The Effect of Performing Preoperative Preparation Program on School Age Children's Anxiety

Objective

The purpose of this study was to examine effects of performing preoperative preparation program on children''s anxiety.

Methods

This study was performed in Amirkola Pediatrics Hospital, Mazandaran. A randomized controlled trail was performed on 122 children (7–12 years of age) admitted for elective surgery during 15 months. The researcher randomly assigned eligible participants in to the experimental and control groups, after pre-test baseline measurement had been taken. Analyzing was performed through independent t-test and χ² test. P<0.005 was considered statistically significant. The experimental group received therapeutic play and the control group received routine preoperative information preparation.

Findings

The mean and standard deviation of the state anxiety scores of children in experimental and control groups before intervention were 35.52±6.99 and 34.98±6.78, after intervention 31.44±5.87 and 38.31±7.44 respectively. The state anxiety score was lower significantly in the experimental group prior to preoperative surgery than in the control group (P=0.000).

Conclusion

Performing preoperative program with using therapeutic play intervention is effective for preparing children before surgery and decreases their anxiety.     

Survival and causes of death in systemic sclerosis patients: a single center registry report from Iran

The aims of the study were to determine prognostic factors for survival and causes of death in a cohort of patients with systemic sclerosis (SSc). This was a cohort study of SSc patients in single rheumatologic center from January 1998 to August 2012. They fulfilled the American College of Rheumatology classification criteria for SSc or had calcinosis Raynaud’s phenomenon, esophageal dysmotility, sclerodactyly, telangiectasia or sine sclerosis. Causes of death were classified as SSc related and non-SSc related. Kaplan–Meier and Cox proportional hazard regression models were used in univariate and multivariate analysis to analyse survival in subgroups and determine prognostic factors of survival. The study includes 220 patients (192 female, 28 male). Out of thirty-two (14.5 %) who died, seventeen (53.1 %) deaths were SSc related and in nine (28.1 %) non-SSc-related causes, and in six (18.8 %) of patients causes of death were not defined. Overall survival rate was 92.6 % (95 % CI 87.5–95.7 %) after 5 years and 82.3 % (95 % CI 73.4–88.4 %) after 10 years. Pulmonary involvement was a major SSc-related cause of death, occurred in seven (41.1 %) patients. Cardiovascular events were leading cause of in overall death (11) 34.3 % and 6 in non-SSc-related death. Independent risk factors for mortality were age >50 at diagnosis (HR 5.10) advance pulmonary fibrosis (HR 11.5), tendon friction rub at entry (HR 6.39), arthritis (HR 3.56). In this first Middle Eastern series of SSc registry, pulmonary and cardiac involvements were the leading cause of SSc-related death.     

The efficacy and safety of low-molecular-weight heparin and unfractionated heparin in the treatment of cerebral venous sinus thrombosis

Objective:

To compare the efficacy and safety of low-molecular-weight heparin (LMWH) and unfractionated heparin (UFH) in the treatment of patients with cerebral venous sinus thrombosis (CVST), and to provide an appropriate treatment option in these patients.

Method:

This is a randomized double blind clinical trial conducted between December 2013 and December 2014. The subjects were selected among patients referred to Neurology Department, Imam Reza Hospital; affiliated to Kermanshah University of Medical Sciences, Kermanshah, Iran. Fifty-two cases of CVST were included in this study and randomly divided into 2 groups. Twenty-six cases received LMWH and the other 26 cases received UFH. The primary outcomes include hospital mortality rate and neurologic deficits as assessed by the National Institutes of Health Stroke Scale (NIHSS). The secondary end point was disability as measured by the Modified Rankin Scale (MRS).

Results:

We observed the rate of mortality and neurological deficits and disability based on NIHSS, and the MRS did not differ between the 2 groups.

Conclusion:

The efficacy of LMWH and UFH in reduction of neurologic deficit and functional disability in patients with CVST are similar.Cerebral venous sinus thrombosis (CVST) is an uncommon stroke that, unlike arterial stroke, occurs mostly in adolescent and young children.1,2 The outcome of patients with CVST is variable from complete recovery to persistent neurological damage.3 Regardless of the fact that most patients have a complete or partial recovery, 10% are observe to have persistent neurological damage by 12 months of follow-up.3 According to information from clinical trials and observational studies, anticoagulation is advised as safe and effective treatment for cerebral venous thrombosis.3-5 Anticoagulants can also prevent pulmonary embolism, which makes sinus thrombosis is highly complicated.4-7 However, there is no agreement on what type of heparin to use: low-molecular-weight heparin (LMWH) or unfractionated heparin (UFH).7,8 The advantage of using UFH is that it acts rapidly due to inhibition of IIa factor, and its effects are reversible by administering protamine sulfate; however, binding to plasma proteins, platelet (platelet factor 4), macrophages, and endothelial cells limit its bioavailability and account for the highly variable anticoagulant response and requires dose adjustments based on activated partial-thromboplastin time values.8,9 The clinical benefits of LMWH comprise higher bioavailability more predictable pharmacokinetic profile, dose-dependent plasma levels, a longer half-life, the lower risk of bleeding and immune-mediated thrombocytopenia and heparin-induced osteoporosis.8,9 Because of these clinical advantages, LMWHs have gradually replaced UFH for most indications. Several clinical trials, in patients with deep venous thrombosis and pulmonary embolism indicates that LMWH is as effective as UFH and associated with the fewest hemorrhagic complications.8,10 There are already limited data directly comparing LMWH with UFH in CVST patients. It is critical for the clinician to understand which drugs are most effective and associated with the fewest adverse events. The aim of this study was to compare the efficacy and safety of these 2 types of heparins in the treatment of patients with CVST to provide an appropriate treatment option in such patients.     

Flavonoids modulate AMPK/PGC-1α and interconnected pathways toward potential neuroprotective activities

Metabolic Brain Disease - As progressive, chronic, incurable and common reasons for disability and death, neurodegenerative diseases (NDDs) are significant threats to human health. Besides, the...     

Selective application of routine preoperative axillary ultrasonography reduces costs for invasive breast cancers

Purpose.

Preoperative axillary sonography with fine needle aspiration (FNA) in patients with invasive breast cancer identifies patients with nodal metastasis who can be spared further surgery. Indiscriminate use of the diagnostic modality can increase costs and yield inaccurate results. We evaluate the costs associated with the use of highly sensitive axillary ultrasonography in patients with stage ≥T2 tumors.

Patients and Methods.

We constructed a decision analysis tree using TreeAge Pro 2009 software comparing direct hospital charges between patients with and without routine use of axillary ultrasound. Base case estimates were derived from our institutional data and compared with those derived from the literature. One- and two-way sensitivity analyses were performed to check the validity of our inferences.

Results.

We found that, for the base case estimate with 35% lymph node positivity in stage ≥T2 tumors and sensitivity of the axillary ultrasound set at 86% with a specificity of 40%, the strategy to perform preoperative axillary ultrasound yielded rollback costs of $15,215, compared with $15,940 for surgery plus sentinel lymph node biopsy (cost difference, $725 per patient favoring axillary ultrasound). On two-way sensitivity analysis, the cost benefit for axillary ultrasound was not seen in patients with a low risk for nodal metastasis.

Conclusion.

The adoption of routine preoperative axillary sonography with FNA is a lower-cost strategy than conventional strategies in patients with stage ≥T2 invasive breast cancer.     

Local cytokine and inflammatory responses to candidate vaginal adjuvants in mice

The current study was undertaken to explore the correlation of adjuvanticity and local inflammatory response elicited in the murine vagina and the draining lymph nodes following local administration of two candidate vaginal adjuvants, Toll like receptor (TLR) 9 agonist CpG ODN, and a non-TLR targeting molecule α-galactosylceramide (α-GalCer). Using real-time PCR array analysis, we could show that a group of 13 common cytokine genes are activated in the vagina within 24 h after vaginal administration of these adjuvants, including Ccl2, Ccl7, Ccl12, Ccl19, Ccl20, Ccl22, Cxcl1, Cxcl5, Il10 and the Th1-inducing molecules Ifng, Cxcl9, Cxcl10 and Cxcl11. A high degree of inflammation in and damage to the epithelium was exclusively observed in the vagina of the CpG ODN treated mice, which was reversed within 48 h. These results indicate that there is a group of common genes that correlate with the adjuvanticity of CpG ODN and α-GalCer in the vagina, and that α-GalCer induces less of local inflammatory reactions in the murine vagina compared to CpG ODN.     

Ascorbic acid supplementation could affect passive avoidance learning and memory in rat

Ascorbic acid (vitamin C) is required for health and, in particular, its supplementation has beneficial effects in some pathological conditions. There are conflicting reports regarding the usefulness of ascorbic acid in the treatment of dementia. In this study, we investigated the effects of acute, short- and long-term pre-training administration of ascorbic acid (60,120 mg/kg) on passive avoidance learning (PAL) and memory in rats. Retention test was done 24 h after training. The results showed that acute injection of ascorbic acid had no significant effect on PAL. On the other hand, both in the short- and long-term ascorbic acid treated groups trials to acquisition were less than control group. Also, ascorbic acid prolonged the step-through latency (STL) and decreased the time spent in the dark compartment in retention test. Thus, it can be concluded that short- and long-term supplementation with ascorbic acid has facilitatory effects on acquisition and retrieval processes of passive avoidance learning and memory in rats.