Low plasma vitamin D is associated with increased 28-day mortality and worse clinical outcomes in critically ill patients.

BACKGROUND & OBJECTIVE: Patients in the intensive care unit have a high prevalence of vitamin D deficiency (VDD). In the present study, clinical outcomes in the ICU were analyzed with vitamin D status. MATERIALS AND METHODS: In this prospective, multicenter study, sampling was conducted on seven ICUs in three hospitals. Within the first 24 h of ICU admission, patient's serum vitamin D levels were measured, and their disease severity was monitored using the scores of acute physiologic assessment and chronic health evaluation II (APACHE II), sequential organ failure assessment (SOFA), and the modified Nutrition Risk in Critically ill (mNUTRIC) score. RESULTS: A total of 236 patients were enrolled in this study, of which 163 (69.1%) had lower vitamin D levels than 20 ng/ml upon ICU admission. The patients with VDD had higher APACHE II scores)P = 0.02), SOFA scores (P < 0.001), and mNUTRIC scores (P = 0.01). Patients with sufficient levels of vitamin D (> 30 ng/ml) had a shorter stay at ICU (P < 0.001). VDD was independently associated with 28-day mortality (OR: 4.83; 95% CI: 1.63-14.27; P = 0.004). CONCLUSION: The data showed that VDD was common among the critically ill and was related to a more severe course of illness and a higher mortality rate.

XCL1, a serum biomarker in neurological diseases; HTLV-1-associated myelopathy and multiple sclerosis.

The XCL1-XCR1 axis has a potential role in the recruitment of immune cells to the site of inflammation. The present study aimed to examine the relation of XCL1 serum levels with Multiple sclerosis (MS) and HTLV-1-associated myelopathy (HAM), as chronic inflammatory diseases of the central nervous system (CNS). DNA was extracted to evaluate HTLV-1 proviral load (PVL) using real-time PCR. Serum levels of XCL1 was determined by using an ELISA assay. The serum level of XCL1 was significantly higher in patients with HAM than that of asymptomatic carriers (ACs) and healthy controls (HCs) (p < 0.001 and p < 0.0001, respectively) and was also higher in MS patients compared to HCs (p < 0.0001). Moreover, the concentration of XCL1 serum level was significantly different between the ACs and HCs group (p < 0.0001). In conclusion, increased expression of XCL1 might contribute to the migration of autoreactive T cells to the central nervous system and play a critical role in the development and pathogenesis of inflammatory neurological diseases including HAM and MS.

3D Printed Models for Teaching Orbital Anatomy, Anomalies and Fractures.

PURPOSE: The aim of this study was to determine the efficacy of using 3D printing models in the learning process of orbital anatomy and pathology by ophthalmology residents. METHODS: A quasi-experimental study was performed with 24 residents of ophthalmology at Mashhad University of Medical Sciences. Each stratum was randomized into two groups. The educational booklets were distributed, and various forms of orbital 3D models were printed from orbital computed tomography (CT) scans. Knowledge enhancement on the topics was measured by comparing pretest and posttest scores. RESULTS: Thirteen residents who were trained using traditional methods were deemed the control group; while 11 residents who were trained using the 3D printed models were classed as the intervention group. The control group was younger than the intervention group (P = 0.047). The results showed that there was a statistically significant difference in the total posttest scores between the two groups. Based on the repeated measures of the analysis of variance (ANOVA), score variables were significant between the two groups (P = 0.008). Interestingly, the use of the 3D educational model was more effective and statistically significant with the year one residents as compared to the year two residents (P = 0.002). CONCLUSION: This study is the first one in Iran quantifying the effects of learning using 3D printed models in medical education. In fact, 3D modeling training is seemingly effective in teaching ophthalmic residents. As residents have never encountered such technology before, their experience using 3D models proved to be satisfactory and had a surprising positive effect on the learning process through visual training.

Nutritional status in kidney transplant patients before and 6-month after transplantation: Result of PNSI study.

OBJECTIVES: Kidney transplantation is an essential treatment in management of kidney failure patients. The present study evaluated and compared the nutritional status of renal transplant patients before and 6 months after kidney transplantation and in comparison with healthy individuals. METHODS: A multi-center, case-control study was conducted among 40 kidney transplant recipients and 40 healthy adults. Biochemical tests, anthropometric indices, and dietary intake were collected at baseline and 6 months post-transplant and compared with healthy controls. RESULTS: Anthropometric indices of the participants increased in post-transplant period compared to baseline (p < 0.05). The calories, fat, carbohydrates, and selenium intakes also increased in patients compared to before transplantation and healthy controls. The mean score of malnutrition index in patients, before transplantation were: good nutrition status (A) = 42.5%, mild to moderate malnutrition (B) = 52.5%, and severe malnutrition (C) = 5%, that changed to A = 75%, B = 20%, and C = 5% six months after surgery. The mean score of malnutrition index in pre-transplant patients were: A = 42.5%, B = 52.5% and, C = 5%, which changed to A = 75%, B = 20% and C = 5% after 6 months. Experimental results showed that mean plasma levels of albumin, total protein, calcium increased as well as mean plasma levels of magnesium and phosphorus decreased over six months (p < 0.001). CONCLUSION: Kidney transplantation led to improvement in clinical and nutritional status of patients with renal failure. Improving dietary intakes as part of the medical care process can help improve their medical conditions.

Endogenous Endophthalmitis after Severe Burn: A Case Report.

PURPOSE: This report describes a rare ocular complication in a burned patient. CASE REPORT: A 12-year-old girl was admitted to our burn center because of full thickness burn of 46% of her total body surface area. On the 23rd day of her stay, she complained of pain and decreased visual acuity in the right eye. Examination of this eye revealed panuveitis, dense vitritis, and a large chorioretinal abscess in the macular area; her best corrected visual acuity (BCVA) in this eye was hand motion. The left eye was completely normal. A smear and culture of the vitreous biopsy revealed the presence of Candida albicans. With a diagnosis of endogenous endophthalmitis due to fungal infection, the patient was treated with systemic fluconazole, intravitreal injection of Amphotericin B, and pars plana deep vitrectomy. After 6 months, the patient's final ocular examination revealed BCVA of counting fingers at two meters, a large macular scar, and quiescence of the intraocular infection. CONCLUSION: Burn patients treated with broad-spectrum antibiotics are at risk of candidemia and its complications, including endogenous endophthalmitis. Early diagnosis of endogenous endophthalmitis in high risk patients could prevent visual loss.

Work-related respiratory symptoms and pulmonary function tests in northeast iranian (the city of Mashhad) carpenters.

OBJECTIVE: To assess the respiratory symptoms and pulmonary function of carpenters from the city of Mashhad (northeast Iran). METHODS: The frequency of respiratory symptoms was retrospectively estimated in a sample of 66 carpenters in the city of Mashhad in northeast Iran using a questionnaire including questions on work-related respiratory symptoms in the past year, allergy, type of irritant chemicals that induce respiratory symptoms, smoking habits, and working periods as a carpenter. PFT values were also measured in all participants, and the age and smoking habits matched those of a sample of men from the general population as a control group. RESULTS: Thirty-five carpenters (53%) reported work-related respiratory symptoms. Cough (34.4%) and sputum (33.3%) were the most common symptoms, and only 15.15% of carpenters reported wheezing during work. All respiratory symptoms were higher in carpenters than in controls, which was statistically significant for cough and sputum (p<0.001 in both cases). Most allergic symptoms were also significantly greater among the carpenters than in the control group (p<0.05 for both itchy eyes and sneezing). Most respiratory and allergic symptoms in the carpenters increased during work compared to rest period which was statistically significant only for cough (p<0.05). PFT values were significantly lower in the carpenters than in control subjects (p<0.05 to p<0.001). CONCLUSIONS: Carpentry work was associated with a high frequency of respiratory symptoms, particularly after exposure to irritating chemicals during work. PFT values were also significantly reduced among carpenters compared to controls.

Work-related respiratory symptoms and pulmonary function tests in northeast iranian (the city of Mashhad) carpenters

OBJECTIVE: To assess the respiratory symptoms and pulmonary function of carpenters from the city of Mashhad (northeast Iran). METHODS: The frequency of respiratory symptoms was retrospectively estimated in a sample of 66 carpenters in the city of Mashhad in northeast Iran using a questionnaire including questions on work-related respiratory symptoms in the past year, allergy, type of irritant chemicals that induce respiratory symptoms, smoking habits, and working periods as a carpenter. PFT values were also measured in all participants, and the age and smoking habits matched those of a sample of men from the general population as a control group. RESULTS: Thirty-five carpenters (53 percent) reported work-related respiratory symptoms. Cough (34.4 percent) and sputum (33.3 percent) were the most common symptoms, and only 15.15 percent of carpenters reported wheezing during work. All respiratory symptoms were higher in carpenters than in controls, which was statistically significant for cough and sputum (p<0.001 in both cases). Most allergic symptoms were also significantly greater among the carpenters than in the control group (p<0.05 for both itchy eyes and sneezing). Most respiratory and allergic symptoms in the carpenters increased during work compared to rest period which was statistically significant only for cough (p<0.05). PFT values were significantly lower in the carpenters than in control subjects (p<0.05 to p<0.001). CONCLUSIONS: Carpentry work was associated with a high frequency of respiratory symptoms, particularly after exposure to irritating chemicals during work. PFT values were also significantly reduced among carpenters compared to controls.