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OBJECTIVE: This study examined whether antihypertensive medications and other patient characteristics are associated with severe depressive symptoms in patients with hypertension. METHODS: Patients with a diagnosis of hypertension were recruited from the internal medicine outpatient clinics of a hospital in Amman, Jordan, into this cross-sectional study. Depression severity was assessed using the Patient Health Questionnaire-9 (PHQ-9); anxiety by the General Anxiety Disorder-7; sleep quality by the Insomnia Severity Index; and psychological stress by the Perceived Stress Scale. Multivariable binary logistic regression was used to examine the association between the different classes of antihypertensive medication and depressive symptoms. RESULTS: Of the 431 participants, 282 (65.4%) were men; 240 (55.7%) reported having type 2 diabetes; 359 (83.3%) had dyslipidemia; 142 (32.9%) were on beta-blockers; 197 (45.2%) were on ACE inhibitors or angiotensin receptor blockers; 203 (47.1%) were on metformin; and 133 (30.9%) were taking sulfonylurea. Severe depressive symptoms, indicated by scoring above the cut-off of 14 on the PHQ-9, were present in 165 (38.3%) patients. Severe depression was associated with younger age (<55 years) (OR = 3.15, 95% CI = 1.83-5.41, P < 0.001), unemployment (OR = 2.15, 95% CI = 1.15-4.00, P = 0.01), diabetes (OR = 1.81, 95% CI = 1.09-3.02, P = 0.02), severe anxiety (OR = 6.40, 95% CI = 3.64-11.28, P < 0.001), and severe insomnia (OR = 4.73, 95% CI = 2.85-7.82, P < 0.001). CONCLUSION: Severe depressive symptoms were not associated with antihypertensive medications or other drugs used by hypertensive patients. Younger age, diabetes, anxiety, and insomnia were the primary correlates of depression.
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Diabetes Mellitus Tipo 2 , Hipertensión , Trastornos del Inicio y del Mantenimiento del Sueño , Masculino , Humanos , Persona de Mediana Edad , Femenino , Antihipertensivos/efectos adversos , Depresión/tratamiento farmacológico , Depresión/epidemiología , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Trastornos del Inicio y del Mantenimiento del Sueño/tratamiento farmacológico , Trastornos del Inicio y del Mantenimiento del Sueño/epidemiología , Trastornos del Inicio y del Mantenimiento del Sueño/complicaciones , Estudios Transversales , Hipertensión/tratamiento farmacológico , Hipertensión/epidemiología , Hipertensión/complicacionesRESUMEN
In a systematic survey of luminescent bis(terdentate) osmium(II) complexes, a tipping point involving a reversal in photophysical tuning is observed whereby increasing stabilization of the ligand-based lowest unoccupied molecular orbital (LUMO) results in a blue shift in the optical absorption and emission bands. The complexes [Os(N^N'^Nâ³)2]2+ [N^N'^Nâ³ = 2,6-bis(1-phenyl-1,2,3-triazol-4-yl)pyridine (Os1), 2,6-bis(1-benzyl-1,2,3-triazol-4-yl)pyrazine (Os2), 6-(1-benzyl-1,2,3-triazol-4-yl)-2,2'-bipyridyl (Os3), 2-(pyrid-2-yl)-6-(1-benzyl-1,2,3-triazol-4-yl)pyrazine (Os4), 2-(pyrazin-2-yl)-6-(1-benzyl-1,2,3-triazol-4-yl)pyridine (Os5), and 6-(1-benzyl-1,2,3-triazol-4-yl)-2,2'-bipyrazinyl (Os6)] have been prepared and characterized, and all complexes display phosphorescence ranging from the orange to near-IR regions of the spectrum. Replacement of the central pyridine in the ligands of Os1 by the more π-accepting pyrazine in Os2 results in a 55 nm red shift in the triplet metal-to-ligand charge-transfer-based emission band, while a larger red shift of 107 nm is observed for the replacement of one of the triazole donors in the ligands of Os1 by a second pyridine ring in Os3 (λemmax = 702 nm). Interestingly, replacement of the central pyridine ring in the ligands of Os3 by pyrazine (Os4, λemmax = 702 nm) fails to result in a further red shift in the emission band. Reversal of the relative positions of the pyridine and pyrazine donors in Os5 (λemmax = 733 nm) compared to Os4 does indeed result in the expected red shift in the emission with respect to that for Os3 based on the increased π-acceptor character of the ligands present. However, an inversion in emission tuning is observed for Os6, in which the incorporation of a second pyrazine donor in the ligand architecture results in a blue shift in the optical absorption and emission maxima (λemmax = 710 nm). Electrochemical studies reveal that while incorporating pyrazine in the ligands indeed results in an expected anodic shift in the first reduction potential through stabilization of the ligand-based LUMO, there is also a concomitant anodic shift in the OsII/OsIII-based oxidation potential. This stabilization of the metal-based highest occupied molecular orbital (HOMO) thus nullifies the effect of stabilization of the LUMO in Os4 compared to Os3, resulting in these complexes having coincident emission maxima. For Os6, stabilization of the HOMO through the incorporation of two pyrazine donors in the ligand structure now exceeds stabilization of the LUMO, resulting in a larger HOMO-LUMO gap and a counterintuitive blue shift in the optical properties in comparison with those of Os5. While it is known that the replacement of ligands (e.g., replacing bipyridyl with bipyrazinyl) can result in a larger HOMO-LUMO energy gap through greater stabilization of the HOMO, these results importantly allow us to capture the tipping point at which this inversion in photophysical tuning occurs. This therefore enables us to explore the limits available in emission tuning with a relatively simple and minimalist ligand structure.
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The series of complexes [Os(bpy)3- n(pytz) n][PF6]2 (bpy = 2,2'-bipyridyl, pytz = 1-benzyl-4-(pyrid-2-yl)-1,2,3-triazole, 1 n = 0, 2 n = 1, 3 n = 2, 4 n = 3) were prepared and characterized and are rare examples of luminescent 1,2,3-triazole-based osmium(II) complexes. For 3 we present an attractive and particularly mild preparative route via an osmium(II) η6-arene precursor circumventing the harsh conditions that are usually required. Because of the high spin-orbit coupling constant associated with the Os(II) center the absorption spectra of the complexes all display absorption bands of appreciable intensity in the range of 500-700 nm corresponding to spin-forbidden ground-state-to-3MLCT transitions (MLCT = metal-to-ligand charge transfer), which occur at significantly lower energies than the corresponding spin-allowed 1MLCT transitions. The homoleptic complex 4 is a bright emitter (λmaxem = 614 nm) with a relatively high quantum yield of emission of â¼40% in deoxygenated acetonitrile solutions at room temperature. Water-soluble chloride salts of 1-4 were also prepared, all of which remain emissive in aerated aqueous solutions at room temperature. The complexes were investigated for their potential as phosphorescent cellular imaging agents, whereby efficient excitation into the 3MLCT absorption bands at the red side of the visible range circumvents autofluorescence from biological specimens, which do not absorb in this region of the spectrum. Confocal microscopy reveals 4 to be readily taken up by cancer cell lines (HeLa and EJ) with apparent lysosomal and endosomal localization, while toxicity assays reveal that the compounds have low dark and light toxicity. These complexes therefore provide an excellent platform for the development of efficient luminescent cellular imaging agents with advantageous photophysical properties that enable excitation and emission in the biologically transparent region of the optical spectrum.
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Complejos de Coordinación/química , Sustancias Luminiscentes/química , Imagen Óptica , Osmio/química , Piridinas/química , Triazoles/química , Supervivencia Celular/efectos de los fármacos , Complejos de Coordinación/síntesis química , Complejos de Coordinación/farmacología , Células HeLa , Humanos , Sustancias Luminiscentes/síntesis química , Sustancias Luminiscentes/farmacología , Mediciones Luminiscentes , Estructura Molecular , Procesos Fotoquímicos , Teoría Cuántica , Células Tumorales CultivadasRESUMEN
This study was conducted to identify the predictors, levels, and prevalence of anxiety and stress and to assess the relationship between these factors and quality of life in recently displaced Iraqis. A cross-sectional design was used. A convenience sample of 171 Iraqi refugees was recruited. The results indicated that more than half of the sample suffered from high anxiety levels, while 42.8% reported high stress. The regression model explained 46.3% of the variance in levels of quality of life. Unemployment, fewer than three family members, and high anxiety significantly predicted low-level quality of life. These three predictors need to be taken into consideration when developing health-related interventions to improve the quality of life of Iraqi refugees.
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Ansiedad/psicología , Calidad de Vida/psicología , Refugiados/psicología , Estrés Psicológico/complicaciones , Estrés Psicológico/etiología , Adolescente , Adulto , Ansiedad/etnología , Estudios Transversales , Femenino , Humanos , Irak/etnología , Jordania , Masculino , Persona de Mediana Edad , Estrés Psicológico/etnología , Encuestas y Cuestionarios , GuerraRESUMEN
The complex [Os(btzpy)2][PF6]2 (1, btzpy = 2,6-bis(1-phenyl-1,2,3-triazol-4-yl)pyridine) has been prepared and characterised. Complex 1 exhibits phosphorescence (λem = 595 nm, τ = 937 ns, φem = 9.3% in degassed acetonitrile) in contrast to its known ruthenium(II) analogue, which is non-emissive at room temperature. The complex undergoes significant oxygen-dependent quenching of emission with a 43-fold reduction in luminescence intensity between degassed and aerated acetonitrile solutions, indicating its potential to act as a singlet oxygen sensitiser. Complex 1 underwent counterion metathesis to yield [Os(btzpy)2]Cl2 (1Cl), which shows near identical optical absorption and emission spectra to those of 1. Direct measurement of the yield of singlet oxygen sensitised by 1Cl was carried out (φ (¹O2) = 57%) for air equilibrated acetonitrile solutions. On the basis of these photophysical properties, preliminary cellular uptake and luminescence microscopy imaging studies were conducted. Complex 1Cl readily entered the cancer cell lines HeLa and U2OS with mitochondrial staining seen and intense emission allowing for imaging at concentrations as low as 1 µM. Long-term toxicity results indicate low toxicity in HeLa cells with LD50 >100 µM. Osmium(II) complexes based on 1 therefore present an excellent platform for the development of novel theranostic agents for anticancer activity.
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Mitocondrias/ultraestructura , Compuestos Organometálicos/síntesis química , Compuestos Organometálicos/farmacología , Osmio/química , Triazoles/síntesis química , Triazoles/farmacología , Línea Celular Tumoral , Supervivencia Celular/efectos de los fármacos , Células HeLa , Humanos , Mediciones Luminiscentes , Mitocondrias/efectos de los fármacos , Mitocondrias/metabolismo , Modelos Moleculares , Estructura Molecular , Compuestos Organometálicos/química , Oxígeno Singlete/química , Solubilidad , Nanomedicina Teranóstica , Triazoles/química , Agua/químicaRESUMEN
INTRODUCTION: Studying mental and physical health problems in refugees facilitates providing suitable health care, thus improving their quality of life. We studied depression tendency in Syrian refugees in Jordan in the light of chronic diseases and medication availability. Also, depression prevalence and depression comorbidity with chronic diseases were identified. METHODS: In this multicenter cross-sectional survey, data from Syrian refugees attending Caritas centers in 6 Jordanian cities from November 2013 through June 2014 were analyzed. Participants' demographics, depression, previously diagnosed chronic diseases, and newly diagnosed chronic diseases and the availability of medications were studied. Logistic regression was used to examine predictors for depression. RESULTS: Of 765 refugees who participated, about one-third demonstrated significant depression as measured by the Beck Depression Inventory. Descriptive analyses showed that depression was comorbid in 35% of participants with previously diagnosed chronic diseases and in 40% of participants with newly diagnosed chronic diseases. Newly diagnosed chronic diseases and lack of medications significantly contributed to depression, but the regression model as a whole explained less than 5% of the variance. CONCLUSION: Because the regression model showed low effect size, we concluded that newly diagnosed chronic diseases and medication shortages could not predict depression in Syrian refugees residing in Jordan. Therefore, further studies of additional factors are recommended. Prompt measures have to be taken to prevent the spread of chronic diseases and improve mental health in this fragile population.
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Antidepresivos/provisión & distribución , Depresión/etnología , Etnicidad , Estado de Salud , Refugiados/estadística & datos numéricos , Adolescente , Adulto , Enfermedad Crónica , Estudios Transversales , Depresión/tratamiento farmacológico , Femenino , Humanos , Jordania/epidemiología , Masculino , Persona de Mediana Edad , Prevalencia , Calidad de Vida , Siria/etnología , Adulto JovenRESUMEN
Background: Dysmenorrhea is the most common gynecological condition among women of reproductive age. Investigating the cross-talk between hypertension and dysmenorrhea is attractive and understudied, moreover, menstrual health is poorly studied in refugees. Objectives: The present study aims at examining the association between dysmenorrhea severity and antihypertensives and analgesics namely acetaminophen and Non-Steroidal Anti-inflammatory Drugs (NSAIDs) used by traumatized Syrian war refugees with hypertension. Methods: This is a cross-sectional study recruiting Syrian female refugees with hypertension. A structured questionnaire probed their demographics and clinical data. Dysmenorrhea severity was assessed using the WaLIDD (working ability, location, intensity, days of pain, dysmenorrhea) self-report scale. Results: Data were analysed from 125 patients, almost half were diabetic, 47 (37.6%) had dyslipidemia, 59 (47%) reported using ß-blockers, 56 (44.8%) reported using ACEIs/ARBs, 43 (34.2) reported using CCBs and 30 (25%) were using diuretics. According to the multivariate binary logistic regression, severe dysmenorrhea was associated with acetaminophen OR 6.5, 95%CI (1.39-30.55), p=0.02 and NSAIDs use OR 2.97, 95%CI (1.28-6.89), p=0.02. Antihypertensive drugs were not associated with dysmenorrhea severity. Conclusion: Determinants of severe dysmenorrhea in patients with hypertension need more study, herein we report that analgesics but not antihypertensives are not associated with dysmenorrhea severity.
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Acetaminofén , Analgésicos , Antiinflamatorios no Esteroideos , Antihipertensivos , Dismenorrea , Hipertensión , Refugiados , Humanos , Femenino , Dismenorrea/tratamiento farmacológico , Estudios Transversales , Adulto , Refugiados/estadística & datos numéricos , Antihipertensivos/uso terapéutico , Hipertensión/tratamiento farmacológico , Analgésicos/uso terapéutico , Persona de Mediana Edad , Acetaminofén/uso terapéutico , Antiinflamatorios no Esteroideos/uso terapéutico , Siria/etnología , Índice de Severidad de la Enfermedad , Encuestas y CuestionariosRESUMEN
Background: Many incisions have been used to perform parotidectomy, but they result in a visible scar on the neck and may cause patient dissatisfaction by producing disfigurement sometimes. Aim of Study: The aim of this study is to use a modified limited incision for superficial parotidectomy as an alternative to the classical incision, with no obvious scarring and without affecting the identification of the facial nerve, resulting in better cosmesis. Patients and Methods: A prospective comparative study on 100 patients has undergone superficial parotidectomy using a modified limited incision and another 100 patients who have undergone superficial parotidectomy using the modified Blair's incision (control group) for variant benign pathologies. The surgeries were conducted in four hospitals (three private and one public) in Baghdad, Iraq, from January 2016 to September 2022. In both groups, the patients were followed up through outpatient visits to assess the cosmetic result of the incision and detect postoperative complications. Results: All tumors were removed with no need for extending the skin incision. The cosmetic result of the incision was very satisfactory and only a nominal scar could be seen 6 months after surgery. Five percent of patients only developed postoperative complications. Conclusion: A modified limited incision for superficial parotidectomy provides better patient satisfaction compared to a modified Blair's incision. The modified limited incision can be performed safely with a better cosmetic appearance of the surgical scar compared to the standard incision.
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The healthcare sector is a significant greenhouse gas emitter. Cataract surgery is a procedure that results in a large amount of carbon dioxide (CO2) emissions. We sought to review the literature for factors contributing to the carbon footprint of this procedure. The literature, although limited, varies greatly by region. The carbon footprint of cataract surgery ranged from approximately 6 kg CO2 equivalents in a center in India to 181.9 kg CO2 equivalents in a center in the United Kingdom. Factors contributing to the carbon footprint of cataract surgery included the procurement of materials, energy use, and the emissions associated with travel. Factors facilitating a lower carbon footprint include the reuse of surgical materials and more efficient autoclave settings. Potential areas for improvement to consider include the reduction in packaging material, the reuse of materials, and potentially reducing travel emissions by performing simultaneous bilateral cataract surgery.
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Extracción de Catarata , Catarata , Oftalmología , Humanos , Dióxido de Carbono , Huella de CarbonoRESUMEN
Pain is a common undertreated worldwide complaint. The need to explore the antinociceptive potential of alternative herbal products is essential. Although used as a mild sedative, limited evidence focused on the potential antinociceptive effect of valerian and hops combination. The present study was carried out to evaluate the in vivo anti-nociceptive effect of the valerian-hops combination to justify its use as an effective and safe analgesic agent. Anti-nociceptive effects of valerian-hops combination (50, 100, and 200 mg/kg) were assessed in swiss albino mice for performing the acetic acid-induced writhing test, the paw licking test using formalin, the paw licking test using glutamate, and the tail immersion test. The effects were compared to those of diclofenac or morphine in the presence or absence of the opioid receptor antagonist naloxone. Valerian-hops" extract of 100 and 200 mg/kg demonstrated a significant reduction in the number of writhing episodes induced by acetic acid compared to the control (p < 0.05), a significant reduction in the licking number at doses of 100 and 200 mg/kg in the late phase formalin-induced paw licking, significantly reduced the number of lickings after glutamate injection compared to control (p < 0.05). And significantly increased pain reaction after 60 and 90 min of tail immersion test, this effect was opposed by naloxone treatment. The valerian-hops combination produced a significant antinociceptive effect that involved the opioid system. Further studies are required to fully uncover the underlying active constituents and their mechanisms.
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OBJECTIVE: Autoimmune pancreatitis (AIP) is often misdiagnosed as pancreatic carcinoma (PC) despite recent advances in imaging tests. The aim of the study was to evaluate whether the quantitative perfusion analysis using software "Time intensity curve" with contrast-enhanced harmonic EUS (CH-EUS) facilitate the differentiation of AIP from PC. METHODS: Consecutive patients with focal AIP and pancreatic carcinoma who underwent CH-EUS from January 2009 to September 2010 were analyzed. CH-EUS was performed with intravenous administration of an ultrasonographic contrast (Sonazoid) and electronic radial echoendoscope. The graph of time intensity curve (TIC) for pancreatic mass was generated to depict the changes in signal intensity over time within the region of interest (ROI). ROI was placed to cover an area with a pancreatic mass lesion. Based on the analysis of TIC, base intensity before injection (BI), peak intensity (PI), time to peak, and maximum intensity gain (MIG: PI-BI) were calculated. RESULTS: Eight patients with focal AIP and twenty-two patients with PC were evaluated by TIC. PI and MIG of mass lesion of AIP were significantly higher than that of PC (21.4 dB vs. 9.6 dB, 17.5 vs. 6.6). Receiver operating characteristics analysis yielded an optimal MIG cutoff value of 12.5 with high sensitivity and specificity. CONCLUSION: Pancreatic mass lesions of AIP and PC exhibited markedly different patterns with the TIC. This novel diagnostic modality using TIC generated by CH-EUS might offer an opportunity to improve accuracy in the differential diagnosis between pancreatic mass lesion of AIP and PC.
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Enfermedades Autoinmunes/diagnóstico por imagen , Carcinoma/diagnóstico por imagen , Endosonografía/métodos , Neoplasias Pancreáticas/diagnóstico por imagen , Pancreatitis/diagnóstico por imagen , Procesamiento de Señales Asistido por Computador , Anciano , Anciano de 80 o más Años , Medios de Contraste , Diagnóstico Diferencial , Femenino , Compuestos Férricos , Humanos , Interpretación de Imagen Asistida por Computador/métodos , Hierro , Masculino , Persona de Mediana Edad , Óxidos , Pancreatitis/inmunología , Curva ROC , Estudios Retrospectivos , Factores de TiempoRESUMEN
OBJECTIVE: There is no comparative study of electronic radial endoscopic ultrasonography (ER-EUS) and electronic curvilinear EUS (EC-EUS). The aim of this study was to compare the accuracy of ER-EUS and EC-EUS for detecting pancreatic malignancies. METHODS: This was a retrospective review of the patients who had EUS assessment from September 2008 to December 2011 for suspicious pancreatic tumors. Sensitivity, specificity, and area under the ROC curve to detect pancreatic malignancies were calculated and compared between the ER-EUS and EC-EUS cohort. The final diagnosis of pancreatic malignancy was based on pathology, or the consensus of patient's clinical course and multimodal imaging tests. RESULTS: Two hundred twenty-one patients were included and divided into two cohorts: ER-EUS (n = 139) and EC-EUS (n = 82) cohorts. With propensity score matching method, 70 cases in each cohort were selected for the comparison. There was no significant difference in sensitivity, specificity, and area under the ROC curve to detect pancreatic malignancy between ER-EUS and EC-EUS cohort (88.5 vs. 100%, 88.6 vs. 90.9%, 0.8855 vs. 0.9545). CONCLUSION: ER-EUS and EC-EUS provided similar accuracy for the detection of pancreatic malignancies. In view of similar diagnostic results of ER-EUS and EC-EUS for the detection of pancreatic malignancy, and the advantage of being able to perform FNA with EC-EUS, EC-EUS may be the preferred choice.
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Carcinoma/diagnóstico por imagen , Endosonografía/instrumentación , Tumores Neuroendocrinos/diagnóstico por imagen , Neoplasias Pancreáticas/diagnóstico por imagen , Anciano , Área Bajo la Curva , Carcinoma/diagnóstico , Biopsia por Aspiración con Aguja Fina Guiada por Ultrasonido Endoscópico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Tumores Neuroendocrinos/diagnóstico , Neoplasias Pancreáticas/diagnóstico , Valor Predictivo de las Pruebas , Puntaje de Propensión , Curva ROC , Estudios Retrospectivos , Estadísticas no ParamétricasRESUMEN
AIMS: To determine the immediate and long-term results of endoscopic drainage and necrosectomy for symptomatic pancreatic fluid collections. METHODS: The data of 80 patients with symptomatic pancreatic fluid collections (mean diameter: 11.7 cm, range 3-20; pseudocysts: 24/80, abscess: 20/80, infected walled-off necrosis: 36/80) referred for endoscopic management from October 1997 to March 2008 were analyzed retrospectively. RESULTS: Endoscopic drainage techniques included endoscopic ultrasound (EUS)-guided aspiration (2/80), EUS-guided transenteric drainage (70/80) and non-EUS-guided drainage across a spontaneous transenteric fistula (8/80). Endoscopic necrosectomy was carried out in 49/80 (abscesses: 14/20; infected necrosis: 35/36). Procedural complications were bleeding (12/80), perforation (7/80), portal air embolism (1/80) and Ogilvie Syndrome (1/80). Initial technical success was achieved in 78/80 (97.5%) and clinical resolution of the collections was achieved endoscopically in 67/80 (83.8%), with surgery required in 13/80 (perforation: four; endoscopically inaccessible areas: two; inadequate drainage: seven). Within 6 months five patients required surgery due to recurrent fluid collections; over a mean follow up of 31 months, surgery was required in four more patients due to recurrent collections as a consequence of underlying pancreatic duct abnormalities that could not be treated endoscopically. The long-term success of endoscopic treatment was 58/80 (72.5%). CONCLUSIONS: Endoscopic drainage of symptomatic pancreatic fluid collections is safe and effective, with excellent immediate and long-term results. Endoscopic necrosectomy has a risk of serious complications. The underlying pancreatic duct abnormalities must be addressed to prevent recurrence of fluid collections.
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Endosonografía , Enfermedades Pancreáticas/cirugía , Ultrasonografía Intervencional , Absceso/diagnóstico por imagen , Absceso/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Distribución de Chi-Cuadrado , Niño , Colangiopancreatografia Retrógrada Endoscópica , Pancreatocolangiografía por Resonancia Magnética , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermedades Pancreáticas/diagnóstico por imagen , Seudoquiste Pancreático/diagnóstico por imagen , Seudoquiste Pancreático/cirugía , Pancreatitis Aguda Necrotizante/diagnóstico por imagen , Pancreatitis Aguda Necrotizante/cirugía , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
INTRODUCTION: We developed a new offset-tip papillotome to facilitate biliary cannulation and reduce the incidence of unintended contrast injection into the pancreatic duct during ERCP. The aim of the present retrospective cohort study was to evaluate the utility of the novel offset-tip papillotome in achievement of biliary cannulation, and prevention of unintended contrast injection into the pancreatic duct during ERCP, compared with a standard straight-tip catheter. MATERIAL AND METHODS: Patients with native papilla who required biliary ERCP were retrospectively reviewed. Biliary ERCPs were performed by two experienced endoscopists using either the offset-tip papillotome or a standard catheter. Patients in whom ERCP involved fellows in training were excluded. RESULTS: Eighty-five patients were included and divided into two cohorts: The offset-tip papillotome (OT; n = 40) and the standard straight-tip cohort (ST; n = 45). Biliary cannulation success rates in OT and ST cohort were 92.5% and 88.9%, respectively. The frequency of unintended contrast injection into the pancreatic duct and time to biliary cannulation of the OT cohort during biliary cannulation were significantly less than those of the ST cohort (0.56 vs. 1.65 times and 103.3 vs. 287.9 seconds). CONCLUSION: The novel offset-tip papillotome could reduce the incidence of unintended contrast injection into the pancreatic duct and the time to biliary cannulation.
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Colangiopancreatografia Retrógrada Endoscópica/métodos , Conducto Colédoco/patología , Conductos Pancreáticos/patología , Pancreatitis/cirugía , Esfinterotomía Endoscópica/métodos , Anciano , Cateterismo/métodos , Estudios de Factibilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pancreatitis/diagnóstico , Estudios Retrospectivos , Estadísticas no ParamétricasRESUMEN
Once the World Health Organization (WHO) declared the COVID-19 (Coronavirus Infectious Disease-19) outbreak to be pandemic, massive efforts have been launched by researchers around the globe to combat this emerging infectious disease. Strategies that must be investigated such as expanding testing capabilities, developing effective medicines, as well as developing safe and effective vaccines for COVID-19 disease that produce long-lasting immunity to human system. Now-a-days, bio-sensing, medication delivery, imaging, and antimicrobial treatment are just a few of the medical applications for nanoparticles (NPs). Since the early 1990s, nanoparticle drug delivery methods have been employed in clinical trials. Since then, the discipline of nanomedicine has evolved in tandem with expanding technological demands to better medicinal delivery. Newer generations of NPs have emerged in recent decades that are capable of performing additional delivery tasks, allowing for therapy via novel therapeutic modalities. Many of these next generation NPs and associated products have entered clinical trials and have been approved for diverse indications in the present clinical environment. For systemic applications, NPs or nanomedicine-based drug delivery systems have substantial benefits over their non-formulated and free drug counterparts. Nanoparticle systems, for example, are capable of delivering medicines and treating parts of the body that are inaccessible to existing delivery systems. As a result, NPs medication delivery is one of the most studied preclinical and clinical systems. NPs-based vaccines delivering SARS-CoV-2 antigens will play an increasingly important role in prolonging or improving COVID-19 vaccination outcomes. This review provides insights about employing NPs-based drug delivery systems for the treatment of COVID-19 to increase the bioavailability of current drugs, reducing their toxicity, and to increase their efficiency. This article also exhibits their capability and efficacy, and highlighting the future aspects and challenges on nanoparticle products in clinical trials of COVID-19.
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COVID-19 , Nanopartículas , COVID-19/terapia , Vacunas contra la COVID-19 , Ensayos Clínicos como Asunto , Humanos , Nanopartículas/uso terapéuticoRESUMEN
Xanthones (9H xanthen-9-one) are an important class of heterocyclic compounds containing oxygen and a moiety of gamma-pirone, dense with a two-benzene ring structure, distributed widely in nature. Naturally occurring xanthones are found in micro-organisms and higher plants as secondary metabolites in fungi and lichens. Compounds of the family Caryophyllaceae, Guttiferae and Gentianaceae, are the most common natural source of xanthones. The structure of the xanthones nucleus, coupled with its biogenetic source, imposes that the carbons are numbered according to the biosynthetic pact. The characteristics oxygenation pattern of xanthones earlier is mixed shikimateacetate biogenesis. The major class of xanthones includes simple oxygenated, non-oxygenated, xanthonolignoids, bisxanthones, prenylated and related xanthones, miscellaneous xanthones. Their great pharmacological importance and interesting scaffolds were highly encouraged by scientists to investigate either the synthesis design or natural products for cancer treatment. Because currently used antitumor drugs possess high toxicity and low selectivity, efficacious treatment may be compromised. This review is limited to the antitumor activity of xanthones and the chemistry of xanthone core, which may help provide fundamental knowledge to the medicinal chemist for new and advanced research in drug development.
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Antineoplásicos , Productos Biológicos , Xantonas , Xantonas/farmacología , Xantonas/química , Antineoplásicos/farmacología , Antineoplásicos/química , HongosRESUMEN
Endoscopic ultrasound (EUS) and EUS-guided fine-needle aspiration (EUS-FNA) play increasingly prominent roles in the diagnosis and management of pancreatic cysts. The Asian Consortium of Endoscopic Ultrasound was recently formed to conduct collaborative research in this area. This is a review of literature on true pancreatic cysts. Due to the lack of systematic studies, there are no robust data on the true incidence of pancreatic cystic lesions in Asia and any change in over the recent decades. Certain EUS morphological features have been used to predict particular types of pancreatic cysts. Pancreatic cyst fluid viscosity, cytology, pancreatic enzymes, and tumor markers, in particular carcinoembryonic antigen, can aid in the diagnosis of pancreatic cysts. Hemorrhage and infection are the most common complications of EUS-FNA of pancreatic cysts. Pancreatic cysts can either be observed or resected depending on the benign or malignant nature, or malignant potential of the lesions. Guidelines from an international consensus did not require positive cytological findings to be present in their recommendation for resection, which included all mucinous cystic neoplasms, all main-duct intraductal papillary mucinous neoplasms (IPMN), all mixed IPMN, symptomatic side-branch IPMN, and side-branch IPMN larger than 3 cm. In patients with poor surgical risks, EUS-guided cyst ablation of mucinous pancreatic cysts is an alternative. As long-term prospective data on pancreatic cysts are still not available in Asia, management strategies are largely based on risk stratification by surgical risk and malignant potential. Gene expression profiling of pancreatic cyst fluid and confocal laser endomicroscopic examination of pancreatic cysts are novel techniques currently being studied.
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Endosonografía , Quiste Pancreático/diagnóstico , Asia/epidemiología , Diagnóstico Diferencial , Humanos , Quiste Pancreático/diagnóstico por imagen , Quiste Pancreático/epidemiología , Quiste Pancreático/terapia , PrevalenciaRESUMEN
BACKGROUND: Inguinal hernia is a frequent problem presented to surgical clinic in Iraq. Surgical treatment options for inguinal hernia are numerous, selecting the appropriate method or technique depends on different factors. AIM OF STUDY: To find a new technique for open inguinal hernia repair with no recurrence even in recurrent cases, without major complications during or after surgery, and can be used even by new surgeons with little experience. PATIENTS & METHODS: A retrospective cross sectional study conducted in the Medical City teaching hospital and Private Hospitals in Baghdad, during the period from January 1, 2000, to December 30, 2016 on convenient sample of 408 Iraqi patients with inguinal hernia. The patients were treated by modified Halsted's technique by open surgery applying polypropylene mesh. The patients were followed up through frequent visits and phone calls to assess the recurrence and complications. RESULTS: No recurrence of inguinal hernia was reported after 5-10 years follow up, while 94.9% of patients reported postoperative complications commonly oedema of spermatic cord. There was a highly significant association between male gender hernia patients and post Modified Halsted operation complications (p < 0.001). A highly significant association was observed between direct hernia and post Modified Halsted operation complications (p < 0.001). The significant risk factors related to complications were anemia and collagen disease. CONCLUSIONS: The modified Halsted's operation for inguinal hernia repair is effective in treatment of inguinal hernia with low recurrence and complications rate.
RESUMEN
BACKGROUND: Parotidectomy is one of the most frequent modes to treate tumors of parotid gland. Previous studies documented a variation in the facial nerve branching which might risk facial nerve injury during Parotidectomy. AIM OF STUDY: To make a new classification system that includes a new branching pattern of facial nerve trunk that has not been described before, also to mention a simple method of how to identify the facial nerve trunk, all that will help the new surgeon in performing parotidectomy with less complications and unpredictable outcome. METHODS: A prospective cross sectional study on 460 patients underwent partial or total parotidectomy for different pathologies were enrolled during the period January 2004 till September 2020. Three investigations were considered; the anatomy of the facial nerve trunk (FNT), exact site of facial nerve trunk in relation to fixed landmarks, finally we observed any communications between the branches. We made a new classification based mainly on the anatomical variations in the branching pattern of the FNT; namely, types (I, II and III). Each type subdivided according to the length of facial nerve trunk and also according to the communication between the branches. RESULTS: Type I reported in majority of cases; 78.26%. type II (15.2%) which is the newly discovered branching pattern, and type III (6.6%). Total FNT length was 1-10 mm in more than half (54.35%) of cases. In 64.35% of cases FNT was in the midpoint between the tragal pointer (TP) and tip of mastoid's process (TMP). In 50 (10.87%) of the cases there was anastomotic connection between the buccal and mandibular branches, and in 20(4.34%) the communication was always a loop between the upper and lower divisions of FNT. CONCLUSION: There is a profound variation in the facial nerve branching pattern that has not been previously reported. Awareness about differences in the anatomy of the facial nerve assisted useful information to surgeon to preserve FN during parotidectomies.
RESUMEN
Dracaena cinnabari (D. cinnabari) is an endemic plant located in Socotra Island, Yemen. Deep red resin attained from different plant species including D. cinnabari is commonly known as dragon's blood. In folk medicine, it is prescribed for the treatment of traumatic dermal, dental, and eye injuries as well as blood stasis, pain, and gastrointestinal diseases in humans. Numerous studies have investigated that this resinous medicine has antidiarrheal, antiulcer, antimicrobial, antiviral, antitumor, anti-inflammatory, analgesic, wound healing, and antioxidant activity. Several phytochemicals have been isolated from D. cinnabari, including the biflavonoid cinnabarone, triflavonoids, metacyclophanes, chalcones, chalcanes, dihydrochalcones, sterols, and terpenoids. The present review highlights the structures and bioactivities of main phytochemicals isolated from D. cinnabari regarding the botany and pharmacological effects of the resin derived from this plant.