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There are a few number of case reports and small-scale case series reporting dilated cardiomyopathy due to vitamin D-deficient rickets. The present study evaluates the clinical, biochemical, and echocardiographic features of neonates with vitamin D deficiency.
Patients and methods:
In this prospective single-arm observational study, echocardiographic evaluation was performed on all patients before vitamin D3 and calcium replacement. Following remission of biochemical features of vitamin D deficiency, control echocardiography was performed. Biochemical and echocardiographic characteristics of the present cohort were compared with those of 27 previously published cases with dilated cardiomyopathy due to vitamin D deficiency.
The study included 148 cases (95 males). In the echocardiographic evaluation, none of the patients had dilated cardiomyopathy. All of the mothers were also vitamin D deficient and treated accordingly. Comparison of patients with normocalcaemia and hypocalcaemia at presentation revealed no statistically significant difference between the ejection fraction and shortening fraction, while left ventricle end-diastolic diameter and left ventricle end-systolic diameter were higher in patients with hypocalcaemia. Previously published historical cases were older and had more severe biochemical features of vitamin D deficiency.
To the best of our knowledge, in this first and largest cohort of neonates with vitamin D deficiency, we did not detect dilated cardiomyopathy. Early recognition and detection before developing actual rickets and preventing prolonged hypocalcaemia are critically important to alleviate cardiac complications.
Coronavirus disease 2019 (COVID-19) has rapidly spread globally, forcing countries to apply lockdowns and strict social distancing measures. The aim of this study was to assess eating habits and lifestyle behaviours among residents of the Middle East and North Africa (MENA) region during the lockdown. A cross-sectional study among adult residents of the MENA region was conducted using an online questionnaire designed on Google Forms during April 2020. A total of 2970 participants from eighteen countries participated in the present study. During the pandemic, over 30 % reported weight gain, 6·2 % consumed five or more meals per d compared with 2·2 % before the pandemic (P < 0·001) and 48·8 % did not consume fruits on a daily basis. Moreover, 39·1 % did not engage in physical activity, and over 35 % spent more than 5 h/d on screens. A significant association between the frequency of training during the pandemic and the reported change in weight was found (P < 0·001). A significantly higher percentage of participants reported physical and emotional exhaustion, irritability and tension either all the time or a large part of the time during the pandemic (P < 0·001). Although a high percentage of participants reported sleeping more hours per night during the pandemic, 63 % had sleep disturbances. The study highlights that the lockdown due to the COVID-19 pandemic caused a variety of lifestyle changes, physical inactivity and psychological problems among adults in the MENA region.
Deaths due to opioid overdose have reached unprecedented levels in Canada; over 12,800 opioid-related deaths occurred between January 2016 and March 2019, and overdose death rates increased by approximately 50% from 2016 to 2018.1 In 2016, Health Canada declared the opioid epidemic a national public health crisis,2 and life expectancy increases have halted in Canada for the first time in decades.3 Children are not exempt from this crisis, and the Chief Public Health Officer of Canada has recently prioritized the prevention of problematic substance use among Canadian youth.4
This article reports the establishment of an isolated, fully functional field intensive care unit (FICU) unit equipped with all necessary critical care facilities as a part of the national pre-emptive preparedness to treat an unexpected surge outbreak of coronavirus disease 2019 (COVID-19) patients in Bahrain. One floor of an existing car parking structure was converted into a 130-bed FICU set-up by the in-house project implementation team comprised of multidisciplinary departments. The setting was a military hospital in the Kingdom of Bahrain, and the car park was on the hospital premises. The FICU contained a 112-bed fully equipped ICU and an 18-bed step-down ICU, and was built in 7 d to cater to the intensive care of COVID-19 patients in Bahrain.
Over the last decades, acupuncture has been seen as an acceptable primary detoxification treatment for opiate dependence, and currently used to relieve the severity of opiate withdrawal symptoms among MMT patient.
To investigate the effectiveness of electroacupuncture treatment in reducing opiate withdrawal symptoms among MMT patient.
This was a pilot study with randomized, single-blinded, and parallel. Recruitment of 22 subjects, 11 in methadone treatment + acupuncture and 11 in methadone treatment without acupuncture. The severity of withdrawal reaction was assessed by Objective Opiate Withdrawal Scale (OOWS) and Subjective Opiate Withdrawal Scale (SOWS) at baseline, third, fifth, seventh, tenth and fourteenth day of treatment.
One way Analysis of Variance (ANOVA) comparing the mean scores of the OOWS between treatment and control group has shown at tenth day of treatment p value is 0.026 and at fourteenth day p value is 0.022. One way ANOVA comparing the mean scores of the SOWS between treatment and control groups has shown at tenth day of treatment, p value is 0.015 and at fourteenth day, p value is 0.009.
The study has shown the promising results, where electroacupuncture treatment had an effectiveness in relieving opiate withdrawal symptoms among MMT patient.
High prevalence of poor sleep quality has been reported among Methadone Maintenance Therapy (MMT) patients. in order to reduce side effects and prevent relapse, new treatment approaches should be considered and recently, electroacupuncture (EA) has believed to have a therapeutic effect in the treatment of drug addiction.
To investigate the effects of EA on sleep quality in patients receiving MMT.
A prospective, open-labelled, parallel, randomized-controlled trial was conducted among MMT patients in Kajang, Selangor, Malaysia. A total of 22 drug misusers who met DSM-IV were randomly assigned into two groups. The treatment group was given methadone plus EA stimulation at 1.1+80Hz while the control group received methadone plus Sham EA without increasing the intensity of the stimulation. Both groups received the EA treatment 30 minutes per session for 14 days. Sleep quality was assessed by validated Pittsburgh Sleep Quality Index.
In terms of pre and post treatment comparison, we found that there were significant difference of mean sleep latency (p= 0.011), use of medication (p= 0.043) and global PSQI (p= 0.009) for the treatment group. However, only sleep efficiency (p= 0.014) showed a significant difference between pre and post treatment for the control group. in terms of group comparison, we found that there was significant difference of mean sleep latency (p= 0.004), sleep efficiency (0.004) and global PSQI (0.008) for post treatment. No significant difference was found for pre treatment.
Electroacupuncture may have adjunct effect on sleep improvement and have potential to reduce Benzodiazepine use among MMT patients.
The “problem of memory” in epistemology is concerned with whether and how we could have knowledge, or at least justification, for trusting our apparent memories. I defend an inductive solution – more precisely, an abductive solution – to the problem. A natural worry is that any such solution would be circular, for it would have to depend on memory. I argue that belief in the reliability of memory can be justified from the armchair, without relying on memory. The justification is, roughly, that my having the sort of experience that my apparent memory should lead me to expect is best explained by the hypothesis that my memories are reliable. My solution is inspired by Harrod's (1942) inductive solution. Coburn (1960) argued that Harrod's solution contains a fatal flaw. I show that my solution is not vulnerable to Coburn's objection, and respond to a number of other, recent and likely objections.
The aim of this study is to determine early changes in cardiac function of children with chronic kidney disease by using 2D-speckle tracking echocardiography.
The study included 38 children – 16 girls and 22 boys – diagnosed as having chronic kidney disease in the nephrology department with a glomerular filtration rate of <90 ml/minute/1.73 m2 for at least 3 months. A total of 37 – 15 girls and 22 boys – age- and sex-matched healthy children were included as the control group. 2D-Speckle tracking echocardiography was performed in all subjects.
The mean age was 13.45±2.8 years in patients and 12.89±3.07 years in controls. Systolic and diastolic blood pressures and left ventricular mass index were significantly higher in patients (p<0.05). The values of mitral e, mitral a, mitral e/a ratio, and mitral deceleration time were not different between the groups. Tricuspid annular plane systolic excursion values were lower in patients (p<0.01). Global strain values in apical long-axis 3-chamber and 2-chamber views were significantly lower in patients (p<0.05). Longitudinal, radial, and circumferential peak systolic strain values were lower in patients, but the difference was statistically significant in all segments of longitudinal view and basal segment of circumferential view (p<0.05). Radial and circumferential systolic strain rates were significantly lower in patients in all three segments (p<0.05). Moreover, early diastolic strain rate was significantly lower in longitudinal and radial apical segments and in all segments of circumferential measurements in patients. Besides, strain rate e/a ratio was significantly lower in all longitudinal segments of patients (p=0.01).
The study concluded that 2D-speckle tracking echocardiography method can determine cardiac involvement earlier than conventional echocardiography in children with chronic kidney disease having preserved ejection fraction.
One of the most important measures following disasters is setting up a communicable disease surveillance system (CDSS). This study aimed to develop indicators to assess the performance of CDSSs in disasters.
In this 3-phase study, firstly a qualitative study was conducted through in-depth, semistructured interviews with experts on health in disasters and emergencies, health services managers, and communicable diseases center specialists. The interviews were analyzed, and CDSS performance assessment (PA) indicators were extracted. The appropriateness of these indicators was examined through a questionnaire administered to experts and heads of communicable diseases departments of medical sciences universities. Finally, the designed indicators were weighted using the analytic hierarchy process approach and Expert Choice software.
In this study, 51 indicators were designed, of which 10 were related to the input (19.61%), 17 to the process (33.33%), 13 to the product (25.49%), and 11 to the outcome (21.57%). In weighting, the maximum score was that of input (49.1), and the scores of the process, product, and outcome were 31.4, 12.7, and 6.8, respectively.
Through 3 different phases, PA indicators for 4 phases of a chain of results were developed. The authors believe that these PA indicators can assess the system’s performance and its achievements in response to disasters. (Disaster Med Public Health Preparedness. 2019;13:158–164)
We present the findings about chromospheric activity nature of KOI-256 obtained from the Kepler Mission data. First, it was found that there are some sinusoidal variations out-of-eclipses due to cool spot activity. The sinusoidal variations modelled by the spotmodel program indicate that the active component has two different active regions. Their longitudinal variation revealed that one of them has a migration period of 3.95 yrs, while the other has a migration period of 8.37 yrs. Second, 225 flares were detected from the short cadence data in total. The parameters, such as increase (Tr) and decay (Td) times, total flare time (Tt), equivalent durations (P), were calculated for each flare. The distribution of equivalent durations versus total flare times in logarithmic scale is modelled to find flare activity level. The Plateau value known as the saturation level of the active component was calculated to be 2.3121 ± 0.0964 s, and the Half-life value, which is required flare total time to reach the saturation, was computed to be 2233.6 s. In addition, the frequency of N1, which is the number of flares per an hour in the system, was found to be 0.05087 h−1, while the flare frequency N2 that the flare-equivalent duration emitting per an hour was found to be 0.00051. Contrary to the spot activity, it has been found that the flares are in tends to appear at specific phases due to the white dwarf component.
Dendritic cells (DC) are central regulators of immune responses and professional antigen-presenting cells (APCs) with the unique ability to induce both innate immune responses and a highly specific acquired immunity. DC communicates through chemical and mechanical signals in the initiation and maintenance of immune responses. DC forms immunological synapses with T-cells thus pulling T-cells strings and leading to activation of T-cells. Owing to their properties, DC are often called ‘nature's adjuvants’ and thus have become an important component of any vaccination strategy. Coccidiosis is a major intestinal disease caused by Eimeria spp., affecting economically valuable livestock animals such as chickens and turkeys. Economic losses are associated with decreased productivity in afflicted poultry. Vaccination strategies involving DC have been developed owing to the special properties of these cells in coordinating innate and adaptive immune responses. Vaccination of chickens with exosomes isolated from DC containing parasite antigens (Ags) represents a promising alternative strategy to control avian coccidiosis. In recent years, emergence of new chicken DC has opened a new horizon for the development of new vaccines and DC derived vaccine could be a possible strategy to control coccidiosis in field. This review summarises the current state of knowledge of DC and their specific functions in immunity against avian coccidiosis.
The results are presented for eclipsing binary KIC 2557430. The mass ratio was computed as 0.868 ± 0.002, while the inclination (i) was found as 69°.75 ± 0°.01 with T2 = 6271±1 K. 50 frequencies were found in the period analysis. 48 frequencies of them are caused due to the primary component, a γ Doradus star, while two of them are caused by the cool spots. 69 flares were detected in the analyses. Two OPEA models were derived for flares, which indicates that the flares were come from two different sources. The Plateau value was found to be 1.4336 ± 0.1104 s for Source 1, which is seen as possible the secondary component and 0.7550 ± 0.0677 s for Source 2, which is seen as possible third body. The half-life value was computed as 2278.1 s for Group 1 and 1811.2 s for Group 2. The flare frequency N1 was found to be 0.02726 h−1 and N2 was computed as 0.00002 for Group 1, while N1 was found to be 0.01977 h−1 and N2 was computed as 0.00001 for Group 2. In a results, KIC 2557430 is a possible triple system consisting of a γ Doradus-type star, a chromospherically active star, and also a flaring third body.
We present spectroscopic and photometric analysis of the eclipsing binary KIC 7385478. We find that the system is formed by F1V + K4III–IV components. Combining results from analysis of spectroscopic data and Kepler photometry, we calculate masses and radii of the primary and the secondary components as M1 = 1.71 ± 0.08 M⊙, M2 = 0.37 ± 0.04 M⊙ and R1 = 1.59 ± 0.03 R⊙, R2 = 1.90 ± 0.03 R⊙, respectively. Position of the primary component in HR diagram is in the region of γ Doradus type pulsators and residuals from light curve modelling exhibit additional light variation with a dominant period of ~ 0.5 d. These are clear evidences of the γ Doradus type pulsations on the primary component. We also observe occasional increase in amplitude of the residuals, where the orbital period becomes the most dominant period. These may be attributed to the cool star activity originating from the secondary component.
The Western-type diet is associated with an elevated risk of Alzheimer’s disease and other milder forms of cognitive impairment. The aim of the present study was to investigate the effects of the environmental enrichment on amyloid and tau pathology in high-fat and high-sucrose-fed rats.
In total, 40 adult male rats were categorised into two main groups according to their housing conditions: enriched environment (EE, n=16) and standard housing condition (n=24). The groups were further divided into five subgroups that received standard diet, high-fat diet, and high-sucrose diet. We performed the analysis of amyloid β-peptide (Aβ) (1–40), Aβ(1–42), amyloid precursor protein (APP), and tau levels in the hippocampus of rats that were maintained under standard housing conditions or exposed to an EE.
The EE decreased the Aβ(1–40), Aβ(1–42), APP, and tau levels in high-fat and high-sucrose-fed rats.
This observation shows that EE may rescue diet-induced amyloid and tau pathology.
Aneurysm of the sinus of Valsalva is a rare congenital cardiac anomaly. It occurs as an outpouching that progresses like a windsock, and it may rupture producing aortic regurgitation, cardiac tamponade, congestive heart failure, conduction abnormalities, and stroke. We describe a case of rupture of the sinus of Valsalva into the interventricular septum producing a large dissecting aneurysm. Despite the location, it did not produce a conduction abnormality.
This study depends on KIC 9641031 eclipsing binary with a chromospherically active component. There are three type variations, such as geometrical variations due to eclipses, sinusoidal variations due to the rotational modulations, and also flares, in the light curves. Taking into account results obtained from observations in the Kepler Mission Database, we discuss the details of chromospheric activity. The sinusoidal light variations due to rotational modulation and the flare events were modelled. 92 different data subsets separated using the analytic models were modelled separately to obtain the cool spot configuration. Acording to the model, there are two active regions separated by about 180° longitudinally between the latitudes of +50° and +100°. 240 flares, whose parameters were computed, were detected. Using these parameters, the OPEA model was derived, in which the Plateau value was found to be 1.232±0.069 s, and half-life parameter was found as 2291.7 s. The flare frequency N1 was found as 0.41632 h−1, while the flare frequency N2 was found as 0.00027. Considering these parameters together with the orbital period variations demonstrates that the period variations depend on chromospheric activity. Comparing the system with its analogue, the activity level of KIC 9641031 is remarkably lower than the others.
Communicable disease management (CDM) is an important component of disaster public health response operations. However, there is a lack of any performance assessment (PA) framework and related indicators for the PA. This study aimed to develop a PA framework and indicators in CDM in disasters.
In this study, a series of methods were used. First, a systematic literature review (SLR) was performed in order to extract the existing PA frameworks and indicators. Then, using a qualitative approach, some interviews with purposively selected experts were conducted and used in developing the PA framework and indicators. Finally, the analytical hierarchy process (AHP) was used for weighting of the developed indicators.
The input, process, products, and outcomes (IPPO) framework was found to be an appropriate framework for CDM PA. Seven main functions were revealed to CDM during disasters. Forty PA indicators were developed for the four categories.
There is a lack of any existing PA framework in CDM in disasters. Thus, in this study, a PA framework (IPPO framework) was developed for the PA of CDM in disasters through a series of methods. It can be an appropriate framework and its indicators could measure the performance of CDM in disasters.
BabaieJ, ArdalanA, VatandoostH, GoyaMM, AkbarisariA. Developing a Performance Assessment Framework and Indicators for Communicable Disease Management in Natural Disasters. Prehosp Disaster Med. 2016;31(1):27–35.
Religious laws do not usually forbid the use of psychotropic medication, but many do forbid the consumption of animal-based derivatives of bovine and/or porcine origin (e.g. gelatin and stearic acid) such as are found in many medications. Demonstrating awareness of this, combined with a genuine concern about how it affects the patient, may strengthen the doctor—patient relationship and avoid non-adherence. In this article, we outline dietary requirements of key religions and belief systems that may have a bearing when prescribing medication containing animal-based ingredients. We identify common psychotropics that contain animal-based derivatives and suggest alternative prescribing options and approaches to dealing with sensitive ethical issues.