[Comparison of planimetric CT­based volumetry with simplified models for determining the size of intrapelvic hematomas due to pelvic fractures in emergency room diagnostics]. / Vergleich von planimetrisch CT­gestützter Volumetrie mit vereinfachten Modellen zur Größenbestimmung intrapelviner Hämatome bei Beckenfrakturen im Rahmen der Schockraumdiagnostik.

BACKGROUND: Bleeding in the pelvis can lead to a circulatory problem. The widely used whole-body computed tomography (WBCT) scan in the context of treatment in the trauma resuscitation unit (TRU) can give an idea of the source of bleeding (arterial vs. venous/osseous); however, the volume determination of an intrapelvic hematoma by volumetric planimetry cannot be used for a quick estimation of the blood loss. Simplified measurement techniques using geometric models should be used to estimate the extent of bleeding complications. OBJECTIVE: To determine whether simplified geometric models can be used to quickly and reliably determine intrapelvic hematoma volume in fractures type Tile B/C during emergency room diagnostics or whether the time-consuming planimetric method must always be used. MATERIAL AND METHODS: Retrospectively, 42 intrapelvic hemorrhages after pelvic fractures Tile B + C (n = 8:B, 34:C) at two trauma centers in Germany were selected (66% men, 33% women; mean age 42 ± 20 years) and the CT scans obtained during the initial trauma scan were analyzed in more detail. The CT datasets of the included patients with 1-5 mm slice thickness were available for analysis. By area labelling (ROIs) of the hemorrhage areas in the individual slice images, the volume was calculated by CT volumetrically. Comparatively, volumes were calculated using simplified geometric figures (cuboid, ellipsoid, Kothari). A correction factor was determined by calculating the deviation of the volumes of the geometric models from the planimetrically determined hematoma size. RESULTS AND DISCUSSION: The median planimetric bleeding volume in the total collective was 1710 ml (10-7152 ml). Relevant pelvic bleeding with a total volume > 100 ml existed in 25 patients. In 42.86% the volume was overestimated in the cuboid model and in 13 cases (30.95%) there was a significant underestimation to the planimetrically measured volume. Thus, we excluded this volume model. In the models ellipsoid and measuring method according to Kothari, an approximation to the planimetrically determined volume could be achieved with a correction factor calculated via a multiple linear regression analysis. The time-saving and approximate quantification of the hematoma volume using a modified ellipsoidal calculation according to Kothari makes it possible to assess the extent of bleeding in the pelvis after trauma if there are signs of a C-problem. This measurement method, as a simple reproducible metric, could be embedded in trauma resuscitation units (TRU) in the future.

A decade genetic diversity in Circulating influenza B virus in Iran (2010-2019): Divergence from WHO-recommended vaccine strains.

BACKGROUND: Data on the disease burden and circulation patterns of influenza B virus lineages for Iran are limited. OBJECTIVE: This review aims to describe the pattern of influenza B occurrence in Iran, comparing it with the proposed vaccine strains and determining the match and mismatch with the prescribed vaccine annually. METHODS: Various sources were used to retrieve information of the data; such as information from an online search of databases such as FluNet, GISAID, and NCBI. After extracting protein sequence records in GISAID, sequence alignment with vaccine strain and construction of a phylogenetic tree were performed. Subsequently, categories of the registered circulating strains were evaluated for matching with the vaccine strains. RESULTS: Of the total registered influenza-positive samples, 20.21% were related to influenza B virus. The phylogenic tree was designed based on 43 samples registered in the GISAID database; 76.74 and 23.25% sequences were of Yamagata and Victoria lineages, respectively. The most prevalent influenza B virus strains circulating during the study years belonged to the Yamagata lineage. In general, the match of the influenza B virus predominant circulating strains with administrated vaccines was observed in Iran. However, a high level of mismatch between the vaccine strain and Iranian isolates was identified in 2016‒2017. CONCLUSION: The review of match and mismatch in influenza vaccine in order to improve the composition of the prescribed vaccine in each region is very important because the vaccine efficacy decreased when the strain included in vaccine did not match the circulating epidemic strain.

Effects of dietary olive leaves on performance, carcass traits, meat stability and antioxidant status of fattening Mahabadi male kids.

Twenty-four Mahabadi goat kids (5-6 months of age) were used to evaluate the effects of feeding olive leaves (OL) on performance, carcass traits and antioxidant status. The kids received three dietary treatments for 84 d with three levels of OL: 0 (control), 7.5 (OL7.5) and 15 (OL15) % (DM basis). Supplementation with OL had no effects on kid performance (P > 0.05). Total antioxidant capacity (TAC) was increased and malondialdehyde (MDA) concentration was decreased in plasma blood (P < 0.01) and Longissimus lumborum (LL) muscle (days 1, 4, 7 and 10) of kids (P < 0.01) with increasing level of OL in diet. The activity of glutathione peroxidase (GSH-Px) in LL muscle was increased (P < 0.05) in OL15 fed kids compared with control group. Also, glucose content of serum was decreased by adding OL to kid diets (P < 0.01). Finally, inclusion of OL to kid diets resulted in similar growth performance compared to alfalfa feeding, and improved the antioxidative potential of LL muscle.

The effect of grapeseed oil on performance, rumen fermentation, antioxidant status and subcutaneous adipose fatty acid profile in lambs.

This experiment was carried out to examine the effect of grapeseed oil (GSO) on performance, rumen fermentation, antioxidant status and subcutaneous adipose fatty acid (FA) profile in lambs. Eighteen Baluchi lambs, 196 ± 14 days of age and 39.8 ± 1.7 kg body weight, were randomly assigned to three experimental diets: (i) diet without GSO (control), (ii) diet containing 2% of GSO (GSO2) and (iii) diet containing 4% of GSO (GSO4) for 42 days. Results showed that the experimental diets had no significant effect on dry matter intake and performance (p > 0.05). The supplemented diets with GSO had no effect on pH and NH3 -N of rumen fluid (p > 0.05), but GSO4 increased (p = 0.003) the concentration of propionic acid and reduced (p = 0.002) the concentration of acetate acid compared to the control. Inclusion 4% of GSO to the diet increased total antioxidant activity and decreased malondialdehyde in serum and muscle (p < 0.001). The level of blood glutathione peroxidase in diets containing GSO was higher than control diet (p = 0.02), but diets had no effect on superoxide dismutase in blood and muscle tissues (p > 0.05). The concentration of vaccenic acid, rumenic acid and linoleic acid and thus polyunsaturated fatty acid in subcutaneous fat was affected by experimental diets (p < 0.001), as control had the lowest amount of these FAs and GSO4 had the highest amount of them. Therefore, it can be concluded that the use of GSO up to 4% improves the antioxidant status and adipose fatty acid profile in lambs without effects on performance.

Prediction of Response to Irinotecan and Drug Toxicity Based on Pharmacogenomics Test: A Prospective Case Study in Advanced Colorectal Cancer

Background: FOLFIRI regimen, which is composed of 5-FU, Leucovorin, and Irinotecan, is used in the first-line chemotherapy of metastatic colorectal cancer. Irinotecan life threatening toxicity is partly related to cytotoxic drug metabolite which is primarily inactivated by the UGT1A1 enzyme. The primary aim of the present research was to find the correlation between UGT1A1-genotype and clinical toxicity of irinotecan. Methods: In a prospective study from March 2011 to December 2013, all patients with metastatic colorectal cancer who had been referred to Medical Oncology Department of Iran Cancer Institute were genotyped for UGT1A1*28 before the first cycle of chemotherapy. All of the patients signed informed consent and trial approved by Ethics Committee of the Tehran University of Medical Sciences. Reduction of the standard dose of Irinotecan (180 mg/m2 body surface area) was measured based on NCI toxicity criteria after the first cycle of chemotherapy. Patients with previous treatment with Oxaliplatin and fluorouracil (5-FU) in the adjuvant setting and adequate liver, kidney, and heart function were included in the trial. Both synchronous and metachronous metastatic disease were noticeable. Results: A total of 50 patients with median age of 52 years were included. Most (70%) of the patients had more than one site of metastases in peritoneum, liver, and/or lung. Thirty-one patients had UGT1A1*1 normal genotype, 13 were in heterozygote and 6 were in homozygote state ofUGT1A1*28/*28. A clinically relevant increase in early toxicity was found in patients carrying the UGT1A1*28/*28 genotype with odds Ratio (OR) of 2.6 (95%CI 2.5-27.28). Similarly, there was a trend of lower overall survival in homozygote group with an HR (Hazardous Ratio) of 2.76 (95%CI .88-.61). No statistically significant relationship was found between UGT1A1genotypes and response to therapy. Conclusions: UGT1A1 28*/28* is strongly associated with drug's life-threatening toxicity even in a moderate dose of Irinotecan. On the other hand, UGT1A1 genotype data was not helpful to differentiate response to treatment.

Creating academic structures to promote nursing's role in global health policy.

AIM: We highlight key components of emerging academic structures in global health nursing and explain how this investment can expand nursing's broader engagement in global health policy development. BACKGROUND: Engaging nursing in global health policy development is vital to ensure the scale-up of effective health programmes. Globally, nurses promote development of interprofessional healthcare teams who are responsible for translating sound global health policy and evidence-based programming into practice. However, the role of nurses within policy forums and on influential decision-making bodies within the global health space remains limited, which reinforces suboptimal global health policy implementation. INTRODUCTION: Investment in globally engaged academic structures is an important way to expand participation of nursing in global health policy development. SOURCES OF EVIDENCE: A review of the current knowledge and substantive findings related to academic structures promoting global health nursing was conducted, and included a directed search of institutional websites, related grey and peer-reviewed literature, and communication with top-tier schools of nursing in the United States, to identify specific developments in global health nursing academic structures. DISCUSSION/CONCLUSION: Effective academic structures promoting global health nursing include a framework of four critical components - Research, Education, Policy and Partnership. Academic structure type and core activities vary depending on institutional priorities. IMPLICATIONS FOR NURSING, HEALTH AND SOCIAL POLICY: Increasingly, global health research, driven by individual nursing investigators, is expanding; however, in order to translate these advances into expanded involvement in global health policy development, academic structures within schools of nursing need to systematically expand educational opportunities, bolster research capacity and promote partnership with policymakers.

Modeling Glucagon Action in Patients With Type 1 Diabetes.

The dual-hormone artificial pancreas is an emerging technology to treat type 1 diabetes (T1D). It consists of a glucose sensor, infusion pumps, and a dosing algorithm that directs hormonal delivery. Preclinical optimization of dosing algorithms using computer simulations has the potential to accelerate the pace of development for this technology. However, current simulation environments consider glucose regulation models that either do not include glucagon action submodels or include submodels that were proposed without comparison to other candidate models. We consider here nine candidate models of glucagon action featuring a number of possible characteristics: insulin-independent glucagon action, insulin/glucagon ratio effect on hepatic glucose production, insulin-dependent suppression of glucagon action, and the effect of rate of change of glucagon. To assess the models, we use measurements of plasma insulin, plasma glucagon, and endogenous glucose production collected from experiments involving eight subjects with T1D who receive four subcutaneous glucagon boluses. We estimate each model's parameters using a Bayesian approach, and the models are contrasted based on the deviance information criterion. The model achieving the best fit features insulin-dependent suppression of glucagon action and incorporates effects of both glucagon levels and its rate of change.

Effects of dietary pomegranate seed pulp on oxidative stability of kid meat.

This study was conducted to evaluate the effects of dietary pomegranate seed pulp (PSP) on meat color and lipid stability of kids. Thirty-two Mahabadi male kids were randomly assigned to one of four diets with different levels of PSP: 1 - diet without PSP (Control), 2 - diet containing 5% PSP (PSP5), 3 - diet containing 10% PSP (PSP10), and 4 - diet containing 15% PSP (PSP15). The kids were slaughtered at the end of the study and m. longissimus lumborum (LL) was sampled. The TBARS values of both raw and cooked meat were decreased (P<0.0001) by increasing levels of PSP in the diet. The meat of kids fed PSP15 showed higher a* and C* values (P<0.01) and lower H* and b* values (P<0.001), than kids fed with Control diet. The results of this experiment indicated that replacing barley and corn grains with PSP in the diet may improve the color and lipid stability of kid meat.

Microscopic characterization of Pseudomonas Aeruginosa confines separate from clinical cases by testing RAPD-PCR method.

Pseudomonas Aeruginosa is one of the leading opportunistic infectious agents especially in immune-suppressed patients such like burn victims. Carbapenems like Imipenem (IMP) and Meropenem (MEM) are the choice antimicrobial drugs, which used in the treatment of Penicillin and Aminoglycoside-resistant Pseudomonas Aeruginosa isolates. Based on the importance of the detection of infectious source and their resistance transfer algorithm have a main effect on the control of nosocomial infections this study designed for to consider the antibiotic sensitivity and the genetic pattern of Pseudomonas Aeruginosa isolate in burned patients hospitalized in Ghotbeddin Shirazi Hospital with RAPD-PCR technique. According to the Antibiogram results, the most sensitivity was related to the Gentamicin with 50% while the most resistant related to the Nalidixic Acid, Erythromycin, and Cefotaxime with 90% resistant to all. With RAPD-PCR technique used primers 272, 277 and 287 were detected 18, 15, and 11 algorithms respectively. RAPD-PCR is a genotyping method with a high efficiency and good for the study of bacterial epidemiology and polymorphism.

Effects of Cr methionine on glucose metabolism, plasma metabolites, meat lipid peroxidation, and tissue chromium in Mahabadi goat kids.

This study was designed to investigate the effects of chromium methionine (Cr-Met) on glucose metabolism, blood metabolites, meat lipid peroxidation, and tissue chromium (Cr) in Mahabadi goat kids. Thirty-two male kids (16.5 ± 2.8 kg BW, 4-5 months of age) were fed for 90 days in a completely randomized design with four treatments. Treatments were supplemented with 0 (control), 0.5, 1, and 1.5 mg Cr as Cr-Met/animal/daily. Blood samples were collected via heparin tubes from the jugular vein on 0, 21, 42, 63, and 90 days of experiment. On day 70, an intravenous glucose tolerance test (IVGTT) was conducted. At the end of the feeding trial, the kids were slaughtered, and the liver, kidney, and longissimus dorsi (LD) muscle samples were collected. Plasma glucose, insulin, and triglyceride concentrations were decreased by Cr supplementation (P < 0.05). LD muscle malondialdehyde (MDA) decreased, and plasma and tissue Cr contents increased with increasing supplemental Cr levels (P < 0.05). Plasma glucose concentrations at 30 and 60 min after glucose infusion were lower in the kids fed 1.5 mg Cr diet than the kids fed control diet (P < 0.05). The IVGTT indicated that the kids supplemented with 1.5 mg Cr had higher glucose clearance rate (K) and lower glucose half-life (T½; P < 0.05). Glucose area under the response curve (AUC) from 0 to 180 min after glucose infusion was decreased linearly (P < 0.01) by supplemental Cr. The results suggested that supplemental Cr may improve glucose utilization and lipid oxidation of meat in fattening kid.

Training and validation of standardized patients for unannounced assessment of physicians' management of depression.

OBJECTIVE: Standardized patients (SPs) have been developed to measure practitioner performance in actual practice settings, but results have not been fully validated for psychiatric disorders. This study describes the process of creating reliable and valid SPs for unannounced assessment of general-practitioners' management of depression disorders in Iran. METHOD: Ten psychology and nursing students (potential SPs) took part in a five-session course involving training in dialogue and body language. Five scenarios, along with corresponding checklists representing common presentations of mood disorders in primary-care settings, were developed by an expert group. The SPs' role-play performance of their respective scenario was videotaped and scored independently by three psychiatrists according to an observational rating scale to assess validity. The role-play was repeated after 1 week with the same scenario and the same doctor, to assess test-retest reliability. The reliability of each checklist to be used by the SPs was assessed by testing interrater reliability between groups of SPs. RESULTS: The cutoff score for the SPs' portrayal validity was 90% or above for all SPs. Mean interrater reliability for the checklists was acceptable for the SPs watching the same videos and filling in the checklists, while the mean kappa for assessing concurrent validity in filling in the checklists was lower. The test-retest performance for assessing reliability resulted in a mean kappa of 0.72. All SPs except one, who was not recruited, performed acceptably well. CONCLUSION: The authors have demonstrated a thorough validation of the technique of using standardized patients in the portrayal of depressive disorders in primary-care settings in Iran, which creates confidence in employing this technique to evaluate doctors' performance, for example, after an educational intervention. Similar methods of validation can be used for SPs' portrayal of other psychiatric disorders.

Night shift work experiences among Iranian nurses: a qualitative study.

AIM: To describe the perceptions held by Iranian registered nurses (IRNs) concerning their night shift work experiences. BACKGROUND: Due to the nature of nursing work and the need for 24-h coverage every day, the majority of nurses work night shifts in their professional practice. Evidence from several studies indicates that night working is a challenge for most nurses. This situation can cause many forms of physical and emotional stress. METHODS: A qualitative design was used with purposeful sampling. Eighteen IRNs from four different general educational hospitals in Iran took part in the study. Data were collected via semi-structured interviews and analysed according to qualitative content analysis. FINDINGS: Three main themes were identified from the data: (a) socio-cultural impacts of night work, (b) health-related impacts of night work, and (c) night work as an opportunity for gaining more clinical experiences and learning more. CONCLUSION: The impact of shift work on nurses' daily professional behaviour and adverse health outcomes related to shift work should be well understood and considered when organizing healthcare systems. We need to identify ways to support nurses who work nights and also give attention to the caregiver's needs.

Developing a culturally valid and reliable quality of life questionnaire for diabetes mellitus.

The aim of this study was to design a culturally adapted questionnaire for studying quality of life (QOL) among type 1 and 2 adult diabetes patients in the Islamic Republic of Iran. The 41 items on the questionnaire were based on qualitative research and covered general and health-related QOL. In a descriptive survey, 104 patients completed the questionnaire; 68 (65.4%) were female. Mean age was 50.5 years (standard deviation 12.8). Most patients (86.5%) had type 2 diabetes. Cronbach's alpha coefficient for the questionnaire was 0.98. The questionnaire successfully distinguished the lower QOL of patients suffering from pain in the limbs, loss of appetite, fatigue, constipation and itching. The questionnaire could determine both general and health-related QOL.

Severe cognitive dysfunction in a patient with polyendocrinopathy.

BACKGROUND: Polyglandular Autoimmune syndromes (PGAs) or polyendocrinopathies are immune mediated multiple endocrine gland failure sometimes accompanied by nonendocrine autoimmune disorders with varieties of presentations. CASE REPORT: We describe a case of a middle aged man with severe cognitive dysfunction, brain atrophy, adrenal insufficiency, hypothyroidism, renal failure, thrombocytopenia, and positive antiphospholipid antibodies, with significant renal and cognitive improvement after hormone replacement. CONCLUSIONS: PGAs may present with a broad spectrum of manifestations related to different organs like nervous,renal,cardiac and hematopoietic systems, sometimes challenging both to physician and the patient.

Recurrent multiple myeloma following renal transplantation: a case report.

Renal transplantation is generally not considered for patients with multiple myeloma (MM) because of their extremely poor prognosis. However, for patients in remission, it offers an alternative to dialysis. There are few reports of MM recurrence among kidney transplant recipients. We report a 57-year-old white man with end-stage renal disease (ESRD) and known multiple myeloma in remission who underwent kidney transplantation. Eighteen months after transplantation upon routine follow-up, he was observed to have an elevated creatinine with no evidence of recurrence of myeloma upon bone marrow aspiration. Light microscopy and immunofluorescence of a renal biopsy showed chronic scarring of the kidney owing to cast nephropathy consistent with MM recurrence. Repeat bone marrow aspiration 1 week later confirmed this diagnosis. A review of the literature of prior studies suggested that it is reasonable to perform renal transplantation in patients with ESRD due to MM in remission, but large prospective studies would help to develop a strategy for prevention of multiple myeloma recurrence.

Two approaches to nursing: a study of Iranian nurses.

BACKGROUND: Studying nurses' experience from a sociocultural perspective can contribute to improving knowledge and understanding in this field. PURPOSE: To describe and compare three different groups of Iranian nurses' experiences of their profession. METHODS: The study was conducted in Iran and Sweden. The data were collected from semi-structured telephone interviews and analysed with latent content analysis. The participants were three groups of registered nurses (RNs) (21 persons). All RNs were born and grew up in Iran. The first group (A) were educated and had worked in Iran but were now working and living in Sweden. The second group (B) were educated and worked in Sweden. The third group (C) were educated and worked in Iran. FINDINGS: The nurses in Sweden worked with a patient-orientated approach while nurses in Iran worked with a task-orientated approach. Nurses in all three groups explained that they suffered from stress, had a heavy workload, were underpaid and understaffed. The findings showed that RNs working with a patient-orientated approach, experienced work satisfaction to a greater extent than RNs working with a task-orientated approach, although other aspects also influenced the nurses' situation considerably.

Developing a culturally valid and reliable quality of life questionnaire for diabetes mellitus

The aim of this study was to design a culturally adapted questionnaire for studying quality of life [QOL] among type 1 and 2 adult diabetes patients in the Islamic Republic of Iran. The 41 items on the questionnaire were based on qualitative research and covered general and health-related QOL. In a descriptive survey, 104 patients completed the questionnaire; 68 [65.4%] were female. Mean age was 50.5 years [standard deviation 12.8]. Most patients [86.5%] had type 2 diabetes. Cronbach's alpha coefficient for the questionnaire was 0.98. The questionnaire successfully distinguished the lower QOL of patients suffering from pain in the limbs, loss of appetite, fatigue, constipation and itching. The questionnaire could determine both general and health-related QOL