of myocardial infarction (MI) before hospitalization for an MI. OBJECTIVE: The aim of this study was to determine the prevalence and correlates of denial of MI in the prehospital phase of a confirmed MI. METHODS: This secondary analysis included 166 hospitalized patients (mean [SD] age, 54.1 [10.5] years) who developed MI outside a healthcare facility and had high congruence between their experienced and expected symptoms. Measurements included the Denial subscale of the Brief COPE Inventory, the modified Response to Symptoms Questionnaire, and a Likert scale measuring perceived risk for MI. Patients who arrived at a hospital at least 1 hour after the onset of their symptoms were considered to have prolonged prehospital delay. RESULTS: Despite their high symptom congruence, 77% of patients denied the possibility of having an MI before hospitalization. The lower denial group was characterized by cardiac history, whereas the higher denial group was distinguished by nonsmoking, a lower perceived risk of MI, less anxiety at symptom onset, and more concerns about seeking medical help. Compared with the lower denial group, patients in the higher denial group were more likely to underestimate the seriousness of their symptoms and delay seeking medical help. The higher denial group responded to symptoms in a more passive manner (eg, waiting), whereas the lower denial group showed a more problem-solving approach (eg, contacting emergency services). CONCLUSIONS: Denial of MI is highly prevalent in the prehospital phase and is negatively linked with cognitive, emotional, and behavioral responses to MI symptoms.

The relationship between diabetes-related knowledge and kidney disease knowledge, attitudes, and practices: a cross-sectional study.

BACKGROUND: Diabetes mellitus (DM) is one of the main noncommunicable diseases encountered in primary health care clinics. DM is considered one of the most common causes of chronic kidney disease (CKD). In this study, we aimed to assess the knowledge, attitudes, and practices (KAP) of patients with DM on the early detection and prevention of CKD, determine its relationship with other variables, and examine the relationship between KAP scores for the prevention and early detection of CKD and the Michigan Diabetic Knowledge Test. METHODS: We collected data from 2 Nablus primary healthcare centers using a questionnaire that contains three sections: sociodemographic section, questions related to DM, and CKD screening index, which is formed of three scales. We used the Michigan Diabetic Knowledge Test (MDKT) to assess the knowledge of diabetic patients. RESULTS: The study was carried out among 386 diabetic patients with a mean age of 57.62 ± 12.4 years (ranging from 28 to 90). The median (interquartile range) was 11 (8-14) for the knowledge scale, 56 (52-59) for the attitude scale, and 30 (26-33) for the practice scale. In the multiple linear regression, only patients under 55 years old (p = 0.012), with normal BMI (p = 0.030), high educational level (p < 0.001), high monthly income (p = 0.020), and MDKT test score (p = 0.007) were significantly associated with higher knowledge score. Furthermore, patients who were over or equal to 55 years old (p = 0.007), had a high monthly income (p = 0.016), used a single oral diabetic drug (p = 0.003), had a total number of medications less than 4 (p = 0.010), and had a high knowledge and MDKT test were significantly associated with a higher attitude score. Finally, a patient with normal BMI (p = 0.002), city residency (p = 0.034), high educational level (p = 0.003), less frequent tobacco use (p < 0.001), last HbA1c (p = 0.023) and greater knowledge, attitude, and MDKT score were significantly associated with better practices toward CKD prevention and early detection. CONCLUSION: Regarding KAP analysis, higher practice scores for the prevention and early detection of CKD were significantly associated with patients with normal BMI, being city residents, high educational level, less tobacco use, last HbA1c below 7, and higher knowledge, attitude, and MDKT score.

Neuroeconomics of decision-making during COVID-19 pandemic.

The coronavirus disease 2019 (COVID-19) pandemic reveals the decision-making challenges faced by communities, governments, and international organizations, globally. Policymakers are much concerned about protecting the population from the deadly virus while lacking reliable information on the virus and its spread mechanisms and the effectiveness of possible measures and their (direct and indirect) health and socioeconomic costs. This review aims to highlight the various balanced policy decision that would combine the best obtainable scientific evidence characteristically provided by expert opinions and modeling studies. This article's main goal is to summarize the main significant progress in the understanding of neuroeconomics of decision-making and discuss the anatomy of decision making in the light of COVID-19 pandemic.

Parent and child adjustment dual trajectories at the beginning of the COVID-19 syndemic.

Children and their families have been significantly impacted by the unfolding of the COVID-19 syndemic. We sought to identify (1) groups of families with distinct profiles of joint trajectories of parental anxiety and child emotional distress and (2) protective and risk factors associated with these dual-trajectory profiles. A sample of 488 parents (65% White; 77% mothers) with 3- to 8-year-old children (MAge  = 5.04, SDAge  = 1.59) was followed from late March to early July in 2020. Survey data on parent (i.e., anxiety symptoms) and child (i.e., emotional distress) adjustment were collected at three time points. Using multivariate growth mixture modeling, we identified one group with low parental anxiety and child emotional distress (42.7%) and three other distinct groups with varying risk levels among parents and/or children. We also identified protective (e.g., positive parenting) and risk (e.g., child negative affect, negative parenting, perceived stress with racism) factors in predicting parent and child adjustment. It can be concluded that, overall, our sample (mostly middle- and high-socioeconomic status families) demonstrated family resilience amid COVID-19, consistent with prior disaster coping literature. At the same time, our findings also indicated the need to identify at-risk families and modifiable factors for post-disaster public health interventions.

Comparison of two self-report scales to assess anxiety and depressive symptoms in hemodialysis patients.

INTRODUCTION: Psychiatric illness is prevalent among hemodialysis (HD) patients. This study compared the assessment of anxiety and depressive symptoms among HD patients using two self-administered scales; hospital anxiety and depression scale (HADS) and brief symptom inventory (BSI). METHODS: A cross-sectional study was conducted among a convenience sample of HD patients (n = 352) from different dialysis centers in Jordan. Patients were interviewed in dialysis units, and demographics, clinical status, disease, and dialysis history data were collected. Symptoms of anxiety (HADS-A ≥ 8 and BSI-A ≥ 0.82) and depression (HADS-D ≥ 8 and BSI-D ≥ 0.82) were also measured. RESULTS: The mean age of participants was 52.2 ± 15.6 years. The majority had been receiving HD three times daily and for >2 years. A significant moderate-strong correlation was observed between HADS-A and BSI-A (r = 0.753, p < 0.0001) as well as HADS-D and BSI-D (r = 0.588, p < 0.0001). Anxiety prevalence was 43.7 % using HADS-A ≥ 8 and 80.7 % using BSI-A ≥ 0.82, while depression prevalence was 53.1 % using HADS-D ≥ 8 and 51.7 % using BSI-D ≥ 0.82. When HADS was used as a standard, the operating characteristics reveal that a higher cut-off for BSI-A is recommended (≥1.58) for better anxiety screening. DISCUSSION: Specific and suitable cut-off points need to be further explored and validated for HADS and BSI scales among patients undergoing dialysis.

Using participatory culture-specific consultation to support the mental health needs of summer camp staff.

Nearly 30% of all U.S. youth attend summer camp each year, making it one of the broadest reaching out-of-school-time interventions in the country. Camp provides a space for seasonal employees, who are often emerging adults, to explore work values and identity, engage in mentoring and support opportunities, and stay connected to a community larger than themselves. However, research on camp experiences also suggests camp settings and expectations around emotional and physical care can cause counselors to experience burnout, compassion fatigue, and reduced job satisfaction. Using participatory culture-specific consultation, the current study addressed a gap in the literature about systemic interventions to manage camp counselor mental health by designing, implementing, and evaluating a mental health consultation model at one of the largest YMCA summer camps in the country. Results suggest the intervention effectively addressed certain administrator and staff needs; results also suggest the model could be refined to more effectively respond to the particular contextual challenges of summer camps. Implications and recommendations for other summer camps are discussed.

The impact of somatic and cognitive depressive symptoms on medical prognosis in patients with end-stage renal disease.

PURPOSE: To determine whether somatic or cognitive depressive symptoms affect hospitalization and death in patients with end-stage renal disease. DESIGN AND METHOD: In an observational retrospective design, the patients (n = 190) completed the Beck Depression Inventory-II at baseline and were followed for 5 years to collect data all-cause mortality and hospitalization. FINDINGS: High somatic (53.7%, n = 102) and cognitive (52.1%, n = 99) depressive symptoms scores significantly associated with mortality (38% vs. 19%; hazard ratio [HR] = 2; 95% CI, 1.1-3.7; p = 0.02) and hospitalization (62.5% vs. 49.4%; HR = 1.6; 95% CI, 1.0-2.6; p = 0.03), respectively. PRACTICE IMPLICATIONS: In the context of diagnosing and intervening, awareness of depressive symptoms dimensionality is crucial.

Influence of active versus passive parental presence on the behavior of preschoolers with different intelligence levels in the dental operatory: a randomized controlled clinical trial.

BACKGROUND: Dental fear and anxiety still pose the most common factors proposed for the child's negative behavior in the dental operatory. Intelligence has an impact on the children's communication, feelings, and responsiveness to dental situations. The benefits of parental presence on reinforcing the child's behavior during dental treatment are still debatable. This study aimed to assess the effect of parental active versus parental passive presence techniques on the overall behavior of preschool children with different intelligence levels. METHODS: This randomized controlled trial was conducted from December 2017 to August 2019. It recruited 150 healthy children, 3-6-year-old, with no history of previous dental pain/treatment, and intelligence quotient level of 70- ≤ 110 stratified into 3 equal groups (high, average, low). In the first visit, each IQ group was randomly divided into test (PAP) and control (PPP) groups. In the second visit, dental fear was assessed before preventive intervention, the test groups were then managed using parental active presence technique, while the control groups were managed using parental passive presence technique. The overall behavior was assessed at the end of the visit. Data was analyzed using Chi-square test and logistic regression analysis. RESULTS: The parental active presence technique had significant effect on children with high and low intelligence quotients. There were significantly higher odds of positive behavior in high than low intelligence quotient children, (OR 4.08, 95% CI 1.43, 11.67, P = 0.01). The parental active presence technique had significantly higher odds of positive behavior than the parental passive presence technique, (OR 4.08, 95% CI 1.71, 9.76, P = 0.002). CONCLUSIONS: The parental active presence technique had positively influenced the children's overall behavior irrespective of their intelligence levels. This trial was retrospectively registered, trial identifier number: NCT04580316, 8/11/2020.

Disseminated Intravascular Coagulopathy in Critically Ill Patients in Amman, Jordan.

BACKGROUND: The disseminated intravascular coagulation (DIC) is under-recognized in critically ill patients. The International Society of Thrombosis and Haemostasis (ISTH; DIC) provides a useful scoring system for accurate DIC identification. The study investigated the period prevalence of ISTH DIC from 2015 to 2017 in critically ill patients. METHODS: In this multi-center, retrospective observational study, we included all patients identified with a DIC code or medically diagnosed with DIC during all admissions. Based on ISTH DIC scores ≥ 5, patients were classified with overt DIC. RESULTS: A total of 220 patients were included in this study. The period prevalence of DIC was 4.45%. The point prevalence of DIC has increased from 3.49% to 5.58% from 2015 to 2017 (27.7% female; median age 61.6 years). Based on the ISTH-Overt DIC criteria, 45.2% of the sample had sepsis. Overt DIC patients had significantly lower baseline hemoglobin (HB; t = 2.137, df = 193, p = 0.034), platelet count (t = 3.591, df = 193, p < 0.001) and elevated serum creatinine level (M = 2.1, SD = 1.5, t = 2.203, df = 193, p = 0.029) compared to non-Overt DIC. There was a statistically significant elevation in FDPs among Overt DIC compared to non-Overt DIC (χ2 = 30.381, df = 1, p < 0.001). Overt DIC patients had significantly prolonged PT (U = 2,298, z = 5.7, p < 0.001), PTT (U = 2,334, z = 2.0, p = 0.045) and INR (U = 2,541, z = 5.1, p < 0.001) compared to those with non-Overt DIC. CONCLUSION: The ISTH overt-DIC score can be used in critically ill patients regardless of the underlying disease. Efforts are required to predict and identify overt DIC using a valid scoring system on admission and follow-up of adult patients admitted to ICU.

Functional health literacy and caregiving burden among family caregivers of patients with end-stage renal disease.

Family caregivers of patients with end-stage renal disease (ESRD) experience significant caregiver-related burden, yet the contribution of their functional health literacy (FHL) to caregiving burden has not been elucidated. We investigated the magnitude of FHL and caregiving burden and their association in a descriptive, correlational cross-sectional study of family caregivers of Jordanian patients with ESRD (N = 88). The short versions of the FHL for Adults and the Zarit Burden Interview were used for assessment of caregivers. Demographic and clinical information of patients and their family caregivers were self-reported. Of family caregivers, 41% had limited FHL and 38% experienced high caregiver burden. FHL and history of comorbidity in family caregivers predicted caregiving burden independent of demographic and clinical factors. Consideration of FHL in support interventions for family caregivers may minimize some of the high perceived caregiving burden, but clinical trials of such interventions are needed to confirm this conclusion.

Validation of the modified NUTRIC score on critically ill Jordanian patients: A retrospective study.

BACKGROUND: Nutritional status has been proven to be associated with poor outcomes in mechanically ventilated patients in intensive care units (ICU). Nutritional assessment has been assessed using different tools. Few data are available on the validity of the modified Nutrition Risk Assessment Tool for Critically Ill (mNUTRIC) score in ICU patients receiving mechanical ventilation (MV). AIM: This study aimed to assess prognostic performance of the mNUTRIC score for discriminative abilities for 30-day mortality and prolonged MV. METHODS: This was a multi-centre retrospective study that included 737 mechanically ventilated patients using secondary data analysis. Data were collected on variables required to calculate mNUTRIC score. Patients with a mNUTRIC score ≥5 were considered at nutritional risk. Predictive performance of the mNUTRIC was assessed for discriminative abilities for Acute Physiology and Chronic Health Evaluation II at baseline, mortality in 42 days of follow-up and outcomes related to MV. RESULTS: A total of 737 patients on MV met the inclusion criteria. The majority (57.1%) of patients were male. The mean age of the participants was 62.1±18 years. Of all patients, 482 (58%) were at high nutritional risk (mNUTRIC score ≥5). Median ventilator days were 3 (±7.2) days and 72 (±174) hours. The overall mortality rate was 78.8% (n=652), and weaning failure was 79.8% (n=660). CONCLUSIONS: This study showed new evidence on the validity of the mNUTRIC as a tool for assessing nutritional risk in an ICU population in Jordan. The mNUTRIC score obtained from the current retrospective data suggests that the use of the tool can truly identify and diagnose critically ill patients with malnutrition.

Pre-existing chronic kidney disease and acute kidney injury among critically ill patients.

BACKGROUND: The impact of pre-existing chronic kidney disease (CKD) and acute kidney injury (AKI) on health outcomes in critically ill patients is unclear. Yet, CKD complicated by AKI in critically ill patients is common. OBJECTIVES: To compare risk of death within one-month of admission in critically ill patients with and without pre-existing CKD who developed AKI. METHODS: A multicenter retrospective comparative study using medical records review was conducted. Study participants consisted of 826 adult patients who received mechanical ventilation for at least 6 h in the critical care units from January 2012 to December 2017. Assessment of kidney function was established by serum creatinine. Severity and staging of AKI were defined using RIFLE criteria: Risk, Injury, Failure, Loss and End stage of renal disease. Chronic kidney disease was defined as eGFR > 60 ml/mg/1.73 m2 on admission. RESULTS: Pre-existing CKD was present in 55% of patients and 7% had AKI within 7 days of admission. The overall mortality rate among these patients was 87.3%. The mortality rate was highest in patients with CKD (70.1%) followed by that of patients without pre-existing CKD but with AKI (20.7%) and that of patients with pre-existing CKD (7.1%) and AKI. Risks associated with mortality were APACHE II score (1.03; 95% CI 1.02-1.05;(P<0.001) and AKI (1.68; 95% CI 1.12-2.5;P<0.01) in patients with pre-existing CKD. Only APACHI-II (1.03; 95% CI 1.0-1.1; p < 0.001) was predictive of death in patients without pre-existing CKD. CONCLUSION: Pre-existing comorbid CKD increases risks of death among critically ill patients compared to patients without CKD and regardless of whether they develop AKI or not. Early identification of CKD and recognition of the risk for mortality among these patients may result in earlier intervention that could reduce mortality.

Pain assessment during mandibular nerve block injection with the aid of dental vibe tool in pediatric dental patients: a randomized clinical trial.

OBJECTIVE: This study aimed to evaluate the effectiveness of DentalVibe in pain reduction during local anesthetic injection compared to traditional injection in pediatric patients. METHOD AND MATERIALS: This cross-over randomized controlled clinical trial included a sample of 60 children, aged 5 to 7 years, who were selected based on the need for local anesthesia for bilateral mandibular pulpotomy treatment. They were randomly allocated into two groups. Each group received two mandibular nerve block injections, with a 2-week interval as the washing out period. At first appointment, mandibular nerve block injection was performed either with vibration using DentalVibe at the injection site or benzocaine gel 20% applied before local anesthetic injection; the alternative technique was used at the second appointment. In each visit subjective pain was evaluated using the Wong-Baker FACES Pain Rating Scale and objective pain was evaluated using the FLACC (Face, Legs, Activity, Cry, Consolability) scale. RESULTS: Assessment using the Wong-Baker FACES Pain Rating Scale showed that the mean pain levels in DentalVibe and traditional injection groups were 0.80 ± 1.34 and 2.60 ± 3.22, respectively. The mean pain levels according to the FLACC scale were 2.20 ± 2.04 and 3.13 ± 2.30 in the DentalVibe and traditional injection groups, respectively. Both scales showed statistically significant differences between the two groups in favor of DentalVibe (P < .001). A positive significant correlation between the two scales in the two interventions was recorded, where the Spearman rho was 0.41 for the DentalVibe group, and 0.52 for traditional injection group (P < .001). CONCLUSION: Compared to the traditional approach, DentalVibe reduced pain sensation during mandibular nerve block injection in pediatric patients.

Exposure to Electronic Screens and Children's Anxiety and Behavior During Dental Treatment.

Purpose:The purposes of this study were to (1) assess the relationship between exposure time to electronic screens and children's anxiety and behavior manage ment problems during dental treatment; and (2) evaluate the effect of the underlying confounding factors.
Methods:A cross-sectional study of 95 five- to eight-year-old patients was conducted. The study consisted of two sessions, one week apart. During the first visit, the socioeconomic status of the family was assessed, and examination and preventive measures were performed. One of the parents was asked to report screen time use by the child over a one week period using a valid questionnaire. In the second visit, dental anxiety and behavior management problems were assessed using the Clinical Anxiety Rating Scale and Frankl Behavior Scale, respectively.
Results: Anxiety and behavior management problems during a dental visit were significantly correlated with the participant's total exposure hours to electronic screens. Exposure to violent media was significantly different between participants with and without behavior management problems. Boys showed a significant higher exposure to violent media than girls.
Conclusion: Anxiety and behavior problems in a dental visit correlate to total hours of exposure to electronic screens. Therefore, limiting a child's screen exposure should be considered. (J Dent Child 2019;86(3):139-44).

Investigating the Contribution of NPSR1, IL-6 and BDNF Polymorphisms to Depressive and Anxiety Symptoms in Hemodialysis Patients.

AIMS: Psychological symptoms are prevalent in hemodialysis (HD) patients. Previous investigations showed that brain-derived neurotrophic factor (BDNF) and interleukin-6 (IL-6) as well as the interaction with neuropeptide S receptor 1 (NPSR1) are linked to the development of psychological distress. This study examined the association of polymorphisms of genes encoding these proteins with depression and anxiety in a representative group of Jordanian HD patients. METHODS: A total of 302 HD patients were involved in the study and categorized into three groups based on the Hospital Anxiety and Depression Scale, HADS-D or HADS-A scores as follows: normal (<7), mild (8-10) and moderate-severe (11-21). Single nucleotide polymorphism (SNP) of NPSR1 Asn107Ile (rs324981), IL-6 G174C (rs1800795), and BDNF Val66Met (rs6265) was genotyped using blood samples. RESULTS: The frequency of Ile-allele of NPSR1 Asn107Ile was significantly higher in patients with moderate-severe HADS-A scores versus normal (53% vs. 40.8%, p = .035). Using ordinal regression analysis, Asn-allele of NPSR1 polymorphism was nominally significantly associated with a lower risk of anxiety (OR = 0.57, CI: 0.33-0.97, p = .038) after adjusting for other covariates. A marginally significant difference in genotype distribution of IL-6 G174C was observed among patients according to HADS-D scores (p = .05). Furthermore, carriers of IL-6174 CC genotype showed lower median IL-6 serum concentration versus carriers of GG genotype (5.2 vs. 1.35 pg/mL, p < .05). CONCLUSIONS: The results support the genetic role of NPSR1 in the pathogenesis of anxiety and suggest that carriers of NPSR1 Ile-allele are at increased risk of anxiety in HD patients. Neither BDNF Val66Met nor IL-6 G174C were linked to psychological symptoms. Future studies among other ethnicities are necessary to verify the observations.

Incidence, Risk Factors and Prognosis of Acute Kidney Injury Following Hematopoietic Stem Cell Transplant: A Pilot Study.

BACKGROUND AND OBJECTIVES: The burden of acute kidney injury (AKI) has not been explored in Jordanian patients who receive hematopoietic stem cell transplant (HSCT). The aim of this study was to evaluate the frequency, risk factors, and mortality of AKI among patients who underwent HSCT. METHODS: A retrospective pilot study included 70 adult patients who received peripheral HSCT was conducted. Weekly measurement of serum creatinine (SCr) was obtained for 3 months after chemotherapy and HSCT. Then, stages of Risk, Injury, and Failure of Kidney were determined based on the Kidney Disease for Improving Global Outcomes (KDIGO). RESULTS: The median follow-up was 41 months. Mortality was reported in 16 patients (23%). Out of 60 patients that had SCr values, 19 patients (31.6%) had AKI in 90 days after chemotherapy. Allogeneic HSCT, male donors, high-dose melphalan protocols and values of blood urea nitrogen (BUN) were significantly higher among patients with AKI. CONCLUSIONS: Combining many nephrotoxic drugs and dosing adjustments should be considered in uniform protocols. Multidisciplinary care should be utilized to assess early kidney dysfunction that decreases adverse events and improves outcomes.

Association of brain-derived neurotrophic factor and interleukin-6 serum levels with depressive and anxiety symptoms in hemodialysis patients.

OBJECTIVE: This study assessed the possible association of serum brain-derived neurotrophic factor (BDNF) and interleukin-6 (IL-6) with depressive and anxiety symptoms in hemodialysis (HD) patients. METHOD: An analytical cross-sectional study was conducted over 274 HD patients from March to October 2017. The Hospital Anxiety and Depression Scale (HADS) was utilized to evaluate depressive (HADS-D) and anxiety (HADS-A) symptoms. The HADS-D/A is a self-report instrument that has a maximum score of 21. Serum BDNF and IL-6 were measured using enzyme-linked immunosorbant assay (ELISA). RESULTS: Serum IL-6 was significantly higher in patients with depressive symptoms compared to normal (20.47 ±â€¯4.27 pg/mL for HADS-D ≥11 versus 9.26 ±â€¯1.59 pg/mL for HADS-D <7, p = 0.014). Multivariable regression analysis revealed that IL-6, education level, hypertension, and dialysis duration were significant predictors of HADS-D. Also, gender, education level, hypertension, and the number of dialysis sessions/week were significant predictors of HADS-A. Significant positive correlation was shown between HADS-D and IL-6 (r = 0.1729, p = 0.004). CONCLUSION: Collectively, HD patients with depressive symptoms showed higher levels of IL-6, supporting previous findings that the circulating inflammatory mediator IL-6 can be used as a biomarker for prediction of depressive symptoms in HD patients. Further longitudinal or interventional studies are needed to further validate this association.