Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,


Pulmonary pleomorphic carcinoma harboring epidermal growth factor receptor mutation: Response to afatinib…

Pulmonary pleomorphic carcinoma harboring epidermal growth factor receptor mutation: Response to afatinibAbeer Hussien Anter, Majid Al-Jahel, Rasha Mohamed AbdelLatif, Mohamed Fouad AbdELmohsen, Ahmed ShataJournal of Cancer Research and Practice 2019 6(2):103-106Pulmonary pleomorphic carcinoma (PPC) of the lung is a rare type of non-small cell lung cancer, exhibiting aggressive behavior and resistance to chemotherapy. We report a case of a 56-year-old female, diagnosed with PPC of the lung at clinical…

Αλέξανδρος Γ. Σφακιανάκης

2m

Cervical cancer with breast metastasis Ching-Ting Wei, Cheuk-Kwan Sun, Jen-Wei Tsai, Chi-Feng Fu Journal…
Cervical cancer with breast metastasisChing-Ting Wei, Cheuk-Kwan Sun, Jen-Wei Tsai, Chi-Feng FuJournal of Cancer Research and Practice 2019 6(2):100-102Breast metastasis from extramammary solid malignancies is rare, and cervical cancer is an especially uncommon origin. It is clinically challenging to differentiate a primary breast cancer from a metastatic lesion if the patient presents with inflammatory breast skin, axillary lymphadenopathy, and ipsilateral upper-limb lymphedema. Herein, we described…

Αλέξανδρος Γ. Σφακιανάκης

2m

Inflammatory Pseudotumor of the Liver Tsen-Long Yang, Hong-Chuen Chang Journal of Cancer Research…
Inflammatory Pseudotumor of the LiverTsen-Long Yang, Hong-Chuen ChangJournal of Cancer Research and Practice 2019 6(2):96-99Inflammatory pseudotumor (IPT) of the liver is a rare benign lesion, characterized by chronic infiltration of inflammatory cells and areas of necrosis mimicking a malignant tumor. Few cases have been reported, and the precise etiology is still unknown. Patients usually present with abdominal pain, fever, and jaundice. Herein, we report the case of a 78-year-old male with a history…

Αλέξανδρος Γ. Σφακιανάκης

3m

Pembrolizumab-induced uveitis in a patient with metastatic urothelial carcinoma Lo-Ho Chen, Jhe-Cyuan…
Pembrolizumab-induced uveitis in a patient with metastatic urothelial carcinomaLo-Ho Chen, Jhe-Cyuan GuoJournal of Cancer Research and Practice 2019 6(2):92-95Immune checkpoint blockade, especially targeting the programmed cell death protein-1/programmed death-ligand 1 axis, has changed the paradigm of anticancer therapy in several cancer types. For urothelial carcinoma (UC), pembrolizumab is an immune checkpoint inhibitor approved by the US Food and Drug Administration for locally advanced or metastatic…

Αλέξανδρος Γ. Σφακιανάκης

3m

Detection of anaplastic lymphoma kinase gene rearrangement in a patient with right colon cancer Chun-Hui…
Detection of anaplastic lymphoma kinase gene rearrangement in a patient with right colon cancerChun-Hui Lee, Chung-Ta Lee, Yi-Lin Chen, Bo-Wen Lin, Peng-Chang Lin, Meng-Ru Shen, Yu-Min YehJournal of Cancer Research and Practice 2019 6(2):89-91Colorectal cancer (CRC) is one of the leading causes of mortality and morbidity worldwide. Recent genome-scale molecular analyses have uncovered several potential therapeutic targets for this disease, including BRAF mutation, ERBB2 amplification, and neurotropic…

Αλέξανδρος Γ. Σφακιανάκης

4m

A Patient with refractory metastatic germ cell tumor successful salvaged after treatment with paclitaxel,…
A Patient with refractory metastatic germ cell tumor successful salvaged after treatment with paclitaxel, ifosfamide, and high-dose 5-Fluorouracil infusional therapyKeng-Man Chiang, Ann-Lii ChengJournal of Cancer Research and Practice 2019 6(2):85-88We report a case of a 24-year-old male with a metastatic extragonadal germ cell tumor (GCT) which was refractory to conventional chemotherapy and progressed after high-dose chemotherapy. The addition of a 24-h infusion of high-dose 5-fluorouracil (5-FU)…

Αλέξανδρος Γ. Σφακιανάκης

4m

Modulation of oxidative stress by doxorubicin loaded chitosan nanoparticles Ankita Leekha, Vijay Kumar,…
Modulation of oxidative stress by doxorubicin loaded chitosan nanoparticlesAnkita Leekha, Vijay Kumar, Imran Moin, Bahadur Singh Gurjar, Anita Kamra VermaJournal of Cancer Research and Practice 2019 6(2):76-84Purpose of the Research: Chitosan nanoparticles (CHNP) are being used to modulate the generation of reactive oxygen species (ROS), as unwarranted generation of ROS can damage proteins, lipid membranes, and DNA of host cells. CHNP possess exceptional abilities to modulate antioxidants and suppress…

Αλέξανδρος Γ. Σφακιανάκης

4m

Antiproliferative effect of oxidative stress induced by tellurite in breast carcinoma cells Ayesha…
Antiproliferative effect of oxidative stress induced by tellurite in breast carcinoma cellsAyesha Noreen, Abdul Rehman, Saira Aftab, Abdul Rauf ShakooriJournal of Cancer Research and Practice 2019 6(2):68-75Background: Recent studies have revealed that tellurium (Te) compounds have pharmacological and/or antioxidant properties against tumors as they have antitumor and chemoprotective properties. The toxic nature of tellurium compounds and their beneficial effects as antitumor agents have led to an…

Αλέξανδρος Γ. Σφακιανάκης

5m

High-intensity focused ultrasound for localized prostate Cancer , Shu-Wei Tsai, Teh-Sheng Hsieh Journal…
High-intensity focused ultrasound for localized prostate Cancer ,Shu-Wei Tsai, Teh-Sheng HsiehJournal of Cancer Research and Practice 2019 6(2):64-67Purpose: The purpose of this study is to report our results regarding the use of transrectal high-intensity focused ultrasound (HIFU) in the treatment of localized prostate cancer. Materials and Methods: From January 2012 to January 2017, 57 patients with localized prostate cancer (cT1c-T2cN0M0) were treated with an Ablatherm™ HIFU device. Of these patients,…

Αλέξανδρος Γ. Σφακιανάκης

5m

Prevention and management catheter-associated urinary tract infection in intensive care unit Mehdi…
Prevention and management catheter-associated urinary tract infection in intensive care unitMehdi Rahimi, Khosro Farhadi, Hossein Babaei, Firouz SoleymaniJournal of Nursing and Midwifery Sciences 2019 6(2):98-103Context: Urinary tract infection (UTI) is the most common hospital-acquired infection. Around 80% of UTIs are associated with urinary catheters. Aims: The aim of this study was to review and to describe epidemiology and approaches for the prevention and management of catheter-associated urinary…

Αλέξανδρος Γ. Σφακιανάκης

5m

people suffering from special phobiasAlireza Sangani, Paria Jangi, Nahid Ramak, Aniseh Ahmadi Journal…
people suffering from special phobiasAlireza Sangani, Paria Jangi, Nahid Ramak, Aniseh AhmadiJournal of Nursing and Midwifery Sciences 2019 6(2):84-90Context: The basis of anxiety disorders in cognitive and emotional fields can be effective in coping strategies to anxiety. Aims: This research aimed to investigate the mediating role of emotional distress tolerance in relationship between self-discrepancy with anxiety in people suffering from special phobias. Settings and Design: The present study…

Αλέξανδρος Γ. Σφακιανάκης

6m

singing on the happiness of older peopleMaryam Entezari, Manijeh Zakizadeh, Jamshid Yazdani, Zohreh…
singing on the happiness of older peopleMaryam Entezari, Manijeh Zakizadeh, Jamshid Yazdani, Zohreh TaraghiJournal of Nursing and Midwifery Sciences 2019 6(2):78-83Context: Happiness is important for all age groups; however, it is more highlighted in elders. Aims: The aim of the current study was to determine the effect of group singing on the happiness of older people. Setting and Design: In this quasi-experimental study, sixty participants selected among elderly referred to two Day Care Centers…

Αλέξανδρος Γ. Σφακιανάκης

6m

Modeling of cardiac function of patients with acute myocardial infarction based on Type-D personality:…
Modeling of cardiac function of patients with acute myocardial infarction based on Type-D personality: Mediating role of negative emotionsMarzieh Mohammadi Pashaki, Yarali Dousti, Bahram MirzaianJournal of Nursing and Midwifery Sciences 2019 6(2):63-71Context: Cardiac function of patients with acute myocardial infarction (MI) plays a central role in their prognosis. Aims: The purpose of this study was to model the cardiac function of these patients based on Type-D personality and the mediating role…

Αλέξανδρος Γ. Σφακιανάκης

7m

patients with spinal muscular atrophy , Ali-Asghar Jesmi, Leila Jouybari, Akram Sanagoo Journal of…
patients with spinal muscular atrophy,Ali-Asghar Jesmi, Leila Jouybari, Akram SanagooJournal of Nursing and Midwifery Sciences 2019 6(2):57-62Context: Spinal muscular atrophy (SMA) is a neuromuscular disease which, in addition to physical disability, causes psychological and social problems for patients and their families. If physiological and mental disorders continue to persist for a long time, it leads to serious deterioration in the patient’s physical condition, influences the treatment process,…

Αλέξανδρος Γ. Σφακιανάκης

7m

Effect of cognitive behavior therapy integrated with mindfulness on perceived pain and pain self-efficacy…
Effect of cognitive behavior therapy integrated with mindfulness on perceived pain and pain self-efficacy in patients with breast cancerMohammad-Rasul Mozafari-Motlagh, Hamid Nejat, Hasan Tozandehjani, Ali-Akbar SamariJournal of Nursing and Midwifery Sciences 2019 6(2):51-56Context: Cancer pain in a complicated situation for patients with breast cancer. Researchers suggested to use complementary and alternative method in order to reduction pain and side effects in these patients. Aims: This study…

Αλέξανδρος Γ. Σφακιανάκης

8m

Warning System Designed to Predict Severe Sepsis and Septic ShockObjective: To assess clinician perceptions…
Warning System Designed to Predict Severe Sepsis and Septic ShockObjective: To assess clinician perceptions of a machine learning–based early warning system to predict severe sepsis and septic shock (Early Warning System 2.0). Design: Prospective observational study. Setting: Tertiary teaching hospital in Philadelphia, PA. Patients: Non-ICU admissions November–December 2016. Interventions: During a 6-week study period conducted 5 months after Early Warning System 2.0 alert implementation, nurses…

Αλέξανδρος Γ. Σφακιανάκης

8m

Neurologic Complications of Infective Endocarditis: A Joint Model for a Septic Thromboembolism and…
Neurologic Complications of Infective Endocarditis: A Joint Model for a Septic Thromboembolism and Inflammatory Small Vessel DiseaseObjectives: Embolic events from vegetations are commonly accepted as the main mechanism involved in neurologic complications of infective endocarditis. The pathophysiology may imply other phenomena, including vasculitis. We aimed to define the cerebral lesion spectrum in an infective endocarditis rat model. Design: Experimental model of Staphylococcus aureus or Enterococcus…

Αλέξανδρος Γ. Σφακιανάκης

9m

Myeloid-Derived Suppressor Cells Mediate Immunosuppression After Cardiopulmonary BypassObjectives: Cardiopulmonary…
Myeloid-Derived Suppressor Cells Mediate Immunosuppression After Cardiopulmonary BypassObjectives: Cardiopulmonary bypass is associated with severe immune dysfunctions. Particularly, a cardiopulmonary bypass–related long-lasting immunosuppressive state predisposes patients to a higher risk of postoperative complications, such as persistent bacterial infections. This study was conducted to elucidate mechanisms of post-cardiopulmonary bypass immunosuppression. Design: In vitro studies with human peripheral…

Αλέξανδρος Γ. Σφακιανάκης

9m

Tumour Spheroids-on-a-Chip , M Ibrahim Khot, Mark A Levenstein, Nikil Kapur, David G Jayne Journal…
Tumour Spheroids-on-a-Chip,M Ibrahim Khot, Mark A Levenstein, Nikil Kapur, David G JayneJournal of Cancer Research and Practice 2019 6(2):55-63Introduction: Three-dimensional (3D) cell cultures are identified as more accurate and representative models of human cancers than conventional two-dimensional monolayer cell cultures. However, currently established 3D culturing techniques are technically challenging, time- and resource-consuming, and performed using traditional laboratory tissue culturing…

Αλέξανδρος Γ. Σφακιανάκης

10m

Cancer Research and Practice
A Review on the Recent Advancement in "Tumour Spheroids-on-a-Chip"M Ibrahim Khot, Mark A Levenstein, Nikil Kapur, David G JayneJournal of Cancer Research and Practice 2019 6(2):55-63Introduction: Three-dimensional (3D) cell cultures are identified as more accurate and representative models of human cancers than conventional two-dimensional monolayer cell cultures. However, currently established 3D culturing techniques are technically challenging, time- and resource-consuming, and performed using…

Αλέξανδρος Γ. Σφακιανάκης

20m

Nursing and Midwifery Sciences
Effect of cognitive behavior therapy integrated with mindfulness on perceived pain and pain self-efficacy in patients with breast cancerMohammad-Rasul Mozafari-Motlagh, Hamid Nejat, Hasan Tozandehjani, Ali-Akbar SamariJournal of Nursing and Midwifery Sciences 2019 6(2):51-56Context: Cancer pain in a complicated situation for patients with breast cancer. Researchers suggested to use complementary and alternative method in order to reduction pain and side effects in these patients. Aims: This study…

Αλέξανδρος Γ. Σφακιανάκης

24m

Critical Care Medicine
Myeloid-Derived Suppressor Cells Mediate Immunosuppression After Cardiopulmonary BypassObjectives: Cardiopulmonary bypass is associated with severe immune dysfunctions. Particularly, a cardiopulmonary bypass–related long-lasting immunosuppressive state predisposes patients to a higher risk of postoperative complications, such as persistent bacterial infections. This study was conducted to elucidate mechanisms of post-cardiopulmonary bypass immunosuppression. Design: In vitro studies with human peripheral…

Αλέξανδρος Γ. Σφακιανάκης

25m

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480
alsfakia

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,

Cancer Research and Practice

A Review on the Recent Advancement in “Tumour Spheroids-on-a-Chip”
M Ibrahim Khot, Mark A Levenstein, Nikil Kapur, David G Jayne

Journal of Cancer Research and Practice 2019 6(2):55-63

Introduction: Three-dimensional (3D) cell cultures are identified as more accurate and representative models of human cancers than conventional two-dimensional monolayer cell cultures. However, currently established 3D culturing techniques are technically challenging, time- and resource-consuming, and performed using traditional laboratory tissue culturing equipment. In recent years, microfluidics has been introduced into biomedical research, allowing cells and tissues to be cultured in microfabricated devices. The current challenge is to adapt existing 3D cell culturing techniques to microfluidic devices, allowing for the fabrication of low-cost, rapid evaluation devices to facilitate biomedical research and clinical application. The aim of this review was to evaluate microfluidics and 3D cell culture research with particular relevance to oncological research. Methods: Journal articles were acquired from different scientific databases and were identified using specific keywords. Three-Dimensional Cell Culturing Microfluidic Concepts: Various 3D cell culturing microfluidic devices have been designed, based on existing 3D cell culturing methods. This includes non-cell adherent-based devices, matrix-embedding, hanging drop, and droplet-based culturing methods. These platforms facilitate the culturing, treatment, and analysis of 3D spheroids, while simultaneously scaling down traditional experimental requirements. Limitations and Future Perspectives: Beyond superficial analysis, a major drawback in the current scope of 3D cell culturing microfluidic devices is the inability to extract spheroids for examining histology. Polydimethylsiloxane is the preferred material to fabricate devices but may need revision for commercializing microfluidic platforms in the future. Integrating 3D bioprinting and organoid cultures could potentially improve the quality of 3D models in microfluidic devices. Conclusion: 3D spheroids are an effective representation of in vivo cancers and microfluidics has streamlined the culture, treatment, and analysis of 3D models. Considerable improvements have been made in combining the two entities, but further work is required to manufacture 3D cell culturing microfluidic devices on a commercial scale.

High-intensity focused ultrasound for localized prostate Cancer in Cathay General Hospital
Shu-Wei Tsai, Teh-Sheng Hsieh

Journal of Cancer Research and Practice 2019 6(2):64-67

Purpose: The purpose of this study is to report our results regarding the use of transrectal high-intensity focused ultrasound (HIFU) in the treatment of localized prostate cancer. Materials and Methods: From January 2012 to January 2017, 57 patients with localized prostate cancer (cT1c-T2cN0M0) were treated with an Ablatherm™ HIFU device. Of these patients, we excluded those with <12 months of follow-up. In total, 33 patients with localized prostate cancer were enrolled in this study. We assessed the efficacy according to posttreatment prostate-specific antigen (PSA) levels and complications. PSA levels were monitored immediately after HIFU therapy as well as every 3 months thereafter. Biochemical failure was defined as an increase in PSA of 2 ng/mL or more above the PSA nadir. Result: The mean age of all patients was 69.12 ± 8.21 (range: 49–80) years,and the average pretreatment PSA level was 15.19 ± 12.89 (range: 4.44–62.91) ng/mL. The Gleason score ranged from 6 (3 + 3) to 9 (4 + 5) and the mean prostate volume was 38.72 ± 17.90 (range: 21–77) mL. The mean follow-up duration was 36.4 ± 10.8 (range: 13–60) months.Ten patients were classified as low risk, 10 patients were classified as intermittent risk, and 13 patients were classified as high risk according to the National Comprehensive Cancer Network guidelines regarding the risk of recurrence. The PSA levels of all patients decreased significantly after HIFU therapy, and an undetectable PSA (0.04 ng/mL) level was observed in four patients (12.12%). The posttreatment mean PSA nadir was 0.609 ± 0.91 (range: 3.21–0.04) ng/mL, and the mean follow-up duration was 3.1 ± 1.9 (range: 1–8) months. The survival rate was 100%. The PSA biochemical failure rate was 27.3% (9/33). Posttreatment complications included urge incontinence (3/33), total urinary incontinence (0/33), bladder neck contracture (5/33), and urethral stricture (1/33). Conclusion: HIFU therapy appeared to be an effective minimally invasive therapy with acceptable complication rate in selected localized prostate cancer patients.

Antiproliferative effect of oxidative stress induced by tellurite in breast carcinoma cells
Ayesha Noreen, Abdul Rehman, Saira Aftab, Abdul Rauf Shakoori

Journal of Cancer Research and Practice 2019 6(2):68-75

Background: Recent studies have revealed that tellurium (Te) compounds have pharmacological and/or antioxidant properties against tumors as they have antitumor and chemoprotective properties. The toxic nature of tellurium compounds and their beneficial effects as antitumor agents have led to an increasing number of studies on their toxicological and pharmacological modes of action. Materials and Methods: The breast cancer cell line, MDA-MB-231, was cultured in the absence or presence of tellurite for biochemical and morphological analysis to measure the extent of cell death. The roles of antioxidant compounds 3-methyladenine, N-acetylcysteine, and 1,2-bis (2-aminophenoxy) ethane-N, N, N′, N′-tetra acetic acid (acetoxymethyl ester) in supporting proliferation in the presence of tellurite were investigated. Results: There was significant oxidative stress in the tellurite-exposed cells, which curtailed cell Adenosine triphosphate (ATP) levels. Tellurite-induced cytotoxicity substantially increased lactate dehydrogenase leakage, lipid peroxidation, and DNA damage, as analyzed by micronuclei and comet formation. Conclusions: Tellurite-induced damage led to cell cycle arrest, resulting in cell death by activating apoptotic machinery by increasing p21 gene expression in tellurite-treated cells.

Modulation of oxidative stress by doxorubicin loaded chitosan nanoparticles
Ankita Leekha, Vijay Kumar, Imran Moin, Bahadur Singh Gurjar, Anita Kamra Verma

Journal of Cancer Research and Practice 2019 6(2):76-84

Purpose of the Research: Chitosan nanoparticles (CHNP) are being used to modulate the generation of reactive oxygen species (ROS), as unwarranted generation of ROS can damage proteins, lipid membranes, and DNA of host cells. CHNP possess exceptional abilities to modulate antioxidants and suppress oxidative stress damage caused by the CHNP themselves in normal cells. Methods and Results: CHNP were prepared by ionic gelation in the size range of ~115 nm, with a polydispersity index of 0.365. Doxorubicin (DOX) was encapsulated in CHNP with entrapment efficiency ~48%. The modulation of free radicals and antioxidative enzymes by DOX-loaded CHNP (DLCHNP) was evaluated. The glutathione s-transferase and glutathione levels induced by DLCHNP were lower in Ehrlich ascites carcinoma cells(EACs) cells (6.60 ± 0.02 nM/min/mg protein and 0.92 ± 0.05 nM/min/mg protein, respectively) compared to void CHNP and DOX per se decreased levels of nitric oxide and superoxide dismutase (0.03 ± 0.001 nMoles and 28.84 ± 0.016 Unit/mg protein), elevated levels of GSSG (11.69 ± 0.004 nM/min/mg protein), marginally reduced levels of GSH reductase (1.87 ± 0.002 Unit/mg protein), reduced levels of GPx (31.35 ± 0.022 Unit/mg protein) and significantly enhanced levels of LPO (1.56 ± 0.01 nMoles/mg protein) indicated cellular damage. As observed in DNA fragmentation assay, void nanoparticles did not show any DNA damage whereas DLCHNP caused significant damage. Enhanced gene expressions of Cyt. C and p21 on EACs cells was observed in DLCHNP-treated cells compared to DOX per se. Conclusion: CHNP were not efficient in generating remarkable oxidative stress, but when coupled with a drug (i.e., DLCHNP) severe damage was caused to the cancer cells compared to the free drug. This indicated the potential of our encapsulated nanoparticles in drug delivery.

A Patient with refractory metastatic germ cell tumor successful salvaged after treatment with paclitaxel, ifosfamide, and high-dose 5-Fluorouracil infusional therapy
Keng-Man Chiang, Ann-Lii Cheng

Journal of Cancer Research and Practice 2019 6(2):85-88

We report a case of a 24-year-old male with a metastatic extragonadal germ cell tumor (GCT) which was refractory to conventional chemotherapy and progressed after high-dose chemotherapy. The addition of a 24-h infusion of high-dose 5-fluorouracil (5-FU) with leucovorin regimen to a salvage regimen of paclitaxel and ifosfamide provided a durable clinical response. We also discuss the potential of repurposing 5-FU for the treatment of a refractory GCT.

Detection of anaplastic lymphoma kinase gene rearrangement in a patient with right colon cancer
Chun-Hui Lee, Chung-Ta Lee, Yi-Lin Chen, Bo-Wen Lin, Peng-Chang Lin, Meng-Ru Shen, Yu-Min Yeh

Journal of Cancer Research and Practice 2019 6(2):89-91

Colorectal cancer (CRC) is one of the leading causes of mortality and morbidity worldwide. Recent genome-scale molecular analyses have uncovered several potential therapeutic targets for this disease, including BRAF mutation, ERBB2 amplification, and neurotropic tropomyosin receptor kinase fusion gene. Gene rearrangements involving anaplastic lymphoma kinase (ALK) gene have been identified as oncogenic drivers in lung adenocarcinomas, and to be highly sensitive to selective kinase inhibitors. To the best of our knowledge, CRC harboring the ALK fusion gene has rarely been reported. Herein, we report a patient with right colon cancer harboring an ALK gene rearrangement and review the clinicopathologic features as well as potential therapeutic targeting of ALK-rearranged CRC in the literature.

Pembrolizumab-induced uveitis in a patient with metastatic urothelial carcinoma
Lo-Ho Chen, Jhe-Cyuan Guo

Journal of Cancer Research and Practice 2019 6(2):92-95

Immune checkpoint blockade, especially targeting the programmed cell death protein-1/programmed death-ligand 1 axis, has changed the paradigm of anticancer therapy in several cancer types. For urothelial carcinoma (UC), pembrolizumab is an immune checkpoint inhibitor approved by the US Food and Drug Administration for locally advanced or metastatic disease. The new anticancer modalities are complicated with immune-related adverse events (irAEs) which are significantly different from conventional treatment such as chemotherapy or targeted therapy. Herein, we present an 85-year-old man with metastatic UC who developed a rare kind of irAE, uveitis, under pembrolizumab therapy, who fortunately partially recovered with local and systemic steroids.

Inflammatory Pseudotumor of the Liver
Tsen-Long Yang, Hong-Chuen Chang

Journal of Cancer Research and Practice 2019 6(2):96-99

Inflammatory pseudotumor (IPT) of the liver is a rare benign lesion, characterized by chronic infiltration of inflammatory cells and areas of necrosis mimicking a malignant tumor. Few cases have been reported, and the precise etiology is still unknown. Patients usually present with abdominal pain, fever, and jaundice. Herein, we report the case of a 78-year-old male with a history of diabetes mellitus who had abdominal fullness and body weight loss for 4 months. A computed tomography scan showed a 15-cm liver tumor in segment 2 and 3 and suspected hepatocellular carcinoma. Left hepatectomy was performed, and the pathology showed IPT. After surgery, the symptom of abdominal fullness subsided.

Cervical cancer with breast metastasis
Ching-Ting Wei, Cheuk-Kwan Sun, Jen-Wei Tsai, Chi-Feng Fu

Journal of Cancer Research and Practice 2019 6(2):100-102

Breast metastasis from extramammary solid malignancies is rare, and cervical cancer is an especially uncommon origin. It is clinically challenging to differentiate a primary breast cancer from a metastatic lesion if the patient presents with inflammatory breast skin, axillary lymphadenopathy, and ipsilateral upper-limb lymphedema. Herein, we described the first case of cervical squamous cell carcinoma with breast metastasis presenting as an inflammatory breast lesion in Taiwan. A 41-year-old woman visited our outpatient clinic with edema of bilateral lower legs as well as a reddish left breast and indurated skin. After systemic workup, she was diagnosed as having cervical cancer with peritoneal carcinomatosis and breast and multiple lymph node metastases for which she received palliative chemotherapy. However, bone metastasis developed, and she died 9 months after the diagnosis. We also reviewed relevant literature on breast metastases from an extramammary origin.

Pulmonary pleomorphic carcinoma harboring epidermal growth factor receptor mutation: Response to afatinib
Abeer Hussien Anter, Majid Al-Jahel, Rasha Mohamed AbdelLatif, Mohamed Fouad AbdELmohsen, Ahmed Shata

Journal of Cancer Research and Practice 2019 6(2):103-106

Pulmonary pleomorphic carcinoma (PPC) of the lung is a rare type of non-small cell lung cancer, exhibiting aggressive behavior and resistance to chemotherapy. We report a case of a 56-year-old female, diagnosed with PPC of the lung at clinical Stage IV in July 2017. She underwent first-line chemotherapy. The disease progressed after 6 cycles of chemotherapy, and we shift to afatinib due to presence of epidermal growth factor receptor (EGFR) mutation in exon 19. We then started second-line treatment in the form of molecular targeted therapy (afatinib), to which she had a partial response. Hence, we recommend the evaluation of driver gene alterations such as EGFR in the treatment of advanced PPC.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480
alsfakia

Cancer Research and Practice

Nursing and Midwifery Sciences

Effect of cognitive behavior therapy integrated with mindfulness on perceived pain and pain self-efficacy in patients with breast cancer
Mohammad-Rasul Mozafari-Motlagh, Hamid Nejat, Hasan Tozandehjani, Ali-Akbar Samari

Journal of Nursing and Midwifery Sciences 2019 6(2):51-56

Context: Cancer pain in a complicated situation for patients with breast cancer. Researchers suggested to use complementary and alternative method in order to reduction pain and side effects in these patients. Aims: This study was aimed to investigate the effectiveness of mindfulness integrated with cognitive behavioral therapy (MiCBT) on perceived pain and pain self-efficacy in patients with breast cancer. Settings and Design: In this clinical trial study, a semi-experimental method was used. Patients with breast cancer were recurred from cancer clinic of a hospital of Mashhad University of Medical Sciences. Material and Methods: Twenty-four patients with breast cancer selected through purposive sampling method and randomly assigned with permutation blocks in two groups of intervention (n = 12) and control (n = 12). The groups were assessed by demographic questionnaire, Perceived Pain Scale, and Pain Self-efficacy Scale before, immediate, and 1 month after the intervention. Participants in the interventional group received MiCBT for 8 weeks. Statistical Analysis Used: Data were analyzed using descriptive methods and multivariate analysis of covariance. Results: The results showed that the interventional group had a significant decrease in perceived pain (P > 0.05). The pain self-efficacy of patients significantly increased in comparison to the control group in posttest and follow-up stage (P < 0.05). Conclusion: According to the results, it can be concluded that using integrated therapy with mindfulness has been effective in reducing pain and enhancing pain self-efficacy in breast cancer patients. Therefore, it can be an adequate complementary therapy for patients with breast cancer.

The lived experiences of patients with spinal muscular atrophy: A phenomenological study
Ali-Asghar Jesmi, Leila Jouybari, Akram Sanagoo

Journal of Nursing and Midwifery Sciences 2019 6(2):57-62

Context: Spinal muscular atrophy (SMA) is a neuromuscular disease which, in addition to physical disability, causes psychological and social problems for patients and their families. If physiological and mental disorders continue to persist for a long time, it leads to serious deterioration in the patient's physical condition, influences the treatment process, and prevents the outcome of the therapies. Aims: The aim of this study was to explore the lived experiences of patients with SMA. Setting and Design: In this qualitative study, a total of six participants (five patients and one patients' wife) were selected by purposive sampling method. Material and Methods: Data were collected by semi-structured interview. Eleven interviews were conducted and analyzed by Colaizzi's descriptive phenomenological approach. Statistical Analysis Used: Data were analyzed by One Note soft ware version 14.0 with Colaizzi's descriptive phenomenological approach. Results: Two main themes – “tragic life” and “vague future” – emerged from data analysis. They had four categories including “physical and psychological problems,” “limitations and lost opportunities,” “concerns,” and “uncertain future.” Conclusions: These patients experienced a lot of physical and psychological impairments in their life. They have many concerns and lost some opportunities. Therefore, policymakers and authorities should support these patients for participating as an effective members in the society, consequently their feeling improve by getting independent.

Modeling of cardiac function of patients with acute myocardial infarction based on Type-D personality: Mediating role of negative emotions
Marzieh Mohammadi Pashaki, Yarali Dousti, Bahram Mirzaian

Journal of Nursing and Midwifery Sciences 2019 6(2):63-71

Context: Cardiac function of patients with acute myocardial infarction (MI) plays a central role in their prognosis. Aims: The purpose of this study was to model the cardiac function of these patients based on Type-D personality and the mediating role of negative emotions (anger, depression, and anxiety) in this relationship. Setting and Design: This correlational study was performed using the structural equation modeling method, and specifically the regression equations (combination of path analysis and second-order factor analysis). Material and Methods: The study population was the patients with acute ST-segment elevation MI (STEMI) who were hospitalized at Mazandaran Cardiovascular Hospital and underwent under primary percutaneous coronary intervention treatment in 2017 and 2018. Using Mueller's formula modeling formula (1996) based on a sample size-to-free parameter ratio, the sample size was calculated to 220 patients were chosen by the purposive method. Data were collected using Denollet'sType-DScale-14, the Spielberger's state-trait anxiety inventory, short-form of the beck depression inventory-13, and Spielberger's state-trait anger expression inventory-2. Statistical Analysis Used: Data analysis was performed using SPSS-18 and AMOS 23. Results: Type-D personality can directly predict of the cardiac function of patients with acute STEMI. This variable also predicts the the cardiac function of these patients via the mediation of negative emotions (anger, depression, and anxiety). Conclusion: Type-D personality affects the incidence and prognosis of myocardial infarction via negative emotions. It is, therefore, recommended to screen the susceptible populations for this personality type.

The effect of teaching on team-based learning and group discussion on learning and academic motivation of operating room students in the technology of gastrointestinal surgery lesson
Zahra Aliakbarzadeh Arani, Mahsa Haji Mohammad Hoseini, Leila Ghanbari Afra, Maede Mohammadzade

Journal of Nursing and Midwifery Sciences 2019 6(2):72-77

Context: Using of varied teaching methods may be effective in motivating to learn better. Aims: The present study aimed to compare the effect of teaching based on team-based learning (TBL) and group discussion methods on academic motivation and learning of operating room students in the technology of gastrointestinal surgery lesson in Qom University of Medical Sciences. Settings and Design: This semi-experimental study was conducted among two groups of continuous and discontinuous undergraduate course students of operating room in Qom University of Medical Sciences in 2016–2017. The sampling method was the census. A combination of the TBL method and lecture was conducted randomly among group of continuous undergraduate course students (21 persons) and group discussion among discontinuous undergraduate course students (14 persons). Material and Methods: Hartler's motivation questionnaire completed by the students at the first and last semesters. The test was also carried out immediately after the end of the term and four months after that. Statistical Analysis Used: Data were analyzed using frequency, percent, and independent and paired t-test in SPSS 13 software. Results: Comparison of educational motivation score in both groups before and after the intervention was not significant (P > 0.05). Academic motivation, after the intervention, was significant in both groups (P > 0.05). Comparison of scores did not differ between the two groups immediately after training and 4 months later (P > 0.05). Conclusions: Considering the lack of significant difference between TBL and group discussion in learning and increasing the level of academic motivation of students due to the use of these two methods, it is suggested that TBL and the group discussion replace with the common teaching methods, including lectures.

The effect of group singing on the happiness of older people
Maryam Entezari, Manijeh Zakizadeh, Jamshid Yazdani, Zohreh Taraghi

Journal of Nursing and Midwifery Sciences 2019 6(2):78-83

Context: Happiness is important for all age groups; however, it is more highlighted in elders. Aims: The aim of the current study was to determine the effect of group singing on the happiness of older people. Setting and Design: In this quasi-experimental study, sixty participants selected among elderly referred to two Day Care Centers of Mazandaran. Materials and Methods: Samples were assigned to two groups of intervention (n = 30)and control (n = 30). The intervention group was assigned into three groups of 10. Each group selected a song from the list of songs and performed it for 10 min. This process was repeated one more time. The intervention was performed two times a week, for 3 weeks. In the control group, no intervention was performed and the elderly received the usual care. The happiness score of both groups, before and 1 month after the end of the intervention, was measured using the Oxford Happiness Inventory. Statistical Analysis Used: Data were analyzed using independent t-test, Chi-square test, and ANCOVA. Results: Before intervention, the mean scores of happiness in the intervention and control groups were 4.38 ± 0.48 and 4. 53 ± 0.26, respectively (P = 0.138). One month after intervention, the mean scores of happiness in the intervention and control groups were 4.77 ± 0.37 and 4.35 ± 0.18, respectively (P = 0.004). Conclusion: The results of this study showed that group singing was effective on the happiness of the elderly. More studies in day-care centers and other settings, especially nursing homes, are recommended. Implementation of such measures is recommended in the day-care centers.

The mediating role of emotional distress tolerance in relationship between self-discrepancy with anxiety in people suffering from special phobias
Alireza Sangani, Paria Jangi, Nahid Ramak, Aniseh Ahmadi

Journal of Nursing and Midwifery Sciences 2019 6(2):84-90

Context: The basis of anxiety disorders in cognitive and emotional fields can be effective in coping strategies to anxiety. Aims: This research aimed to investigate the mediating role of emotional distress tolerance in relationship between self-discrepancy with anxiety in people suffering from special phobias. Settings and Design: The present study was a correlational research with structural equation modeling. Materials and Methods: The statistical population of this study was all individuals suffering from specific phobia disorders in the 5th Azar Hospital in Gorgan City. The sample size selection, which was made by Loehlin method (2004), was 220 persons suffering from anxiety disorder referring to Psychiatric Clinics of 5 Azar Hospital in Gorgan City and was investigated by purposeful sampling. Data gathering tools included Distress Tolerance Scale, self-discrepancy questionnaire, and Spielberger State-Trait Anxiety Inventory. Statistical Analysis Used: The collected data were analyzed using structural regression equations using SPSS 18 and Amos 23 software. Results: The findings showed that the research model is fit and overall, 42% of the anxiety could be explained through emotional stress tolerance and self-discrepancy, and emotional distress tolerance has a mediating role in relationship self-discrepancy with anxiety. Conclusions: The results of this research emphasized the necessity of self-discrepancy as well as the role of mediator of emotional distress tolerance in anxiety in people suffering from special phobias, which can provide applied templates for improving the psychological state of anxious individuals with therapists and counselors.

Relationship between Self-efficacy and Perceived Burden among Schizophrenic Patients’ Caregivers
Azar Ramzani, Mehran Zarghami, Jamshid Yazdani Charati, Maedeh Bagheri, Hamideh Azimi Lolaty

Journal of Nursing and Midwifery Sciences 2019 6(2):91-97

Context: Caregiver burden is high in schizophrenia. Self-efficacy is an emotional and behavioral response to such stressors. Aims: The aim of the study is to determine the relationship between self-efficacy and the perceived' burden among schizophrenic patients' caregivers. Setting and Design: A total of 384 schizophrenic patients' caregivers referring to a psychiatry Clinic in Sari, Iran, were selected via convenient sampling, for this descriptive correlational study. Materials and Methods: The caregivers filled the demographic questionnaire (the patient and the caregivers), the Zarit burden interview, and the general self-efficacy scale. Statistical Analysis Used: Using SPPS 20 software, the demographics of the caregivers were compared using Chi-square tests for categorical data and t- tests for continuous data. Pearson's correlation and regression method were applied after normality testing (P > 0.05). Results: Among 40.5%, 38.7%, and 7.7% of the caregivers, the burden was mild-to-average, average-to-severe, and highly severe, respectively. The mean of caregivers' self-efficacy and burden was 28.79 ± 5.60 and 40.11 ± 13.60, respectively. Furthermore, the burden had significant relationship with the patient's disease duration and income, caregiver's educational level, job, economic status, and relationship with the patient (P < 0.05). Besides, the caregivers' self-efficacy had meaningful relationship with the patient's gender, income potential, housing status, and with the caregiver's age, gender, educational level, job, housing status, economic status, and relationship with the patient (P < 0.05). The relationship between caregivers' burden and self-efficacy was significantly negative (r = −0.445, P = 0.001). Conclusion: When the self-efficacy increases, the caregiver's burden decreases. The importance of economic status of the caregivers and the patient requires special attention.

Prevention and management catheter-associated urinary tract infection in intensive care unit
Mehdi Rahimi, Khosro Farhadi, Hossein Babaei, Firouz Soleymani

Journal of Nursing and Midwifery Sciences 2019 6(2):98-103

Context: Urinary tract infection (UTI) is the most common hospital-acquired infection. Around 80% of UTIs are associated with urinary catheters. Aims: The aim of this study was to review and to describe epidemiology and approaches for the prevention and management of catheter-associated urinary tract infection (CAUTI) in intensive care unit (ICU) patients. Settings and Design: A narrative review of studies was undertaken. Materials and Methods: A review of PubMed, Google Scholar, Medline, and CINAHL databases were conducted to identify peer-reviewed, English language, and studies published between 1999 and 2018. Related papers were reviewed with using standard keywords. The research was conducted on epidemiology and management of CAUTI in the ICU. Of the 186 English publications, 36 were duplicates. Statistical Analysis Used: Quality assessments, data extractions, and analysis were completed on all included studies. Results: The prevalence of UTI in the ICU is directly related to the widespread use of urethral catheter (32.2%). Guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections for CAUTI. Conclusions: Further studies are needed due to the importance and high prevalence of these infections. We recommend the opportunity to increase any strategy able to reduce the incidence of infections related to urinary catheterization and its consequences in ICUs.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480
alsfakia

Nursing and Midwifery Sciences

Critical Care Medicine

Myeloid-Derived Suppressor Cells Mediate Immunosuppression After Cardiopulmonary Bypass
Objectives: Cardiopulmonary bypass is associated with severe immune dysfunctions. Particularly, a cardiopulmonary bypass–related long-lasting immunosuppressive state predisposes patients to a higher risk of postoperative complications, such as persistent bacterial infections. This study was conducted to elucidate mechanisms of post-cardiopulmonary bypass immunosuppression. Design: In vitro studies with human peripheral blood mononuclear cells. Setting: Cardiosurgical ICU, University Research Laboratory. Patients: Seventy-one patients undergoing cardiac surgery with cardiopulmonary bypass (enrolled May 2017 to August 2018). Interventions: Peripheral blood mononuclear cells before and after cardiopulmonary bypass were analyzed for the expression of immunomodulatory cell markers by real-time quantitative reverse transcription polymerase chain reaction. T cell effector functions were determined by enzyme-linked immunosorbent assay, carboxyfluorescein succinimidyl ester staining, and cytotoxicity assays. Expression of cell surface markers was assessed by flow cytometry. CD15+ cells were depleted by microbead separation. Serum arginine was measured by mass spectrometry. Patient peripheral blood mononuclear cells were incubated in different arginine concentrations, and T cell functions were tested. Measurements and Main Results: After cardiopulmonary bypass, peripheral blood mononuclear cells exhibited significantly reduced levels of costimulatory receptors (inducible T-cell costimulator, interleukin 7 receptor), whereas inhibitory receptors (programmed cell death protein 1 and programmed cell death 1 ligand 1) were induced. T cell effector functions (interferon γ secretion, proliferation, and CD8+-specific cell lysis) were markedly repressed. In 66 of 71 patients, a not yet described cell population was found, which could be characterized as myeloid-derived suppressor cells. Myeloid-derived suppressor cells are known to impair immune cell functions by expression of the arginine-degrading enzyme arginase-1. Accordingly, we found dramatically increased arginase-1 levels in post-cardiopulmonary bypass peripheral blood mononuclear cells, whereas serum arginine levels were significantly reduced. Depletion of myeloid-derived suppressor cells from post-cardiopulmonary bypass peripheral blood mononuclear cells remarkably improved T cell effector function in vitro. Additionally, in vitro supplementation of arginine enhanced T cell immunocompetence. Conclusions: Cardiopulmonary bypass strongly impairs the adaptive immune system by triggering the accumulation of myeloid-derived suppressor cells. These myeloid-derived suppressor cells induce an immunosuppressive T cell phenotype by increasing serum arginine breakdown. Supplementation with L-arginine may be an effective measure to counteract the onset of immunoparalysis in the setting of cardiopulmonary bypass. Drs. Hübner and Tomasi contributed equally to this work. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (simone.kreth Copyright © by 2019 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
Factors Associated With Quality of Death in Korean ICUs As Perceived by Medical Staff: A Multicenter Cross-Sectional Survey
Objectives: Facilitating a high quality of death is an important aspect of comfort care for patients in ICUs. The quality of death in ICUs has been rarely reported in Asian countries. Although Korea is currently in the early stage after the implementation of the “well-dying” law, this seems to have a considerable effect on practice. In this study, we aimed to understand the status of quality of death in Korean ICUs as perceived by medical staff, and to elucidate factors affecting patient quality of death. Design: A multicenter cross-sectional survey study. Setting: Medical ICUs of two tertiary-care teaching hospitals and two secondary-care hospitals. Patients: Deceased patients from June 2016 to May 2017. Interventions: Relevant medical staff were asked to complete a translated Quality of Dying and Death questionnaire within 48 hours after a patient’s death. A higher Quality of Dying and Death score (ranged from 0 to 100) corresponded to a better quality of death. Measurements and Main Results: Total 416 completed questionnaires were obtained from 177 medical staff (66 doctors and 111 nurses) of 255 patients. All 20 items of the Quality of Dying and Death received low scores. Quality of death perceived by nurses was better than that perceived by doctors (33.1 ± 18.4 vs 29.7 ± 15.3; p = 0.042). Performing cardiopulmonary resuscitation and using inotropes within 24 hours before death were associated with poorer quality of death, whereas using analgesics was associated with better quality of death. Conclusions: The quality of death of patients in Korean ICUs was considerably poorer than reported in other countries. Provision of appropriate comfort care, avoidance of unnecessary life-sustaining care, and permission for more frequent visits from patients’ families may correspond to better quality of death in Korean medical ICUs. It is also expected that the new legislation would positively affect the quality of death in Korean ICUs. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (yjlee1117 Copyright © by 2019 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
Neurologic Complications of Infective Endocarditis: A Joint Model for a Septic Thromboembolism and Inflammatory Small Vessel Disease
Objectives: Embolic events from vegetations are commonly accepted as the main mechanism involved in neurologic complications of infective endocarditis. The pathophysiology may imply other phenomena, including vasculitis. We aimed to define the cerebral lesion spectrum in an infective endocarditis rat model. Design: Experimental model of Staphylococcus aureus or Enterococcus faecalis infective endocarditis. Neurologic lesions observed in the infective endocarditis model were compared with three other conditions, namely bacteremia, nonbacterial thrombotic endocarditis, and healthy controls. Setting: Research laboratory of a university hospital. Subjects: Male Wistar rats. Interventions: Brain MRI, neuropathology, immunohistochemistry for astrocyte and microglia, and bacterial studies on brain tissue were used to characterize neurologic lesions. Measurements and Main Results: In the infective endocarditis group, MRI revealed at least one cerebral lesion in 12 of 23 rats (52%), including brain infarctions (n = 9/23, 39%) and cerebral microbleeds (n = 8/23, 35%). In the infective endocarditis group, neuropathology revealed brain infarctions (n = 12/23, 52%), microhemorrhages (n = 10/23, 44%), and inflammatory processes (i.e., cell infiltrates including abscesses, vasculitis, meningoencephalitis, and/or ependymitis; n = 11/23, 48%). In the bacteremia group, MRI studies were normal and neuropathology revealed only hemorrhages (n = 2/11, 18%). Neuropathologic patterns observed in the nonbacterial thrombotic endocarditis group were similar to those observed in the infective endocarditis group. Immunochemistry revealed higher microglial activation in the infective endocarditis group (n = 11/23, 48%), when compared with the bacteremia (n = 1/11, 9%; p = 0.03) and nonbacterial thrombotic endocarditis groups (n = 0/7, 0%; p = 0.02). Conclusions: This original model of infective endocarditis recapitulates the neurologic lesion spectrum observed in humans and suggests synergistic mechanisms involved, including thromboembolism and cerebral vasculitis, promoted by a systemic bacteremia-mediated inflammation. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (marie.cantier; mikael.mazighi Copyright © by 2019 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
Pro: Should Patients With Acute Respiratory Distress Syndrome on Veno-Venous Extracorporeal Membrane Oxygenation Have Ventilatory Support Reduced to the Lowest Tolerable Settings?
No abstract available
Why the Adjunctive Corticosteroid Treatment in Critically Ill Patients With Septic Shock (ADRENAL) Trial Did Not Show a Difference in Mortality?
No abstract available
Impact on Patient Outcomes of Pharmacist Participation in Multidisciplinary Critical Care Teams: A Systematic Review and Meta-Analysis
Objectives: The objective of this systematic review and meta-analysis was to assess the effects of including critical care pharmacists in multidisciplinary ICU teams on clinical outcomes including mortality, ICU length of stay, and adverse drug events. Data Sources: PubMed, EMBASE, and references from previous relevant systematic studies. Study Selection: We included randomized controlled trials and nonrandomized studies that reported clinical outcomes such as mortality, ICU length of stay, and adverse drug events in groups with and without critical care pharmacist interventions. Data Extraction: We extracted study details, patient characteristics, and clinical outcomes. Data Synthesis: From the 4,725 articles identified as potentially eligible, 14 were included in the analysis. Intervention of critical care pharmacists as part of the multidisciplinary ICU team care was significantly associated with the reduced likelihood of mortality (odds ratio, 0.78; 95% CI, 0.73–0.83; p < 0.00001) compared with no intervention. The mean difference in ICU length of stay was –1.33 days (95% CI, –1.75 to –0.90 d; p < 0.00001) for mixed ICUs. The reduction of adverse drug event prevalence was also significantly associated with multidisciplinary team care involving pharmacist intervention (odds ratio for preventable and nonpreventable adverse drug events, 0.26; 95% CI, 0.15–0.44; p < 0.00001 and odds ratio, 0.47; 95% CI, 0.28–0.77; p = 0.003, respectively). Conclusions: Including critical care pharmacists in the multidisciplinary ICU team improved patient outcomes including mortality, ICU length of stay in mixed ICUs, and preventable/nonpreventable adverse drug events. Drs. Lee and Ryu contributed equally to this work as co-first authors. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (eykimjcb777 Copyright © by 2019 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
Adjusting for Disease Severity Across ICUs in Multicenter Studies
Objectives: To compare methods to adjust for confounding by disease severity during multicenter intervention studies in ICU, when different disease severity measures are collected across centers. Design: In silico simulation study using national registry data. Setting: Twenty mixed ICUs in The Netherlands. Subjects: Fifty-five–thousand six-hundred fifty-five ICU admissions between January 1, 2011, and January 1, 2016. Interventions: None. Measurements and Main Results: To mimic an intervention study with confounding, a fictitious treatment variable was simulated whose effect on the outcome was confounded by Acute Physiology and Chronic Health Evaluation IV predicted mortality (a common measure for disease severity). Diverse, realistic scenarios were investigated where the availability of disease severity measures (i.e., Acute Physiology and Chronic Health Evaluation IV, Acute Physiology and Chronic Health Evaluation II, and Simplified Acute Physiology Score II scores) varied across centers. For each scenario, eight different methods to adjust for confounding were used to obtain an estimate of the (fictitious) treatment effect. These were compared in terms of relative (%) and absolute (odds ratio) bias to a reference scenario where the treatment effect was estimated following correction for the Acute Physiology and Chronic Health Evaluation IV scores from all centers. Complete neglect of differences in disease severity measures across centers resulted in bias ranging from 10.2% to 173.6% across scenarios, and no commonly used methodology—such as two-stage modeling or score standardization—was able to effectively eliminate bias. In scenarios where some of the included centers had (only) Acute Physiology and Chronic Health Evaluation II or Simplified Acute Physiology Score II available (and not Acute Physiology and Chronic Health Evaluation IV), either restriction of the analysis to Acute Physiology and Chronic Health Evaluation IV centers alone or multiple imputation of Acute Physiology and Chronic Health Evaluation IV scores resulted in the least amount of relative bias (0.0% and 5.1% for Acute Physiology and Chronic Health Evaluation II, respectively, and 0.0% and 4.6% for Simplified Acute Physiology Score II, respectively). In scenarios where some centers used Acute Physiology and Chronic Health Evaluation II, regression calibration yielded low relative bias too (relative bias, 12.4%); this was not true if these same centers only had Simplified Acute Physiology Score II available (relative bias, 54.8%). Conclusions: When different disease severity measures are available across centers, the performance of various methods to control for confounding by disease severity may show important differences. When planning multicenter studies, researchers should make contingency plans to limit the use of or properly incorporate different disease measures across centers in the statistical analysis. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Dr. Brakenhoff and Dr. Plantinga contributed equally. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (N.L.Plantinga Copyright © by 2019 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
Recommendation of New Medical Alarms Based on Audibility, Identifiability, and Detectability in a Randomized, Simulation-Based Study
Objectives: Accurate and timely identification of existing audible medical alarms is not adequate in clinical settings. New alarms that are easily heard, quickly identifiable, and discernable from one another are indicated. The “auditory icons” (brief sounds that serve as metaphors for the events they represent) have been proposed as a replacement to the current international standard. The objective was to identify the best performing icons based on audibility and performance in a simulated clinical environment. Design: Three sets of icon alarms were designed using empirical methods. Subjects participated in a series of clinical simulation experiments that examined the audibility, identification accuracy, and response time of each of these icon alarms. A statistical model that combined the outcomes was used to rank the alarms in overall efficacy. We constructed the “best” and “worst” performing sets based on this ranking and prospectively validated these sets in a subsequent experiment with a new subject sample. Setting: Experiments were conducted in simulated ICU settings at the University of Miami. Subjects: Medical trainees were recruited from a convenience sample of nursing students and anesthesia residents at the institution. Interventions: In Experiment 1 (formative testing), subjects were exposed to one of the three sets of alarms; identical setting and instruments were used throughout. In Experiment 2 (summative testing), subjects were exposed to one of the two sets of alarms, assembled from the best and worst performing alarms from Experiment 1. Measurements and Main Results: For each alarm, we determined the minimum sound level to reach audibility threshold in the presence of background clinical noise, identification accuracy (percentage), and response time (seconds). We enrolled 123 medical trainees and professionals for participation (78 with < 6 yr of training). We identified the best performing icon alarms for each category, which matched or exceeded the other candidate alarms in identification accuracy and response time. Conclusions: We propose a set of eight auditory icon alarms that were selected through formative testing and validated through summative testing for adoption by relevant regulatory bodies and medical device manufacturers. This work was performed at the University of Miami. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http;/mcneer Copyright © by 2019 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
A 360° Rotational Positioning Protocol of Organ Donors May Increase Lungs Available for Transplantation
Objectives: To evaluate the improvement in lung donation and immediate lung function after the implementation of a 360° rotational positioning protocol within an organ procurement organization in the Midwest. Design: Retrospective observational study. Setting: The Midwest Transplant Network from 2005 to 2017. Rotational positioning of donors began in 2008. Subjects: Potential deceased lung donors. Interventions: A 360° rotational protocol. Presence of immediate lung function in recipients, change in PaO2:FIO2 ratio during donor management, initial and final PaO2:FIO2 ratio, and proportion of lungs donated were measured. Outcomes were compared between rotated and nonrotated donors. Measurements and Main Results: A total of 693 donors were analyzed. The proportion of lung donations increased by 10%. The difference between initial PaO2:FIO2 ratio and final PaO2:FIO2 ratio was significantly different between rotated and nonrotated donors (36 ± 116 vs 104 ± 148; p < 0.001). Lungs transplanted from rotated donors had better immediate function than those from nonrotated donors (99.5% vs 68%; p < 0.001). Conclusions: There was a statistically significant increase in lung donations after implementing rotational positioning of deceased donors. Rotational positioning significantly increased the average difference in PaO2:FIO2 ratios. There was also superior lung function in the rotated group. The authors recommend that organ procurement organizations consider adopting a rotational positioning protocol for donors to increase the lungs available for transplantation. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (mendezmar Copyright © by 2019 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
Clinician Perception of a Machine Learning–Based Early Warning System Designed to Predict Severe Sepsis and Septic Shock
Objective: To assess clinician perceptions of a machine learning–based early warning system to predict severe sepsis and septic shock (Early Warning System 2.0). Design: Prospective observational study. Setting: Tertiary teaching hospital in Philadelphia, PA. Patients: Non-ICU admissions November–December 2016. Interventions: During a 6-week study period conducted 5 months after Early Warning System 2.0 alert implementation, nurses and providers were surveyed twice about their perceptions of the alert’s helpfulness and impact on care, first within 6 hours of the alert, and again 48 hours after the alert. Measurements and Main Results: For the 362 alerts triggered, 180 nurses (50% response rate) and 107 providers (30% response rate) completed the first survey. Of these, 43 nurses (24% response rate) and 44 providers (41% response rate) completed the second survey. Few (24% nurses, 13% providers) identified new clinical findings after responding to the alert. Perceptions of the presence of sepsis at the time of alert were discrepant between nurses (13%) and providers (40%). The majority of clinicians reported no change in perception of the patient’s risk for sepsis (55% nurses, 62% providers). A third of nurses (30%) but few providers (9%) reported the alert changed management. Almost half of nurses (42%) but less than a fifth of providers (16%) found the alert helpful at 6 hours. Conclusions: In general, clinical perceptions of Early Warning System 2.0 were poor. Nurses and providers differed in their perceptions of sepsis and alert benefits. These findings highlight the challenges of achieving acceptance of predictive and machine learning–based sepsis alerts. The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Dr. Ginestra, Dr. Schweickert, Ms. Meadows, Mr. Lynch, and Ms. Pavan helped with data collection; Dr. Ginestra helped with analysis and interpretation of the data, and drafting of the article; and all authors helped with conception and design, and critical revision of the article for important intellectual content. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http;/craigumscheid Copyright © by 2019 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480
alsfakia

Critical Care Medicine

Family Medicine and Primary Care

A primary care–based patient centric palliative care model
Sunil Kumar Raina, Raman Kumar, Rajiv Kumar Gupta

Journal of Family Medicine and Primary Care 2019 8(5):1519-1522

The World Health Organization defined palliative care as “an approach that improves the quality of life of patients and their families facing the problems associated with life threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial, and spiritual. The patient centric primary care model (PCCM) promises to provide a solution to control these health-care challenges. The model is largely based on the chronic care model (CCM) and the model developed by the Organized Medicine Academic Guild (OMAG) for delivering health care in India.

Medical problem in Asia pacific and ways to solve it: The roles of primary care/family physician (Indonesia Xperience)
Retno Asti Werdhani

Journal of Family Medicine and Primary Care 2019 8(5):1523-1527

WHO reported that Environment contributed significantly as the causal of the disease in Asia Pacific. Indonesia is facing major health challenges, namely triple burden health problems, due to communicable diseases, non-communicable diseases and re-emerging disease. Primary care in Indonesia is conducted by Public Health Centers/Puskesmas and Primary Care Clinic covering around 86% of total health care facilities in Indonesia. Primary Care Physician plays important role as a gatekeeper and care coordinator. Primary care in Indonesia responsible for primary prevention and screening, should also be prepared to deal with various reasons for encounters of patient/community health problems, and conduct comprehensive management including referral management. It is therefore necessary to have teamwork with various health workers and patients/families at all levels of prevention.

Need for a universal thalassemia screening programme in India? A public health perspective
Arulmani Thiyagarajan, Sudip Bhattacharya, Neha Sharma, Abhay Srivastava, Dipak Kumar Dhar

Journal of Family Medicine and Primary Care 2019 8(5):1528-1532

Thalassemia is one of the significant public health concerns as the carrier rate and disease numbers are increasing worldwide. The increase in number is because of consanguineous marriage which has a deep-rooted norm among many people globally. Besides various clinical and psychological problems associated with thalassemia, a lifelong treatment aspect makes it much more difficult for a person or family to sustain with thalassemia or thalassemia-affected children. Though the government has come up with a screening programme for thalassemia, given the fact that it is optional, people tend to ignore it. Examples from Pakistan and Iran remind us to have a mandatory prenatal screening programme which is very much cost-effective. With a highly recommended notion, we suggest that it should be universal to have an antenatal screening programme to avert thalassemia-related deaths.

Cytochemical tests to investigate sperm DNA damage: Assessment and review
Soheila Pourmasumi, Alireza Nazari, Niloofar Fagheirelahee, Parvin Sabeti

Journal of Family Medicine and Primary Care 2019 8(5):1533-1539

Male factor infertility has been diagnosed as the cause of infertility in about 20% of infertile couples. Sperm analysis is the most common method for diagnosing infertility in a laboratory. However, approximately 15% of infertile men have a normal sperm analysis. Therefore, the result of a routine sperm analysis often cannot be a definitive diagnosis for male factor infertility. Also, approximately 8% of infertile men with normal sperm parameters have high levels of abnormal sperm DNA. This indicates the role of the integrity of sperm DNA in male infertility. Here, we review the current tests available to evaluate the sperm DNA integrity along with their benefits and limitations.

Cosmetovigilance: A review of the current literature
Hale Z Toklu, Abigail Antigua, Vanessa Lewis, Mar'Tina Reynolds, Jennifer Jones

Journal of Family Medicine and Primary Care 2019 8(5):1540-1545

The term “pharmacovigilance” defines the activities related to the collection, detection, assessment, monitoring, and prevention of adverse reactions occurring with medications. Recently, the spectrum of “-vigilance” has broadened to include safety of herbal products and cosmetic products as well. “Cosmetovigilance” was introduced as a new term used for defining surveillance carried out by industry to address the safety of cosmetic products. It was first used in literature by Vigan (1997) to refer to the monitoring of cosmetic product safety. Today, it is recognized globally as a concept of public health. For this systematic review, a PubMed search was conducted in July 2018 for the term “cosmetovigilance.”

Get lean and go green: Role for “Eat-ology” behavior modification
Samra Abouchacra, Satish Chandrasekhar Nair, Oudi Abouchacra, Omar Yaman

Journal of Family Medicine and Primary Care 2019 8(5):1546-1549

Obesity rates are rising exponentially reaching global epidemic proportions and are associated with substantially increased morbidity and mortality. Less appreciated are the serious risks this poses on our environment from increased greenhouse gas emissions related to obesogenic behavior. In spite of a plethora of diets, the results are short term and nonsustainable, thereby leaving individuals battling with more weight than they lost. This is likely attributable to inherent flaws in the nature of weight loss diets or perhaps the approach of implementing them. These grim realities will be exposed to lead the way to uncover a novel “behavior modification for weight loss” strategy called Eat-ology. It exposes eating errors and imparts techniques to transform them into eating essentials, thereby enabling weight loss and its long-term maintenance. It is through such approaches that we can hope to win the fight against obesity and achieve not only a leaner global society but also a greener environment.

Nursing efficiency in patient care: A comparative study in perception of staff nurse and hospital management in a trust hospital
Homa Mosaffay Khomami, Nasreen Rustomfram

Journal of Family Medicine and Primary Care 2019 8(5):1550-1557

Background and Objective: While efficient use of resources and cost control is the responsibility of hospital managers, it is the duty of the nurses to carry out patient care and provide high-quality services. The aim of present research was to study the perception of staff nurses and nurse managers about nursing efficiency in patient care in a trust hospital. Materials and Methods: This quantitative and explanatory research has been done on staff nurses as well as nurse managers in a 550-bedded trust hospital in rural Gujarat of India. Data collection tool was a researcher made questionnaire and the data collection method was interview schedules for staff nurse and nurse managers. The total number of staff nurse in this hospital was 450 including 50 nurse managers. Results: Staff nurses had shown dissatisfaction regarding managers' practice and stated some aspects of managers practice which needed to improve such as keeping competitive salary for staff nurse, providing counseling system to supporting nursing practice, better recognition and acknowledgement system, better job security, providing supportive managerial style, better unit size and Applying vacation system. Conclusions: There was a difference between staff nurses' perception and nurse managers' perception regarding professional characteristics for nursing profession and factors, which affect nursing efficiency in patient care (with 95% confidence interval and P < 0.05).

Evaluation of hypercalciuria in patients receiving intravenous Cefotaxime
Zahra Kalantari, Parsa Yousefichaijan, Manijeh Kahbazi, Ali Arjmand Shabestari

Journal of Family Medicine and Primary Care 2019 8(5):1558-1561

Introduction: Cefotaxime is one of the third generation cephalosporins, which is used against many infections. This drug has a urinary excretion and potentially may have nephrotoxic effects. Hypercalciuria can cause important complications, including the formation of kidney stones. In the recent study, we decided to evaluate hypercalciuria in children receiving cefotaxime. Materials and Methods: This case-control study was conducted in Amirkabir hospital (Arak, Iran), where 30 children received intravenous cefotaxime were placed in the case group and 30 children without intravenous administration of cefotaxime were included in the control group. The ratio of calcium to creatinine was measured in both groups. Data were analyzed by SPSS software version 23. Results: This study showed that the ratios of male and female children in both the groups were 19 (63.3%) and 11 (36.7%) respectively, the mean age of children in the case group was 2.36 years with a standard deviation of 0.71 and the mean age of the children in the control group was 5.18 years with a standard deviation of 3.31. The ratios of urine calcium to creatinine in the case and control groups were 0.90 with a standard deviation of 1.79 and 0.37 with a standard deviation of 0.44 (P value = 0.003). Conclusion: According to the above results, it is concluded that receiving intravenous cefotaxime may increase calcium to creatinine ratio in children.

Prevalence of smoking among dental students and gauging their knowledge about tobacco cessation methods: An original study
Jubin Thomas, R B Vinod Kumar, S Akhil, Ajish M Saji, Amal K Iype, Diana Antony

Journal of Family Medicine and Primary Care 2019 8(5):1562-1566

Aims: The aims of this study are to determine the prevalence and type of tobacco use among dental students and to identify the factors that influence them to initiate tobacco use. Subjects and Methods: Dental students at two dental colleges affiliated to State Health University of Kerala answered a 20-item questionnaire during Jan–Feb 2015 that investigated their smoking habits and knowledge about the risk factors of smoking habits. The questions were based on the modified Global Health Professional Students Survey (GHPSS) by WHO. Some additional questions were also added from Global Youth Tobacco Survey (GYTS) by WHO to meet the objective of this study. Result: Current smoking was reported by 17% of the participants. None of the participants smoked more than half a packet of cigarette. More students from families with at least one tobacco user were using tobacco than those from families with no members using tobacco (51.2 versus 37.0%, respectively). The majority of dental students (92%) considered education on tobacco use cessation to be the responsibility of dentists/doctors. Conclusion: One of the main aims of this study was to shed light on the knowledge and attitudes of dental students on tobacco use cessation. Fairly high number of participants reported receiving inadequate information on tobacco cessation during their studies. Dental students should be taught and encouraged early on to routinely discuss with smokers the impacts of smoking on health.

Toll like receptors (TLRs) in response to human gut microbiota of Indian obese and lean individuals
Tej Bahadur, Rama Chaudhry, Vishwa Deepak Bamola, Sonu K Agrawal, Pawan Malhotra, Alka M Chutani, Bijay R Mirdha, Bimal K Das, Rahul K Sharma, Chandan K Thakur

Journal of Family Medicine and Primary Care 2019 8(5):1567-1570

Background: The rising incidence of obesity is one of the most serious public health issues in the developed as well as in developing countries like India. Obesity and overweight are most important risk factors for many chronic diseases, including cardiovascular diseases, diabetes and cancer. In this study the body mass index (BMI) cut off was taken as 18.5-22.9 kg/m2 for normal, 23.0-24.9 kg/m2 for Overweight and >25 kg/m2 for obese as per WHO recommendation for Asian Indians, which is different for developed and developing countries. Role of gut microbiota mediated immune response in the development of obesity has been studied but the literature on Indian population are lacking. Therefore, a study was conducted to determine Toll like receptors (TLRs) in response to human gut microbiota of Indian obese and lean individuals using viable colonocytes in a Non invasive technique and Flowcytometry. Methods: A total of 20 healthy volunteer (10 obese and 10 lean) were enrolled in the study as per inclusion and exclusion criteria. Viable colonocytes were isolated from fecal samples using a Non invasive technique (SCSR Method). Toll like receptors (TLRs) and immunoglobulin (IgA &IgG) receptor concentration were measured by standard Flowcytometry methods using specific fluorochrome conjugated antibodies. Results: Average TLR2 receptor concentration was significantly higher in obese (6.35 %) as compared to lean (2.9 %) (P = 0.01). TLR4 receptor concentration was 1.4 % in obese and 1.65 % in lean although the difference was not statistically significant (P = 0.59). IgA & IgG receptor concentration was 49.6 % & 11.2 % in the obese and 67.15 % & 8.05 % in the lean respectively but the differences among both the group were not statistically significant. Conclusion: The results of the present study will be helpful for physicians and researchers to find some biomarkers which can determine predisposition of the obesity in Indian population and helps to use alternative therapeutics such as probiotics to maintain gut homeostasis and immune modulation to prevent obesity.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480
alsfakia

Family Medicine and Primary Care

Otolaryngology & Head and Neck Surgery

Current approaches to cleft lip revision
Purpose of review Cleft lip repair requires multidisciplinary follow-up throughout a child’s life and often requires lip revision surgery in adolescence to restore function and symmetry of the lip. There is significant variability in the approaches taken for lip repair and therefore a review of current techniques and subsequent guidance to secondary cleft lip repair is warranted. Recent findings New methods of secondary reconstruction can be divided into superficial or muscle related. Recent suggestions for superficial reconstruction include botulinum toxin injection, silicone gel sheeting, local flap reconstruction, fat grafting, and CO2 laser ablation. Suggestions for muscular reconstruction include pedicled prolabial flaps, modified Abbe flap, and orbicularis oris eversion. Summary Secondary cleft lip deformities can be classified as superficial or muscle related. Superficial problems require relatively minor treatments such as laser, local scar revisions, small local flaps, mucosal excision, or fat grafting. Muscle deformities generally require total lip revision and rerepair as a first step to achieving longstanding improvements in lip esthetics and function. Cleft lip revision should only be considered in concert with the patient, be based on the patient’s concerns and desires, and offered at the appropriate timeline to improve social integration and/or psychosocial wellbeing. Correspondence to Damir Matic, MD, MSc, FRCSC, Associate Professor, Plastic and Reconstructive Surgery, London Health Sciences Centre, Victoria Hospital Campus, Room E2-646, 800 Commissioners Rd E, London, ON, Canada. Tel.: +1 519 685 8557;. e-mail: Damir.matic Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.
An update in facial gender confirming surgery
Purpose of review To summarize current surgical and nonsurgical approaches to facial gender confirming surgery (FGCS) and highlight standards of care and areas of future research. Recent findings Gender nonconforming individuals may encounter considerable internal coping and external social stressors that may contribute to gender-associated dysphoria. FGCS provides patients the ability to align facial appearance with gender identity, using recently described advances in surgical and nonsurgical techniques. The majority of FGCS is performed on transwomen (individuals identifying as female), yielding the more common term of facial feminization surgery (FFS). Although no set protocols or standards are in place, certain procedures are commonly performed to alter sex-determining characteristics of the face, and further research may help define guidelines. As many training programs have minimal exposure to FGCS, promotion of transgender health awareness is paramount for diverse and inclusive surgical training. Summary Although demand for FGCS is increasing, there remains a need for improving surgical approaches, developing evidence-based care guidelines, and implementing education and awareness in training programs. Correspondence to Rahul Seth, MD, University of California San Francisco, 2233 Post Street, 3rd Floor, San Francisco, CA 94115, USA. Tel.: +1 415 885 7494;. fax: +1 415 885 7785; e-mail: rahul.seth Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.
Update on empty nose syndrome: disease mechanisms, diagnostic tools, and treatment strategies
Purpose of review To discuss the proposed pathophysiology of empty nose syndrome (ENS), summarize and evaluate the role of validated diagnostic tools in the diagnosis of ENS, and review the medical and surgical treatment strategies for patients with ENS. Recent findings Historically, ENS has been associated with a reduction in nasal turbinate size; new data suggest that impaired trigeminal nerve function may also play a role in the pathophysiology of the disease. The newly validated empty nose syndrome 6 item questionnaires and Cotton test are steps forward to standardize the diagnosis of ENS. Finally, there has been a marked increase in surgical treatment strategies to reconstitute turbinate volume with various implant materials. Summary The diagnosis of ENS remains controversial but the last several years have seen a rejuvenation of interest in this disease entity. The validated empty nose syndrome 6 item questionnaires and Cotton test provide a standardized and objective means by which to characterize ENS. Prevention of iatrogenic ENS through avoidance of excessive turbinate reduction remains critical in preventing paradoxical nasal obstruction. Nasal humidification, patient education, and treatment of possible concomitant medical conditions (e.g., depression) constitute first lines of treatment. We support the cautious use of these screening tools as adjuncts to clinical decision-making. Although injectable implants to augment turbinate volume show promise as a therapeutic surgical technique, there is insufficient data to fully support their use at this time. Correspondence to Toby O. Steele, MD, Department of Otolaryngology – Head and Neck Surgery, University of California Davis, Davis, CA 95616, USA. E-mail: tosteele Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.
Contemporary management of frontal sinus fractures
Purpose of review Frontal sinus fracture management is evolving. This article will highlight recent literature and provide an evidence-based algorithm in the contemporary management of frontal sinus fractures. Recent findings The role of transnasal endoscopic treatment of frontal sinus fractures has expanded to include fracture reduction and posterior table reconstruction. Evidence continues to support the safety of nonoperative management in select frontal sinus outflow tract fractures. Summary The management of frontal sinus fractures with frontal sinus outflow tract injury continues to evolve with a trend toward observation and minimally invasive approaches. Restoration of the frontal sinus outflow tracts with transnasal endoscopic techniques is being used increasingly in the acute and delayed setting. For severe fractures, the role of conservative treatment paradigms requires further research. Correspondence to E. Bradley Strong, MD, Department of Otolaryngology – Head and Neck Surgery, University of California Davis, 2521 Stockton Blvd., Suite 7200, Sacramento, CA 95817, USA. Tel: +1916 734 2801; fax: +1916 703 5011; e-mail: ebstrong Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.
Rib cartilage in Asian rhinoplasty: new trends
Purpose of review Costal cartilage has many advantages over other grafting materials because of its large quantity and high biocompatibility. As a result, it has been considered as a good option for Asian rhinoplasty. However, costal cartilage is difficult to use and is associated with a high complication rate. To avoid the disadvantages and complications of costal cartilage graft, several techniques have been proposed in the literature. This review addresses the conventional uses of costal cartilage in Asian rhinoplasty and recent updates. Recent findings Different techniques have been reported for Asian rhinoplasty using costal cartilage. Solid-block costal cartilage and diced cartilage with or without wrapping materials are widely used for dorsal augmentation. Many different grafting techniques for the tip and septal reconstruction have been reported by numerous surgeons. When using costal cartilage graft, surgeons should pay attention to both graft complications, such as warping or infection, and donor-site morbidity. Several strategies have recently been developed to avoid these complications. Summary This article summarises grafting options for Asian rhinoplasty using costal cartilage and possible complications. This information may assist with proper selection of appropriate techniques for harvesting, carving and grafting costal cartilage. Correspondence to Yong Ju Jang, MD, PhD, Professor, Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea. Tel: +82 2 3010 3710; fax: +82 2 489 2773; e-mail: jangyj Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480
alsfakia

Otolaryngology & Head and Neck Surgery

Tropical Medicine

Antimalarial activity of a novel series of artemisinin-derived 1, 2, 3-triazole dimers
Kabita Gogoi, Gokul Baishya, Biswajit Saikia, Nabin Chandra Barua, Chandrajit Dohutia, Akalesh Kumar Verma, Anil Prakash

Asian Pacific Journal of Tropical Medicine 2019 12(5):195-203

Objective: To obtain suitable artimisinin-based drug candidates with high antimalarial activity. Methods: Three different reaction schemes were used to synthesize a total of 15 artemisinin-based compounds. The first synthetic scheme involved the synthesis of diazido aliphatic and aromatic compounds from commercially available dihalides and azido derivatives of artemisinin. The second scheme consisted of the reaction of dibromoaliphatic compounds with sodium azide in dimethylformamide which yielded the desired compounds. Artemisinin-based compounds on treatment with sodium azide and bromotrimethylsilane in dichloromethane produced the most potent compound GB-2. Another potent compound GB-1 was synthesized from artemisinin by treatment with alcohols in the presence of Aberlyst-15 in anhydrous dichloromethane. The third scheme involved the Huisgen 1,3-dipolar cycloaddition between the synthesized aliphatic and aromatic diazides and two alkyne derivatives of artemisinin to obtain the desired artemisinin dimers with average yields. Results: The best in vitro antiplasmodial activity was shown by the compound GB-2 registering IC50 value 0.066 μg/mL against chloroquine-sensitive and 0.865 μg/mL against chloroquine-resistant strains of Plasmodium falciparum. It suppressed 59.0% parasitaemia in vivo of rodent malaria parasite Plasmodium berghei in Swiss albino model at 50 μg/kg body weight dosage. Molecular docking interactions of Plasmodium falciparum ATP6 (PfATP6) protein revealed strong bonding of GB-2 with Thr255 residue which is likely to be the reason for excellent antimalarial activity of this compound. Conclusion: Two compounds GB-1 and GB-2 exhibited excellent in vitro antiplasmodial activity and fair in vivo antimalarial activity. Of the two, GB-2 showed better activity which could be attributed to its strong bonding interactions with Thr255 as evidenced from the molecular docking study. Study helped in identifying artemisinin analogues possessing good antimalarial properties and further research in structural alterations of the selected molecules should be carried out which may result in obtaining potent drug candidates against the malarial parasite.

Climate change and potential distribution of zoonotic cutaneous leishmaniasis in Central Iran: Horizon 2030 and 2050
Babak Shiravand, Ahmad Ali Hanafi-Bojd, Abbas Ali Dehghani Tafti, Mohammad Reza Abai, Ali Almodarresi, Masoud Mirzaei

Asian Pacific Journal of Tropical Medicine 2019 12(5):204-215

Objective: To investigate and predict the effects of climate change on the potential distribution of the main vector and reservoir hosts of the disease in Yazd province in the future. Methods: Distribution data for vector and reservoir hosts of zoonotic cutaneous leishmaniasis in Yazd province were obtained from earlier studies conducted in the area. MaxEnt ecological niche modeling was used to predict environmental suitability. BCC-CSM1-1(m) model and two climate change scenarios, RCP 4.5 and RCP 8.5 were used for horizons 2030 and 2050 climate projections. Future projections were based on data of a regional climate change model. Results: With both scenarios in 2030 and 2050, the results of jackknife test indicated that the mean temperature of wettest quarter and temperature annual range had the greatest effect on the model for the vector and the reservoir hosts, respectively. Conclusions: The climate conditions are the major determinants of zoonotic cutaneous leishmaniasis incidence rate in Yazd Province. These climate conditions provide favorable habitats for ease transmission of zoonotic cutaneous leishmaniasis in this endemic area. Habitats suitability for the vector and reservoir will be expanding in the coming years compared with the current conditions, such that, in horizon 2030 & 2050, the probability of the presence of the vector and reservoir within 38 580 and 37 949 km2, respectively, from Yazd province is above 60%. Moreover, an increase is predicted in the presence of the vector in the western parts and the reservoir in the northern and central parts of the province in the future. Understanding the role of environmental and bioclimatic factors in zoonotic cutaneous leishmaniasis occurrence can provide a guide for policy-makers in the creation and implementation of more effective policies for prevention and control.

Phylogeny of Culex theileri virus flavivirus in Spain, Myanmar, Portugal and Turkey
Eleonora Cella, Domenico Benvenuto, Daniele Donati, Francesco Garilli, Silvia Angeletti, Stefano Pascarella, Massimo Ciccozzi

Asian Pacific Journal of Tropical Medicine 2019 12(5):216-223

Objective: To study the genetic diversity of Culex theileri flavivirus and the spread of this virus among Spain, Portugal and Turkey. Methods: A database consisting of 55 sequences of the NS5/3’UTR region of Culex theileri flavivirus group downloaded from GenBank were aligned and manual edited with Bioedit. ModelTest v. 3.7 was used to select the simplest evolutionary model that adequately fitted the sequence data. Maximum likelihood analysis was performed using MEGA7. The phylogenetic signal of the dataset was investigated by the likelihood mapping analysis. Results: The phylogenetic tree showed three clusters. Myanmar sequences clusterd together with Turkish sequences, Spain and Portugal strains grouped together and two Turkish sequences grouped separately. Selective pressure analysis showed a moderate percentage of sites (22.5%) under pervasive negative selection and only 1% under pervasive positive selection. The sites subject to selective pressure in CTFV RdRp NS5 fragments have been located onto the predicted three-dimensional structure. Conclusions: Phylogenetic and evolutionary analysis can be an important tool for understanding the evolutionary impact of the probable contemporary existence between non-pathogenic and pathogenic flaviviruses among these vectors.

Evaluation of phytochemical properties and larvicidal activities of Cynodon dactylon, Clerodendrum viscosum, Spilanthes acmella and Terminalia chebula against Aedes aegypti
Ananta Swargiary, Manita Daimari, Mritunjoy Roy, Dipanjali Haloi, Bijit Ramchiary

Asian Pacific Journal of Tropical Medicine 2019 12(5):224-231

Objective: To investigate the phytochemical, antioxidant and larvicidal property of Cynodon dactylon, Clerodendrum viscosum, Spilanthes acmella and Terminalia chebula against Aedes aegypti. Methods: Antioxidant capacity of methanolic extract of the plants was studied by 2,2- Diphenyl-1-picryl-hydrazyl-hydrate (DPPH) assay, ferric reducing antioxidant power assay, 2,2’-azinobis-(3-ethylbenzothiazoline-6-sulfonate) assay (ABTS), thiobarbituric acid reactive substance (TBARS) assay, superoxide anion scavenging activity and total antioxidant activity assay following standard protocol. Total phenolic content, total flavonoid content, carbohydrate, and plant protein were also estimated following standard protocols. Larvicidal property of plant extracts were determined following World Health Organization standard protocol. Additionally, glutathione-s-transferase (GST) and acetylcholinesterase (AchE) inhibitory property was also tested biochemically. Results: Phytochemically, high protein, carbohydrate and phenolic were found in Terminalia chebula, while Cynodon dactylon showed high flavonoid contents. Similarly, high antioxidant activity was found in Terminalia chebula with IC50 values at 13.7, 2.9, 45.2 and 46.0 μg/mL in DPPH, ABTS, TBARS and superoxide anion scavenging activity, respectively. Larvicidal study showed strongest activity in Spilanthes acmella followed by Cynodon dactylon, and Clerodendrum viscosum and Terminalia chebula. GST and AchE of Aedes aegypti larvae showed reduced enzyme activity when pre-incubated with Cynadon dactylon and Spilanthes acmella. Conclusions: The methanolic crude extracts of Cynodon dactylon, Clerodendrum viscosum, Spilanthes acmella and Terminalia chebula possess strong antioxidant and larvicidal property against Aedes aegypti and therefore, may be further investigated for the molecular mode of action.

Seroprevalence of Cryptosporidium and risks of cryptosporidiosis in residents of Sothern Egypt: A cross-sectional study
Ismail Elshahawy, Fatma AbouElenien

Asian Pacific Journal of Tropical Medicine 2019 12(5):232-238

Objective: To identify the serological epidemiology of Cryptosporidium infections and to follow up on the changes in the infection profile in Southern Egypt in order to establish a suitable scheme for control and prevention of cryptosporidiosis. Methods: A total of 1 912 (960 from human and 952 from animals) stool specimens and sera were screened for Cryptosporidium species using modified Ziehl Neelsen technique and a newly-developed enzyme-linked immunosorbent assay (ELISA). Environmental risk factors and socioeconomic data were surveyed by questionnaire between September 2016 and December 2017. Results: Totally, 20.83% of the human subjects were positive for Cryptosporidium infection tested by ELISA. The seropositivity was positively correlated with age. The prevalence of Cryptosporidium infections in females was significantly higher than in males (P<0.05). The sensitivity and specificity of ELISA for Cryptosporidium were 99.06% and 88.88%, respectively. Furthermore, a high prevalence of Cryptosporidium in domestic animals (42.20%). Conclusions: The study observed that Cryptosporidium infections are common in the study area, with water sanitation, socioeconomic level; eating habits and hygienic status are considered the main risk factors for cryptosporidiosis. Therefore, environmental sanitation and health education will be useful in reducing the prevalence of infection.

Parsonage-Turner syndrome following chikungunya virus infection: A case report
Luis Arthur Brasil Gadelha Farias, Marina Vasconcelos Sampaio, Antônio Carlos Delgado Sampaio, Roberto da Justa Pires Neto, Jorge Luiz Nobre Rodrigues

Asian Pacific Journal of Tropical Medicine 2019 12(5):239-242

Rationale: Parsonage-Turner syndrome is a rare syndrome of unknown etiology, affecting mainly the lower motor neurons of the brachial plexus. Chikungunya fever is a mosquito-borne viral disease characterized by acute fever and polyarthritis/polyarthralgia. Patient concerns: A 54-year-old Brazilian male patient who presented with a 2-day history of fever (temperature 38.8 °C), arthralgia, erythematous rash, diffuse osteomuscular pain and headache, which evolved into left shoulder pain associated with morning stiffness. Diagnosis: Parsonage-Turner syndrome and chikungunya fever. Interventions: Symptomatic treatment (a combination of short-acting dypirone (500 mg every 6 h) and slow-release opioids (tramadol 100 mg every 4 h) and physiotherapy/rehabilitation with improvement. Outcomes: The patient was improved and discharged, remaining with symptomatic treatment and physiotherapy/rehabilitation. Lessons: To the best of our knowledge, there were no reports of Parsonage-Turner syndrome following chikungunya virus infection. Awareness of the possibility of this rare association is important. The present case report highlights the importance of awareness of this association as a new cause of morbidity in patients with chikungunya virus infection.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480
alsfakia

Tropical Medicine