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81.
Parisa Mansouri Shohreh Javadpour Farid Zand Fariba Ghodsbin Golnar Sabetian Mansoor Masjedi Hamid Reza Tabatabaee 《Journal of critical care》2013
Background
Inappropriate diagnosis and treatment of pain, agitation, and delirium (PAD) in intensive care settings results in poor patient outcomes. We designed and used a protocol for systematic assessment and management of PAD by the nurses to improve clinical intensive care unit (ICU) outcomes.Materials and Methods
A total of 201 patients admitted to 2 mixed medical-surgical ICUs were randomly allocated to protocol and control groups. A multidisciplinary team approved the protocol. Pain was assessed by Numerical Rating Scale and Behavioural Pain Scale, agitation by Richmond Agitation Sedation Scale, and delirium by Confusion Assessment Method in ICU. The Persian version of the scales was prepared and tested for validity, reliability, and feasibility in a preliminary study. The patients in the protocol group were managed pharmacologically according to the protocol, whereas those in the control group were managed according to the ICU routine.Results
The median (interquartile range) for the duration of mechanical ventilation in the protocol and control groups was 19 (9.3-67.8) and 40 (0-217) hours, respectively (P = .038). The median (interquartile range) length of ICU stay was 97 (54.5-189) hours in the protocol group vs 170 (80-408) hours in the control group (P < .001). The mortality rate in the protocol group was significantly reduced from 23.8% to 12.5% (P = .046).Conclusion
The current randomized trial provided evidence for a substantial reduction in the duration of need to ventilatory support, length of ICU stay, and mortality rates in ICU-admitted patients through protocol-directed management of PAD. 相似文献82.
83.
OBJECTIVE: To explore factors affecting recruitment and retention of pharmacists in rural/remote areas of New South Wales (NSW). DESIGN: Qualitative semistructured in-depth interviews. SETTING: Primary care--rural/remote community pharmacies. PARTICIPANTS: Purposive sample of 12 community pharmacists. MAIN OUTCOME MEASURES: Factors affecting recruitment and retention of pharmacists in rural/remote areas of NSW. RESULTS: Respondents reported a variety of personal and professional reasons for taking up rural practice, including previous rural experience and a preference for working in rural over metropolitan areas. The main factor affecting retention in rural areas was the high level of professional satisfaction and interprofessional rapport. Perceived reasons for the current under-supply of pharmacists to rural/remote areas of NSW included changing demographics of the pharmacy undergraduate degree programs and pharmacy workforce, and negative perceptions of rural pharmacy practice and rural lifestyle. CONCLUSIONS: This study identified factors believed to affect recruitment and retention of pharmacists in rural/remote areas. There appears to be considerable overlap between the factors, with different weightings of importance for different individuals. The lack of consensus for a proposed method of resolving this problem highlights its complexity and the need for further studies in this area. 相似文献
84.
Malignant melanoma is an aggressive form of skin cancer that is highly resistant to conventional therapies. The melanoma inhibitor of apoptosis protein is a potent inhibitor of apoptosis and is overexpressed in melanoma cells, but undetectable in most normal tissues including melanocytes. We designed 20-mer phosphorothioate antisense oligonucleotides complementary to five putatively single-stranded sites on the melanoma inhibitor of apoptosis protein mRNA and investigated their ability to sensitize G361 melanoma cells to cisplatin. Inhibition of melanoma inhibitor of apoptosis protein mRNA and protein expression were measured by real-time polymerase chain reaction and immunoblotting. Cell viability and apoptosis were quantitated by colorimetric viability assays and by annexin V staining, respectively. Oligonucleotide M706 was identified as the most efficient antisense sequence which downregulated melanoma inhibitor of apoptosis protein mRNA and protein levels in G361 cells by 68 and 78%, respectively. The specificity of target downregulation was confirmed using scrambled sequence control oligonucleotides that only marginally decreased melanoma inhibitor of apoptosis protein expression. Whereas downregulation of melanoma inhibitor of apoptosis protein moderately inhibited cell growth by 26%, in combination with cisplatin, this resulted in a supra-additive effect with almost 57% reduction in G361 cell viability compared with cisplatin alone (17%) (P<0.05). Cell death was mainly due to apoptosis as demonstrated by a 3- to 4-fold increase in annexin V-positive cells and typical morphological changes compared with controls. In summary, we describe a new antisense oligonucleotide that efficiently downregulates melanoma inhibitor of apoptosis protein expression and sensitizes melanoma cells to cisplatin. 相似文献
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86.
Nasrin Moghadami Tabrizi Babak Dabirashrafi Parisa Salehi Shahram Shams Hormoz Dabirashrafi 《JSLS, Journal of the Society of Laparoendoscopic Surgeons》2006,10(1):74-75
Objectives:
To determine the cause of severe, disabling, groin pain.Methods:
We describe in this case report 2 patients with severe groin pain. Two myoma-like masses were found on the uterus near the right round ligament. Both masses were excised via laparoscopy.Results:
The pathology report of these 2 cases indicated adenomyosis. Both patients were asymptomatic after the procedure. Adenomyosis usually propagates in the myometrium, and the nodular shape of this pathology is rare. In patients with severe groin pain (menstrual or continuous), the gynecologist should think about both endometriosis of the round ligament and adenomyosis near the round ligament.Conclusion:
Severe groin pain is rare but disabling. Endometriosis of the external part of the round ligament is described as a cause. In this case report, we explain that nodular adenomyosis can also be a cause. 相似文献87.
Ashraf Mohamadkhani Faegh Bastani Masoud Sotoudeh Kourosh Sayehmiri Parisa Shahnazari Ghodratollah Montazeri Hossein Poustchi 《Journal of medical virology》2012,84(12):1889-1896
The development of the liver disease in chronic hepatitis B with common viral variants can be determined through the interaction between the virus and the host immune response. B cells constitute half of the intrahepatic lymphocyte population with an impact on fibrosis. A proliferation‐inducing ligand (APRIL) has been shown to have a co‐stimulatory activity on B cells. For this study HBV DNA was amplified and then sequenced to show the presence of the basal core promoter (BCP) mutations in the serum from 57 patients with chronic hepatitis B. The range of IgD‐positive B cells was detected by immunohistochemistry in liver biopsies; and patients serum was assayed for APRIL levels by enzyme immunoassay. Twenty‐seven patients (47.4%) harbored the A1762T‐G1764A BCP mutations. Coefficients of logistic regression showed that the effect of increasing IgD‐positive B cells in rising odds of the liver disease is the same in the patients with BCP mutation A1762T‐G1764A and in the patients without mutation, nevertheless the effect of APRIL is not similar in these two groups of patients. Logistic regression in patients with BCP A1762T‐G1764A mutations demonstrated that increasing one score of APRIL decreased the odds of fibrosis stage about 8%. These results suggest that in infection with viral variants of hepatitis B virus, the population of IgD‐positive B cells may play a decisive role in later stages of the liver disease which is reduced by APRIL in chronic hepatitis patients with BCP mutations. J. Med. Virol. 84:1889–1896, 2012. © 2012 Wiley Periodicals, Inc. 相似文献
88.
89.
Background
In Iran, there is limited evidence on the prevalence of hepatitis B and C viruses (HBV and HCV) among females who engage in illegal sexual behavior.Objectives
To determine the prevalence of HBV and HCV infections and their associated factors in this population in Isfahan-Iran.Patients and Methods
In this cross-sectional study, 100 females who engaged in illegal sexual behavior during 2009-2010 in Isfahan were recruited from welfare to the DIC for women, and referrals were made among those who knew others who engaged in prostitution. Markers for HBV and HCV-Ab were measured by ELISA, and recombinant immunoblot assay was used for confirmation of HCV infection. Also, a questionnaire on demographics and prostitution-associated risk data in a face-to-face interview was completed for each participant. Chi-square and multivariate logistic regression models were used for data analysis.Results
Of the 100 samples collected, 91 were sufficient for testing. The mean age and time spent in sex work were 30.84 ± 9.34 years and 36 ± 28.5 months, respectively. HBsAg was detected in 1 (1.1%), anti-HBc in 4 (4.4%), anti-HBs in 60 (65.9%), and HCV Ab in 9 (9.9%) subjects. The evidence of vaccination was seen in 54 subjects (59.3%). There were no significant differences in the prevalence of HBV or HCV infection by estimated risk factors, and there was no independent risk factor for these infections.Conclusions
The high prevalence of HCV infection in this study indicates the need to implement preventive interventions for female sex workers and, perhaps more importantly, to involve their male clients. 相似文献90.
Badiee P Alborzi A 《Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation》2011,9(6):355-362
Invasive fungal infections are a significant and often lethal problem in transplant patients. Infections caused by geographically limited endemic fungi are infrequent, and Aspergillus species, Mucorales species, Candida species, and Cryptococcus neoformans are the opportunistic fungi responsible for most such infections. The symptoms of systemic fungal infections are nonspecific, particularly in their early stages. The high rates of mortality and graft loss owing to fungal infections render early diagnosis and treatment imperative in immunosuppressed patients. Current methods for the diagnosis of systemic fungal infections include imaging procedures, endoscopic methods and biopsies, microscopic and culture techniques, antibody and antigen-based serologic testing, and the detection (via polymerase chain reaction) of fungal deoxyribonucleic acid in blood or bronchoalveolar lavage fluid, as well as the careful analysis of signs and symptoms. Antifungal therapy should be initiated early in patients with a suspected fungal infection (even before laboratory findings have confirmed that diagnosis) and should be administered with appropriate adjustment of immunosuppressive regimens. To manage fungal infections in patients with renal failure, optimizing the pharmacokinetics of antifungal drugs to reduce the risk of nephrotoxicity is crucial. 相似文献